Why we’re dying younger

The ideas and innovators shaping health care

Sep 29, 2022 View in browser   By Ben Leonard, Ruth Reader and Carmen Paun Paramedics unload a patient in Houston last year. | John Moore/Getty Images MINEFIELD U.S. life expectancy fell in 2021— and not by a little. Americans' lifespans dropped nearly a full year. And that followed a decline of nearly two years in 2020, erasing a quarter century of health gains. It marked the biggest two-year drop since 1923. The trend is heading in the wrong direction. Ben Leonard surveyed experts for their opinions on what's going wrong in U.S. health care. What's causing shorter lifespans? It isn't just Covid, which will be a continuing problem partly because of Americans' declining interest in vaccination. Also contributing to the bad news are increases in heart attacks, liver disease, strokes, drug overdoses, suicides and homicides. The opioid epidemic is still raging, about two in five Americans are obese, the nation is facing a mental health crisis and racial disparities in health outcomes are intractable. None of those fundamentals are on track to improve. The money motive "Our system remains unbelievably fragmented, extraordinarily hard for patients to navigate, has very, very weak incentives for improvement [in] everything from quality to patient experience to efficiency and cost," said Bob Wachter, head of the University of California, San Francisco's department of medicine. Vested interests with stakes in the health care system actively oppose reforms that would make it work better, Wachter added. The profit motive drives key players, like hospitals and insurers, to raise costs, not necessarily quality. Money's not the answer One impulse, of course, is to throw money at the problem. But that may not be the solution. The U.S. spends more than double what other wealthy nations spend per person on health care, and health spending makes up about 20 percent of the nation's economy. Still, the outcomes here are worse than in our peer nations. You have to scroll a long way down a list of nations ranked by life expectancy to find the United States. Administrative costs are sky high, and there's no evidence that innovations like electronic health records have saved money, said Kevin Schulman, a professor of medicine at Stanford. "Organizations are designed to produce inefficiency, high-cost health care, provide elective surgeries and not take care of people," he said. Obamacare's limits The Affordable Care Act has broadened access to care, but it hasn't made a significant dent in health disparities, said Jeanne Marsh, director of the Center for Health Administration Studies at the University of Chicago. It's a health risk in America to be poor, Native American or Black. "We had a prime opportunity for real transformative change during the pandemic. The pandemic exposed the inequities that were always there," said Uché Blackstock, an emergency medicine physician and CEO of Advancing Health Equity. "But now we may be falling back into old habits." WELCOME TO FUTURE PULSE This is where we explore the ideas and innovators shaping health care, and where we didn't expect monkeys used in medical research to become the latest tool for geopolitical leverage. Share news, tips and feedback with Ben at bleonard@politico.com, Ruth at rreader@politico.com or Carmen at cpaun@politico.com.  Send tips securely through SecureDrop, Signal, Telegram or WhatsApp. SURPRISING FINDINGS Medical appointments by phone spiked during the pandemic. | Getty Images Congress made it easier for Medicare patients to use telehealth during the Covid-19 pandemic. Now its watchdog arm, the Government Accountability Office, wants to know whether the quality of care suffered. That likelihood would make sense. A doctor might miss a diagnosis on a video call with a patient that the physician could have caught during an in-person appointment. But new research shows the opposite result. What scientists found: A study published this week found that patients who used telemedicine did better overall than those who had only in-person appointments. The authors examined five areas of primary care: the cardiovascular system, diabetes, prevention and wellness, behavioral health and the respiratory system. They looked at more than half a million patients who had either in-person visits or telemedicine appointments from March 1, 2020, to Nov. 30, 2021, at more than 200 health care facilities in Pennsylvania and Maryland. Telehealth patients did better in 11 of 16 measures, the study found. These patients were more likely to keep their blood pressure in check and get screened for colon cancer, among other benefits. As Congress debates whether to extend the pandemic-era rules, the study "demonstrates telemedicine's value in appropriate populations: augmenting primary care capacity without negatively affecting care quality," the researchers wrote. One explanation: Convenience is a big plus for preventive care and chronic disease management because it makes it easier for patients to stay on track. WASHINGTON WATCH Hurricane Ian slams into Florida. | NASA/Getty Images When Hurricane Ian hit Florida, it brought high winds, a foot of rain and a massive storm surge. It also forced some hospitals to evacuate patients. As climate change increases the frequency of extreme weather events like hurricanes, danger is growing for health care organizations. In a new report , House Ways and Means Committee Democrats found most of the sector unprepared. Examples of extreme weather's impact on health care services aren't hard to find. In 2019, nearly 250 hospitals lost power in California because of wildfire-prevention efforts. Hurricane Maria in 2017 led to shortages of pharmaceutical and health products in Puerto Rico. Hospitals across the country have repeatedly had to evacuate patients as extreme weather approached, the report noted. Be prepared: Despite the threat, the report said that only a little more than a third of the 63 organizations surveyed had plans to limit their risk. Those plans varied in approach and thoroughness, the report said. Some were "one-size-fits-all" emergency plans, while others were comprehensive strategies for multiple types of emergencies. The most thorough plans included blueprints for keeping facilities open, helping staff get to work, protecting critical supplies and working with government agencies. Policy ideas: The report called for additional federal funding for hospital preparedness. It suggested bolstering renewable energy grids and patient warning systems. It recommended that state and local officials develop fall-back plans to keep their power running.   Follow us on Twitter Ben Leonard @_BenLeonard_ Ruth Reader @RuthReader Carmen Paun @carmenpaun   Follow us

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