Wednesday, May 16, 2007

Health Care Blog Loses It After U.S. Health System is Defended in AP Article

Q: When is a think-tank not a think tank?

A: When it's a conservative one.

Or so implies Matthew Holt, proprietor of the not very objective, but certainly quite emotional Health Care Blog.

Mr. Holt appears to be incensed that the Associated Press quoted David Hogberg in a story about the U.S. health care system.

Holt says:
...the AP found a rent-a-quote to make the article fair and balanced:
David Hogberg, senior policy analyst at the National Center for Public Policy Research, said a strong case can be made that the U.S. health care system is the best. “It depends on what measures you use,” Hogberg said. Life expectancy is influenced by many factors other than health care, he said, and nations measure infant death rates inconsistently. Other measures show the United States performing well, he said.
Just in case you wondered the National Center for Public Policy Research may sound like its some official well respected non-partisan body but its header title describes it as a “A Conservative Think Tank” (an oxymoron perhaps). Yeah, those guys know all about health care, I’m sure...
"Rent-a-quote"? What does that even mean?

As for the rest of it, if calling The National Center for Public Policy Research "conservative" is Holt's best response to The National Center's contention that the U.S. health care system performs well overall when compared to the systems of other nations, we'll take that as a compliment. We assume that if there had been a fault in our actual logic as applied to the question, as opposed to our political philosophy, Holt would have pointed it out.

P.S. David Hogberg and Matthew Holt continued their debate in the comments to the Health Care Blog post. David Hogberg notes briefly, on his own blog, and in more detail, in this in this National Center paper, why he has been critical of those who claim the U.S. has an inferior health care system based on the statistics of life expectancy and infant mortality.

Holt heatedly replies that Hogberg's "argument... is illogical crap" and claims to have "dealt with it" in this post at another blog. However, the post Holt references does not even address life expectancy and infant mortality, and is actually kind of a disjointed rant, so it is safe to say Holt hasn't dealt with the issue at all.

It is amazing how angry some idealogues can get, and for what little provocation.

Addendum, 5/16/07: Matthew Holt writes:

Thanks for writing about me. But I must say that if you were brave you'd a) allow comments on your post, and b) answer the two specific questions I raise in my "rant".

If you'd bothered to follow the long debates about this topic you'd know that I too consider the life expectancy and infant mortality rates irrelevant....the problem is the BS about "which disease gets treated better where" is all equally irrelevant. It's all cultural and got little to do with the structure of the health care system. But the joke is, that it's clear that we do a much worse job in many disease categories here than many other countries. It baffles me as to why so many on the right want to talk about it so much. Hence the questions in my rant.

Meanwhile your rent a quote colleague David is apparently going to take me up on my offer. Brave lad.

As for the rent a quote and "fair and balanced"....if you can find me more than 5 top CEOs, academic or physician leaders -- or any other serious observer of the system not making millions from it-- who believes that the US system isn't screwed up to the core, then I'll be very surprised. You may not travel in their circles but I do. There's a reason that American business is so pissed off with the health care system. The point is that there's a very very wide consensus that things are badly wrong here. Emmanuel is absolutely in the mainstream of thinking about this. Your man Hoggy is not. But yet the AP presented them as two equals. It's like the global warming "crossfire style" debate all over again.

I assure that I am not emotional at all about this topic. Unlike many of your friends on the free-market right in health, where libertarianism works (drug policy or your post about real estate brokers) I'm all for it. Where in cases of market failure it doesn't I advocate sensible solutions that reform the market so that the best outcomes happen.

And frankly the quality of thinking from even the sensible libertarians in health care (Michael Cannon et al) is poor. By their OWN admissions their solutions don't work for sick people. Go read up on the Cato debate I & Jon Cohn had with Arnold Kling, and/or try to find the solutions to provide insurance for the chronically ill in Cannon's book. You'll be looking for a long time!

Meanwhile if you're a conservative think tank...why call yourselves "National". You wouldn't possibly be trying to fool people into thinking that you're somehow nationally representative of anything, would you?



