Tuesday, August 25, 2009

Health Care, Again

I've made a point of having a conversation on health care at least once a day with someone who disagrees with the need for health care reform. Below is an email I sent to someone after our conversation ended prematurely. The person this is directed at is in his early 60's, is very much a member of the Conservative Christian Right, and very eager to tell others that they are wrong without providing proof to back it up.

This is a long email. I did a lot of research and put a lot of thought into it, so I hope that you will read it and give it some thought. This is my work, my understanding, and my conclusions, based upon hard data -- not some TV personality's opinions vomited up for your consumption.

You said: "The US has Best Health Care in the World" and when I said that was incorrect, you told me I was wrong. So I did some research with the following question in mind:
How do I quantitatively measure "best" using statistics you'd trust? I know that a lot of people have been lead by certain media outlets to mistrust the World Heath Organization statistics, so... Would you trust the stats compiled in the CIA FACT BOOK? I think you would, so I'll start there. https://www.cia.gov/library/publications/the-world-factbook/index.html

So, if the US does indeed have the best health care in the world, then we should have the lowest rate of infant mortality and the highest life expectancy, right? The measure of the health of a nation's citizens is fairly easily determined by infant mortality rates, as there is a correlation between maternal health and the health of infants. Additionally, longevity is an excellent measure of the health of a nation. Healthier people live longer, right? But to be generous, lets say that for a country to be a contender for the "Best Health Care in the World Award" that country should be in the top 10%. So the CIA evaluates 224 countries, which means the US would need to be within the TOP 22 in order to qualify for the upper 90th percentile. Lets see how we rank:

INFANT MORTALITY RATE: 6.26 per 1000 = #180th highest out of 224 countries / 44th lowest out of 224.
If the US has the best health care, then we should have one of the lowest infant morality rates, right? Uhm, there 43 countries with fewer infant deaths. Cuba, a communist country with socialized medicine, has fewer deaths per 1000 than we do. Canada is beats the US by 9 slots. The top 10 countries with the lowest infant mortality rates: Singapore, Bermuda, Sweden, Japan, Hong Kong, Macau, Iceland, France, Finland, Anguilla. Germany is 15th, Switzerland is 16th, the UK is 31st and Canada is 35th. The vast majority of these countries have government subsidized health care for all citizens. Source: https://www.cia.gov/library/publications/the-world-factbook/rankorder/2091rank.html?countryName=United%20States&countryCode=us&regionCode=na&rank=180#top

LIFE EXPECTANCY: 78.11 years = 50th out of 224 countries.
If the US has the best health care system then our population should be living longer and healthier than people in other countries. But we're not. The US, at #50, is in the 77th percentile. Canada is 8th, in the top 5%. UK is 36th, Germany 32nd, Sweden is 10th, France is 9th, Australia is 7th. Macau, Andorra, Japan, Singapore and San Marino are in the top 5.
Source: https://www.cia.gov/library/publications/the-world-factbook/rankorder/2102rank.html

I think the only way we can say that we have the best heath care system in the US is if we think "most expensive" = "best". But I won't stop there. How else can we quantitatively evaluate the qualitative assertion "The US has Best Health Care in the World" ?

The US as a country is the single largest producer of wealth in the world. Our 2008 GDP was 14.2 trillion. The EU combined was 14.8 trillion. GDP per capita, however, we are #10, with Singapore just ahead of us at #9, and with the UK and Canada at 19 and 21 respectively. Other countries with lower GDP but higher life expectancy and lower infant mortality rates such as Canada, the UK, and Sweden manage to provide health care that exceeds American standards (as measured by our infant mortality and life expectancy rates) at a lower percentage of GDP / per capita. How is it that countries with similar or lower GDP manage to provide health care to their citizens that demonstrably (via infant mortality and life expectancy rates) exceeds our own? Obviously, Government subsidized health care is both more economically efficient and individually effective. Source: https://www.cia.gov/library/publications/the-world-factbook/rankorder/2004rank.html

The reason why Singapore keeps coming up is because, by all accounts, Singapore has the best health care in the world. The Singapore government spent only 1.3 percent of GDP on healthcare in 2002, whereas the combined public and private expenditure on healthcare amounted to a low 4.3 percent of GDP. By contrast, the United States spent 14.6 percent of its GDP on healthcare that year... How does Singapore do it? Yep, Government-subsidized health care. Not only does it make excellent marks on life expectancy and infant mortality, but Singapore subsidizes its citizen's health without endangering its economy. Source: http://econlog.econlib.org/archives/2008/01/singapores_heal.html

Yes, I know that in the cases of certain catastrophic illnesses, the US has a higher survival or extension of life rate and that in those cases, wealthy people from other countries come here for care. But my understanding is that we have a higher percentage of catastrophic illnesses as a result of poor health maintenance / preventive care, and thus our "supremacy" in this area is born of necessity and opportunistic profitability rather than of efforts at excellence.

Lastly, I know that some people have argued that we can't afford a health care system because our Defense spending is so high. Well, the CIA Factbook shows that the US is #28 in Defense pending as a percentage of GDP, between Chad and Libya, and almost a full percentage point behind Singapore (#20). Source: https://www.cia.gov/library/publications/the-world-factbook/rankorder/2034rank.html Now, back in the 60's when most other First World countries were developing national health care systems, the US was caught up in funding the Cold War and that is why only Medicare for the Elderly was passed, because it was thought the country could not afford it. Once the Cold War was over, however, there was very little agreement about how involved the Government should be in the US Economy, and in fact, there were significant cut-backs in "entitlement" spending, the funds of which were then funneled into Defense spending. Even so, according to a Brookings Institute study, the US now spends more money on health care than it does on Defense and Social Security combined. Source: http://www.brookings.edu/projects/opportunity08.aspx Surely, if we are putting that much of our GDP into health care, we can get a better value for our dollars.

