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Thursday, February 15th 2007

A Question That Really Does Need Asking…

Investors.com has an op/ed that asks if we’re truly getting screwed as badly as everyone thinks in health care bang for buck (H/T Kevin, MD).

I love this article because it addresses my pet peeve. Mainly what Senator Kennedy does here,

“As a proportion of GDP spent on health care, America is first in the world by a large margin. . . . Our extraordinary level of health spending, however, is not reflected in better health outcomes. Among the world’s leading industrialized countries, the United States ranks 22nd in average life expectancy and 25th in infant mortality.”

MORON! As I’ve said over and over and over again those are terribly poor quality measures of bang for buck.

Okay, I shouldn’t be too harsh…I still think the U.S. health care system is the least efficient in the world. But it really is a giant pet peeve when people say we spend X per capita and only get this much quality. I’ve laid out why in numerous posts but here we go again.

But is it true? Does the U.S. really rank behind Italy, Greece, Slovenia, the Czech Republic and Malta in terms of infant mortality? Are we really wasting so much health care money that we rank behind Bosnia, Jordan, Israel and Guam in terms of life expectancy?

The short answer is no. While politicians love to cite these international comparisons, they are rife with problems that end up making the U.S. look worse, a fact pointed out by researchers for years.

Take infant mortality. The international statistics that Hillary, Ted and others love to cite come from the World Health Organization (WHO), which defines a life birth as any baby showing any signs of life. While the U.S. carefully follows this definition, many other countries do not. As the WHO itself points out, “underreporting and misclassification are common, especially for deaths occurring early on in life.”

For example, the U.S. tries to save extremely premature babies, many of which die and then get counted as an infant mortality. Other countries simply count these as stillbirths.

In Switzerland, a baby must be at least 12 inches long to be counted as living, according to Nicholas Eberstadt, a scholar at the American Enterprise Institute.

In addition, other countries have suspiciously low infant mortality rates in the first 24 hours after birth. Eberstadt found that in the U.S., Canada and Australia, more than 33% of infant deaths occurred in the first day of life. In France, just 16% died in the first day, in Luxembourg just 10%, and in Hong Kong only 4% of infant deaths occurred in the first day of life. Eberstadt concludes that these countries are artificially pushing down their infant mortality rates by counting many first-day deaths as stillbirths.

This is certainly true. At some points the WHO has listed countries like Kazakhstan as having better infant mortality figures than the U.S. I can almost guarantee this is a figment of how infant mortality is self reported (and ALL of these figures are self reported).

Even if the infant mortality and life expectancy figures aren’t skewed by reporting, there is the simple fact that the U.S. is the sickest country in the western world independent of health care access or quality (i.e. dependent solely on genetic and life style factors). The U.S. has a heterogeneity in its population which other parts of the western world don’t have to face on such a large scale (the genetic predisposition to HTN in African-Americans or to diabetes in Hispanic-Americans).

And more importantly the U.S. is the fattest country in the western world with one of the highest rates of diabetes and other disease states which come with such girths.

The casual relationship goes the opposite direction than the rant of Senator Kennedy above implied. We’re sicker because we live less healthy which means we spend more on health care and we die sooner. It isn’t: we have terribly inefficient health care which means we spend more plus get poorer quality which leads to us dying sooner. That latter is a ridiculous notion and those implying it should be ashamed.

As I’ve said over and over, this comes nowhere near explaining away America’s $5300 per capita figure, but proponents of reform should have the decency to step away from the ridiculously hyperbolic rhetoric. I know it is effective at selling their points, but it is basically a giant lie to the uninformed public in this debate.

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