Matthew Holt Consulting
Research, forecasting & strategy
for the health care marketplace
Quick response to these points:
1) I would be stupid to allow comments on this blog, as it is supported by a 501(c)(3) non-profit institution. As such, there are topics it is not allowed to cover. The only way to prevent commenters from violating this would be to censor comments, which seems to me worse than not allowing comments in the first place. If I write critically about someone and they send me a letter, I do publish it, unless they ask me not to do so.

2) I still don't know what is meant by "rent a quote."

3) If Matthew Holt also considers "the life expectancy and infant mortality rates irrelevant," then I wonder why he objected so emotionally to the short quotation of David Hogberg in the AP article. Perhaps because David also said that a strong case can be made that the U.S. health system is the best? I think it is the best also, but that doesn't mean we are arguing that it is perfect. Our health care system does have massive problems -- I just don't agree with folks who advocate "solutions" (such as government-run "universal" care) that would make the system worse.

4) "Screwed up to the core" is not a precise description of a health care system's outcomes, but it does sound similar to what people in Canada and Britain tend to say about their health care system. No country has a perfect system, but I prefer ours to theirs and -- important -- we do not object to improving ours.

5) The AP gave nearly all the ink to Ezekiel Emanuel, who supports a universal coverage system for the USA and a new value-added tax on the American people, and gave no ink whatsoever to anyone skeptical of the wisdom of Emanuel's recommendation. Some balance. David Hogberg was merely given a few sentences at the very end and then only on the narrow question of whether the U.S. system is the world's best. Yet Matthew Holt is indignant, calling this a case of AP presenting Emanuel and Hoigberg as "two equals." If they were presented as two equals, one was presented with tape over his mouth.

6) In 25 years of operation, I think Matthew Holt is the first person to express the thought that The National Center for Public Policy Research has the word "national" in our name as a way to fool people. No, it is there to indicate that The National Center for Public Policy Research was set up to work on issues of national concern, as opposed to issues affecting only a certain region, state or locality. No fooling.

6) As for the two questions in Matthew Holt's "rant" he wants me to answer: Re-reading it, I see four questions, no two, mostly phrased in a "when did you stop beating your wife" vernacular. A quick response
"Why are you so happy to have a health care system that kills so many more people who have heart attacks, and amputates the feet of so many more diabetics?" I don't accept either of the two premises of the question.

"Ask the free marketeers to explain why they feel comfortable with a financing system that causes at least 25% of all the nation's bankruptcies." Same answer as above.

"Why [do free marketeers] espouse even greater cost sharing even though it's been shown yet again this week that increased payment at the point of care reduces people's likelihood of following their doctor's advice? One argument for "letting" people control more of their own health care spending is that the people who earned the dollars have the highest moral right to decide how they are spent. Another argument, which Matthew Holt presumably knows already, is the theory that folks who are spending their own money will shop around for the lowest prices, thereby adding incentive for health care providers to keep prices competitively low.

"Why do you want to raise taxes in order to transfer money from the poor and sick to people who are already richer and healthier than average?" I don't. Nor during my working lifetime have I seen many examples of tax increases afflicting primarily the poor and the sick (though perhaps tobacco tax increases could be considered an exception; those of us who opposed those, however, were considered to be puppets of Big Tobacco). My primary health care concerns are these: I oppose a U.S. adoption of a government-run, so-called "single payer" or "universal" health care system because I believe it would lead to needless misery, pain and death. I also am extremely concerned about Medicare's poor financial prognosis (which I also believe will lead to an ever-worsening standard of care under Medicare). I do not believe that my position on either of these means I "want to raise taxes in order to transfer money from the poor and sick to people who are already richer and healthier than average."
My answers here are intentionally brief (nor should they be perceived as representative of the views of libertarians, since I'm not one). David Hogberg already agreed to address Matthew Holt's questions, and Matthew Holt agreed to post what David writes on the Health Care Blog. I see no reason at this point to believe they need my help in arguing this out.

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Posted by Amy Ridenour at 5:53 PM

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