American Elephants

Misinformation, Misconceptions, Bum Statistics, and Plain Old Spin. by The Elephant's Child

Heated political battles are often as much about misinformation as fact. Many statistics on cross-country comparisons of health care come from the OECD (the Organization for Economic Co-operation and Development) which is a pro-socialized medicine organization.

We do spend substantially more on health care as a percentage of GDP than other developed countries. In 2010 US health care spending amounted to 17.9 percent of GDP, which worked out to $8402 per person. The primary source of comparison data on health outcomes is the OECD’s health system performance data and reports. The information is used to support broad criticisms of the US health care system and to compare it unfavorably with others, specifically the state-operated or controlled systems of Europe.

There is a common misconception that people value health care itself. This is false. Using most health care is unpleasant. What people care about is the state of their health, and that cannot be measured. The proxies that can be measured are all some derivative of mortality.  The OECD uses infant mortality, life expectancy, and premature death as measures of mortality in their reports, and these measurements are supposed to be proxies for  the value of the system.

Infant Mortality concerns three OECD mortality measures: infant, neonatal, and perinatal mortality.Infant mortality is the number of deaths in the first year per one thousand live births. Neonatal mortality is the number of deaths in the first twenty-eight days per one thousand live births. Perinatal mortality is the number of deaths in the first week after birth, plus fetal deaths after 28 weeks of gestation or fetuses  that exceed a weight of one thousand grams. The problem is that the definition of infant mortality is not consistent across countries.

In the US doctors often go to great lengths to save a baby with poor survival chances. Our hospital magazine just arrived with a picture of a very small girl named Mila, who weighed just two pounds at birth and has spent six weeks in the neonatal care unit, and is doing fine.

Babies who are not viable and who die quickly after birth are classified as stillbirths in Japan Sweden, Norway, Ireland, Netherlands and France.  A detailed study of medical records and birth and death certificates found that U.S. infant mortality has been overstated by 40 percent. The U.S has more neonatal intensive care units, and our hospital is looking to upgrade further.

Life Expectancy incorporates infant mortality as well as mortality from violence and accidents and seems to be much greater when calculated from birth or from a later age, like 65, where the differences between countries are small.

Premature Morality is determined by potential years of life lost. It is also strongly influenced by infant mortality. One advantage is that it can be linked to the cause of death, so deaths from specific causes can be more closely related to health care in some cases, but the OECD does not use these measurements in their cross-country comparisons.

In 2011, an estimated 46,159 Canadians received treatment outside of Canada, mostly in the US, the largest numbers from British Columbia, Alberta and Ontario. The national median wait time for treatment after consultation with a specialist increased from 9.3 weeks in 2010 to 9.5 weeks in 2011. That’s a long time to wait if you are in pain and waiting for surgery, and unacceptably long if the problem is life-threatening. These numbers do not represent emergency medical treatment.

Health and Human Services Secretary Kathleen Sebelius wrote an op-ed for the Washington Post, in which she said that national health expenditures have increased only by about 4 percent annually over the past two years, significantly less than in previous years.

She boasted that health care costs are “projected to stay level as a share of gross domestic product from 2009 all the way through 2013. “She stops at 2013 because the expensive costs of Obamacare kick in 2014.” The Medicare actuary says the next decade will experience overall acceleration in projected national health spending to 7.4% — 2.1 percentage points more than would be expected in the absence of health reform.

Sebelius claimed that ObamaCare lowers premiums. But an annual employer survey shows that premiums for employer-based coverage grew faster from 2010 to 2011 than they did the year before.  The Kaiser-Family Foundation CEO stated that ObamaCare was responsible for 20 percent of the premium increase. The impact of ObamaCare on small business includes new taxes, penalties and other regulatory burdens. Secretary Sebelius spins a good story, but it is, unfortunately — spin.

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First, it would be helpful to provide a link to the OECD data.

Second, while the USA fares slightly better than the OECD average (which is dragged down by the numbers for poor countries, like Estonia, Mexico and Poland) for males at age 65, it is below the OECD average for females at age 65.

The differences are not tiny, but significant.

The remaining life expectancy for U.S. females aged 65 is 20.3 years. By comparison, the numbers for Switzerland (22.5), France (22.6), Spain (22.7), and Japan (23.9) are two or more years longer. Even for males, the USA (17.7 years) is outshone by countries like Spain (18.6), New Zealand (18.8), Israel (18.9), Japan (18.9), Switzerland (19.0), and even the UK (18.3).

As for medical tourism, 46,159 Canadians leaving their country to seek medical treatment elsewhere, on a per capita basis, is about the same as 420,000 Americans. A 2008 study by McKinsey and Co. estimated that 750,000 American medical tourists traveled from the United States to other countries in 2007 (up from 500,000 in 2006) — the majority to Asia and Latin America. According to this article in Time magazine, that number could reach as high as 6 million by 2010.

I am still looking to see what the actual number was for that year (or more recently). But the upshot is, no matter how much one spins the data, the U.S. health system is not generating good value for money.


Comment by Subsidy Eye

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