The Third-Lead­ing Cause Of Death Is Pre­ventable, But Can­di­dates Don’t Men­tion It


It is more likely to kill you than ter­ror­ism. It has pro­foundly im­pacted vir­tu­ally ev­ery Amer­i­can fam­ily. So this elec­tion year, why aren’t politi­cians at all lev­els of gov­ern­ment talk­ing about the third-lead­ing cause of death in Amer­ica—pre­ventable er­rors in health­care?

The sta­tis­tics are stag­ger­ing: More than 500 pa­tients per day are killed by er­rors, ac­ci­dents and in­fec­tions in hos­pi­tals alone. Med­i­cal er­rors kill more peo­ple an­nu­ally than breast can­cer, AIDS or drug over­doses. One in four Medi­care ben­e­fi­cia­ries ad­mit­ted to a hospi­tal suf­fers some form of pre­ventable harm dur­ing their stay. And yet, it’s nowhere to be found in those stump speeches.

There are a few rea­sons for the si­lence. First is all about the il­log­i­cal way Amer­i­cans pay for health­care. With the tra­di­tional “fee for ser­vice” model, we pay for pro­ce­dures and tests—not out­comes. It means we also pay for med­i­cal mis­takes. If you got the wrong med­i­ca­tion in post-op, chances are no doc­tor or nurse will tell you about it. But it will show up on your bill, along­side the charges for any other in­ter­ven­tion re­quired to treat your ad­verse re­ac­tion. Con­sid­er­ing that de­ci­pher­ing these bills is akin to read­ing hi­ero­glyph­ics, many of us are vic­tims of med­i­cal mis­takes with­out even re­al­iz­ing it.

An­other rea­son we may not hear much about it is that our po­lit­i­cal can­di­dates are not ea­ger to an­noy deep-pock­eted sup­port­ers. Last year, the health­care and phar­ma­ceu­ti­cal sec­tor was the top lob­by­ing in­dus­try in Wash­ing­ton, spend­ing $240 mil­lion—twice as much as Big Oil. At the lo­cal level, hos­pi­tals are of­ten one of the largest em­ploy­ers in a com­mu­nity, a pil­lar of al­most ev­ery con­gres­sional district. While many health­care lead­ers are out­spo­ken and bold pro­po­nents of change, some are em­bar­rassed by the er­rors and would pre­fer their politi­cians not dwell on them.

Just this sum­mer, CMS faced enor­mous back­lash af­ter an­nounc­ing its in­ten­tion to is­sue five-star rat­ings for hospi­tal safety and qual­ity, based on over 60 tested and val­i­dated mea­sures. (My or­ga­ni­za­tion also as­signs grades to hos­pi­tals based on data from CMS and our own an­nual hospi­tal sur­vey.) Congress tried to sup­press the re­lease of the CMS star rat­ings, at the urg­ing of the hospi­tal lobby, which ar­gued the mea­sures weren’t per­fect and the method­ol­ogy wasn’t fair. (For­tu­nately, it didn’t pre­vail and the rat­ings were re­leased, al­beit a few months be­hind sched­ule.)

Fi­nally, how to mea­sure health­care per­for­mance—what data to col­lect and how to share it—can be as con­tro­ver­sial as the cur­rent elec­tion it­self. Most health­care lead­ers agree we need to mea­sure qual­ity to en­sure ac­count­abil­ity and im­prove­ment, but the agree­ment stops there. Many lead­ing re­searchers and or­ga­ni­za­tions like the Na­tional Qual­ity Fo­rum, which re­views and val­i­dates qual­ity met­rics, have helped guide us to­ward re­solv­ing some of these con­tro­ver­sies, but the de­bate rages on.

Cu­ri­ously, ex­perts even dis­agree over how to mea­sure the death toll from med­i­cal er­rors. Ear­lier this year the rep­utable

BMJ re­leased a study show­ing that med­i­cal er­rors are the third-lead­ing cause of death in the U.S. But some re­searchers pushed back, cit­ing con­cerns about the study’s def­i­ni­tion of med­i­cal er­ror. This led to a dis­tract­ing and dis­heart­en­ing se­ries of ar­gu­ments in the med­i­cal lit­er­a­ture about which er­rors out­right kill pa­tients and which merely has­ten a pa­tient’s in­evitable de­cline. Can’t we agree that even one pre­ventable pa­tient death is one too many? And ev­ery­one agrees that at a min­i­mum the death toll is in the thou­sands.

The good news that can­di­dates should em­brace is that this prob­lem can be solved, and it’s not ex­pen­sive to do so. The ad-

min­is­tra­tions of Pres­i­dents Bush and Obama made sub­stan­tial moves to shift Medi­care away from the bloated fee-for-ser­vice model. Many em­ploy­ers and other pur­chasers of health ben­e­fits have taken sim­i­larly bold steps. A good num­ber of hos­pi­tals and health sys­tems have dra­mat­i­cally im­proved their safety records by mak­ing pa­tient well-be­ing a top pri­or­ity. That means they en­force rules about hand hy­giene or sur­gi­cal check­lists, and fol­low known best prac­tices for pro­tect­ing their pa­tients. As a re­sult of this progress, deaths and in­juries from in­fec­tions and er­rors are down, par­tic­u­larly in high-per­form­ing health sys­tems. But too many Amer­i­cans re­main at se­ri­ous risk.

Solv­ing this re­quires putting a pri­or­ity on pa­tients. Elected of­fi­cials, health sys­tems and busi­ness lead­ers showed us re­sults by em­brac­ing that pri­or­ity. Now it’s time for our can­di­dates to do the same.


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