Anthony DiGiorgio, DO, MHA@DrDiGiorgio
There’s plenty to criticize about the US healthcare system.
But using life expectancy to criticize it is dumb.
It is one of the worst healthcare metrics ever created.
Life expectancy is mostly a lifestyle metric. Not a medical metric.
It’s almost entirely driven by lifestyle choices: violent crime, car accidents, suicide, drugs, metabolic disease from poor diet and lack of exercise.
In all of these, the United States is an outlier. And none of them reflect hospital or physician performance. No national insurance scheme fixes fentanyl or violent crime or 70 percent of the population being metabolically unhealthy.
If you want to measure the healthcare system, you look at outcomes the healthcare system actually controls.
Cancer survival. Heart attack survival. Stroke care. Trauma care. ICU mortality. Complex surgery outcomes.
On those measures, the United States is at or near the top once you adjust for baseline health. That is what a high performing medical system looks like.
Now to maternal mortality. Another activist favorite.
They love waving around these numbers because they sound dramatic, but the data behind them are a mess.
The U.S. “increase” in maternal mortality was driven by bad data collection. The pregnancy checkbox on death certificates was mis-marked so often that audits in Texas, Colorado, and Georgia found false maternal deaths all over the place. As many as half of the reported maternal deaths were misclassified.
We also count “maternal” deaths no one else counts. Homicides. Suicides. Drug overdoses. Car crashes. Anything within a year of delivery. So the comparisons are meaningless.
When states actually perform chart reviews, only a small fraction of maternal deaths are related to obstetric care. Again, lifestyle and social pathology drive the numbers. Not the quality of physicians.
Infant mortality comparisons have similar problems. Different countries draw the line on viability at different gestational ages. The United States attempts aggressive resuscitation at extremely early gestational ages that many European countries classify as stillbirths. If you resuscitate more fragile infants, you will by definition record more infant deaths.
So if we are going to do international comparisons, they need to be honest.
Most of the scary statistics activists use are distorted by demographics, social determinants, violent deaths, substance use, and definitional differences.
When you strip out the noise and measure what healthcare systems actually control, the U.S. system performs extremely well. Our problem is not medical quality. It is the burden of obesity, addiction, violence, and chronic disease that society keeps handing to the medical system to fix.
And Medicare for All does not fix any of that.
It just centralizes power. It puts one political appointee in charge of every medical decision in the country. It amplifies every mistake and every bias at national scale. It replaces physician and patient autonomy with bureaucratic control.
If you want better outcomes, you do not centralize everything in Washington. You do not hand the entire healthcare system to HHS. You give patients control. You allow physicians to practice medicine. You let competition work.
But pretending those numbers are a referendum on the quality of American medicine is dishonest. And pretending Medicare for All solves them is pure fantasy
