US Healthcare System Loses Ground

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A recent study1 looked at the 15-year survival rate for 45 and 65 year old Americans from 1975 to 2005 and compared them to those seen in a dozen modern countries. They also looked at healthcare spend- ing in these 13 countries. Back in the 1970s, the US spent more on average than all other countries except Switzerland.

However, from 1970 through 2002 healthcare expenditures in the USA have increased much faster than those in all other modern countries - about twice as fast on average in the US. As a result, today the US is now spending far more per capita than all other countries. During this same time period while the US was increasing spending much more than other countries the 15 year survival rate for Americans went from about average to last or nearly last for both men and women at ages 45 and 65. For example, the 15 year survival of 45 year old men dropped from the 3rd highest in 1975 to next to last over the next 30 years. Other studies have found that back in 1950 the US ranked 5th in the world in life expectancy for both men and women but today American men and women have a life expectancy shorter than those in 49 other countries - some of which spend less than 1/10 what we spend on medical care.1 Clearly Americans are spending much more on average than every other country on healthcare but getting far less bang for the buck.

Most of the commonly cited explanations for the smaller gains in life expectancy for the US relative to other modern countries [i.e., smoking, obesity rates, rising numbers of uninsured] did not hold up in the authors’ analysis. Instead they speculated the problems lie in the USA’s healthcare systems emphasis on fee-for service treatments, specialty care, and lack of care coordination.2 In this reviewer’s opinion the blame falls squarely and largely on the medical pro- fession itself that appears to have grown more interested in making money than in caring for patients. A few examples should suffice. In America our interventional cardi- ologists perform about 800,000 elective angioplasties each year. These procedures do nothing to reduce the risk of heart attacks and other cardiovascular events and yet most people who undergo these procedures are led to believe they are effective at reducing the risk of having a heart attack and dying from cardio- vascular disease.3 The medical justification for elective angio- plasty is to relieve angina but data shows that in most cases the angina is often not reduced much and/or returns within a few years. In the vast majority of cases diet and exercise can eliminate angina by stopping and reversing atherosclerosis. Indeed, diet and exercise program have been shown to dramatically increase life expectancy in patients with advanced coronary artery disease, relieve angina, and even reverse the atherosclerotic disease process and yet Ameri- cans a systematically denied this cheaper, safer, and more efficacious alternative.

Another study looked at the impact of back surgery to relieve back pain in 1450 patients diag- nosed with disc problems and/or nerve impingement. About 600,000 Americans undergo this procedure annually. Half the patient underwent spinal fusion and the other half with similar diagnosis did not. After two years only 26% of those who had the surgery returned to work while 67% who did not get the back surgery were working again. They also found that 41% higher intake of pain killing drugs in those who had the surgery compared to those who did not. The results of this study appeared in the July 2010 issue of the journal Spine. Clearly for most people spinal surgery reduces the qual- ity of their life. A randomized controlled trial for a standard arthroscopic knee operation for those with arthritic knees found that those who had the procedure fared no better than those who had a sham procedure.

Bottom Line: Despite strong evidence that a growing number of standard medical tests and procedures drive up healthcare costs dramatically while providing little or no improvement in the length or quality of life, America’s healthcare system is reluctant to change. Maybe healthcare reform that leads to less access to specialist MDs and more access to physical therapists and nutritionists and other allied health professionals might drive down healthcare costs and increase the quality and length of life for Americans.

By James J. Kenney, PhD, RD, FACN.


1. Muennig PA, Giled SA. What changes in survival rates tell us about US health care. Health Affairs. Nov. 2010, pp 1-9

2. Xu J, et al. Deaths: preliminary data for 2007. Natl Vital Stat Rep. 2009;58:1-52

3. continuinged.php - click on “Bypassing the Evidence” under CPE courses and you can read the article for free

Editor’s Update:

Congratulations to Dr. Kenney for decades of research that is now helping to lower costs and improve health. The Pritikin Program has recently been approved, along with the Ornish Program, for reimbursement for medicare expenses as an approved Medicare-covered inten- sive cardiac rehabilitation, or ICR. Visit and click on Medicare for more information. This is a landmark step forward that could one day benefit dietitians and other professionals in preventative services.

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