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Wednesday, August 02, 2006

Medicare for All? No Thanks, Part IV

From David Hogberg:
After my first post on this subject, Joshua Holland responded here. If you can get through the ad hominem attacks, he has two basic points. The first is that I'm dishonest when I criticize his post by pointing out the problems with Britain's health care system. Says Holland:
The strawman here is that I never proposed a national health system like they have in the UK; I proposed a single-payer healthcare system with diverse providers, and said it would be like the UK only in that a small percentage of the population would remain privately insured (17% of healthcare in the UK was privately financed in 2004 compared to our 55% (OECD data)).
Here is the quote from Holland's original post that led me to bring up the Britain comparison:
The day you pass a law opening up Medicare enrollment to everyone who wants in, is the beginning of the end for our bloated, overpriced private healthcare system. Within ten years, we'd have universal, single-payer healthcare, with just a small percentage of Americans sticking with private insurance (like in the UK).
Holland claims that the UK reference only refers to the clause regarding a small percentage sticking with private insurance. However, it's not clear whether that the phrase in parenthesis refers only to the last clause or the entire sentence. Holland should have made that last clause a separate sentence to avoid any confusion.

He now claims what he was really talking about was a single-payer system with "diverse providers." But nowhere does he mention what type of provider set-up we would have. In fact, the term "diverse providers" doesn't appear anywhere in that first post. What was that about dishonesty, Josh?

Holland’s second point is that we don't get more health care than the Brits even though we pay about twice as much per capita. When comparing health care systems, leftists have a Pavlovian response: Trot out statistics like life expectancy and infant mortality. Holland does not disappoint:
Our infant mortality rate is 36 percent higher than the Brits; they live a year longer than we do on average and they have more nurses per patient and more beds per capita.
The fact is that life expectancy and infant mortality tell us next to nothing about the efficacy of a health care system. I examine this at length in this National Policy Analysis paper, but here is a summary:
1. Academic research consistently shows that life expectancy is impacted by factors such as GDP per capita, sanitation, clean water, and literacy rate. Factors such as spending on health care or number of doctors per capita have no effect.

2. The reason the U.S. has lower life expectancy than Britain -- not to mention most of the rest of the industrialized world -- is that it has a much larger population of African descent. Life expectancy in the U.S. for African-Americans is about 72.3 years, while for whites it is about 77.7 years. The reasons for this are primarily ones of genetics and lifestyle. Even studies that suggest disparities in health care have some effect on the lower life expectancy of African-Americans still emphasize the importance of factors such as income, education, and social environment.

3. Infant mortality is an unreliable comparative statistic of health care systems because it is measured inconsistently across nations. For example, Switzerland excludes children under 30 centimeters from its definition of infant mortality, thereby eliminating most high-risk infants. Indeed, as Table 3 in my policy analysis paper points out, the number of infants who die in the first twenty-four hours (when the largest proportion of deaths of low-weight babies occur) seems abnormally low in most European countries. Either they have figured out methods of saving infants that we don't know about here in the U.S. (unlikely), or the way they measure it differs from ours.
As for more nurses per capita and hospital beds per capita, they don't tell us much, either. Surely, it's possible to have too few nurses or hospital beds, but our numbers aren't much lower than those of Britain, so that's not likely in this case. What matters is how efficiently a health care system uses those resources. Given that Britain has long waiting lists of hospital admittance (much of it due to a phenomenon known as bed-blocking), it would seem that the British health system is less efficient than our own.

Finally, Holland also claims that:
It's not only life expectancy -- we're sicker across the board. A study looking at U.S. and British health released earlier this year found that "Americans had higher rates of diabetes, heart disease, strokes, lung disease and cancer -- findings that held true no matter what income or education level.” Of course, that can't all be put on our healthcare delivery system - there are lifestyle factors and whatnot - but, remember, they're getting those outcomes while spending 40 cents to our dollar.
In fact, those phenomena have nothing to do with a health care system, and everything to do with factors such as lifestyle and genetics. After all, if a man comes from a family with a history of heart disease, or he smokes four packs a day, or he eats a plate full of deep fried Twinkies every day for twenty years, what can the health care system do about it? Aside from some public service announcements and maybe warnings from your doctor, it can't do anything. What matters is how well a health care system performs after you become sick. On the few reliable statistics that measure such outcomes, the U.S. performs quite well.

One such statistic is the ratio of the incidence of a disease with its rate of mortality, a measure that yields insight into how well a health care system actually treats an illness once it is diagnosed. The Commonwealth Fund compared a few nations this way on breast cancer and prostate cancer using OECD data. The U.S. outperformed the other countries on these measure (see p.17, here (pdf)), including Britain. (We also did much better on AIDS, although the disparity in incidence numbers leads me to think that there are differences-of-measurement issues.)

A study published in Circulation found that the five-year mortality rate among patients who had severe heart attacks was higher in Canada than the U.S. This was due to the fact that the U.S. does more angioplasty and bypass surgery than Canada. Given that the U.S. does more angioplasty and bypass surgery than other nations, it is probably a safe bet that we have lower post-heart attack mortality rates than those other nations.

In short, it appears that we in the U.S. do get more for at least some of the additional dollars we spend on health care.

Other than that, there are few measures that are internationally comparable-although the OECD along with the Commonwealth Fund is working on that (see here (pdf)). Thus, as measures improve, it is certainly possible that we will find out that health care systems with more government involvement outperform those with less (although I wouldn't bet money on it.)

What we can say for certain is that the statistics that leftists usually trot out - like life expectancy and infant mortality - somehow always show the U.S. health care system to be worse than most other nations'. Those statistics tell us a lot about the left's agenda, but tell us nothing about health care systems.
Next up: Odds and ends.

Past posts in this series: #1 is here; #2 is here, #3 is here.

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Posted by Amy Ridenour at 4:52 PM

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