Conclusion: Americans have a tendency to believe in our dominance and supremacy in the world, without recognizing that it is an illusion. Stubbornly insisting that "We are the Best!!!" does not make it so. It isn't unpatriotic to recognize that the US is slipping. But I think it is unpatriotic to blindly accept what the rah-rah "patriotic cheerleaders" have to say about where the US stands in comparison to the rest of the world. We've lost our moral high ground with the torture of prisoners and we're losing our economic vitality to idiots who want a return to the Free Market Robber Baron days. Well, the excesses of the late 1800s and early 1900s lead to the crash in 1929, and the same practices and policies lead to the crash of 2008. And as a result of the abuses of the early 1900's, the Federal government implemented a social security network (pensions in the 1930s), which it later expanded upon with the Medicare program of 1965 and the WIC program of 1975. In all three cases, a significant number of people argued very heatedly against these "entitlement programs" and yet, without them, where would we be? In the US, the poverty rate in 2007 was 12.6% of the population. 18% of those living in poverty in this wealthiest of nations are children, and nearly 10% of them are people over 65. Source: http://www.census.gov/hhes/www/poverty/poverty07/pov07hi.html If we didn't have these socialized care / entitlement programs (Social Security, Medicare, WIC, etc) the lives of those living in poverty would be much, much harder.

Now we are at an important cross-roads. We either ensure that every citizen in the US has access to affordable health care, thus improving the overall health of the nation and thus decreasing medical costs long-term, or we sink even farther in the world rankings. It is better that our elderly enter the Medicare program healthy from a lifetime of adequate health care, because there will be fewer instances of catastrophic illnesses and other costly issues resulting from neglected health. And it is better that Americans enter the work-force healthy from adequate health care in childhood. Singapore learned that lesson big time. In 1969, Singapore was ranked #59 for GDP in the world, and today it is at #46, and the per capita income went from #38 in 1969 (Source: http://www.nationmaster.com/graph/eco_gdp_percap-economy-gdp-per-capita&int=-1&date=1969) to #9. What accounts for the upward mobility? Most people give a government focus on health care the bulk of the credit. Singapore once had a very high incidence of malaria, a disease that created a huge drag on their economy (and still has a profound effect on the health and economies of most equatorial countries) because a significant percentage of the population was too sick to work in any given time. In the same time frame, the US went from #1 in GDP per capita in 1969 to #10 per capita in 2008. In 2003, lost work days due to illness and injury carried total annual costs of nearly $63 billion in lost work and productivity for private US employers, not including actual health care costs (Source: http://journals.lww.com/joem/Abstract/2007/07000/Cost_of_Lost_Work_and_Bed_Days_for_US_Workers_in.7.aspx). Could it be that the 9 point drop in US GDP per capita is at least partially related to the high costs of poor health maintenance? There is a lot of compelling data out there to suggest that it is in the best economic interests of every country to provide public health care -- and all this without even touching upon the moral argument of the world's wealthiest Christian nation's unwillingness to provide for its poor and sick citizens as Christ chided us all to do.

If you've gotten this far, I hope you'll at least give all of this some thought. I've provided the sources of all of the numbers I've quoted. Most of them are from the CIA Fact Book, as I'm sure you've noticed. It is my nature to question what others assert. I've never been very good at taking "because I said so" as an answer, and no matter how charismatic the person or compelling the argument, I've always, always, looked for the facts. Here they are. Make of them what you will.



Blogger shewhowill said...

awesome!! that was perfect..
it's the whole fear of
"socialised medicine" that is driving the christian right..
god forbid the communist rise to power.. on the heels of healthcare..
it's funny and not funny at the same time...
well done.. !

2:10 AM, August 25, 2009  
Blogger KR Silkenvoice said...

Sharon Begly of Newsweek Magazine posted an interesting article called "Lies of Mass Destruction - Why We Believe Lies, Even When We Learn The Truth" http://www.newsweek.com/id/213625

What is fascinating about it is her account of a study: Some people form and cling to false beliefs about health-care reform (or Obama's citizenship) despite overwhelming evidence thanks to a mental phenomenon called motivated reasoning, says sociologist Steven Hoffman, visiting assistant professor at the University at Buffalo. "Rather than search rationally for information that either confirms or disconfirms a particular belief," he says, "people actually seek out information that confirms what they already believe." And God knows, in the Internet age there is no dearth of sources to confirm even the most ludicrous claims (my favorite being that the moon landings were faked). "For the most part," says Hoffman, "people completely ignore contrary information" and are able to "develop elaborate rationalizations based on faulty information."

I recommend reading this article. It explains a lot.

9:55 PM, August 25, 2009  
Anonymous Anonymous said...

I think you make many valid points about the US health care system. I do not profess to know very much about the US system, what I do know is that here in Australia it is often argued that the US system is a 'worst case senario' for Australia. We do not want to have a system like yours. Everyone should have access to health care.

6:44 AM, August 27, 2009  
Blogger DJRRyan said...

Well done write up ... I have been searching for independent thinking and voices on the subject of healthcare and I think your approach of looking at birth rates and mortality are right on. And we do have great catastrophic herculean capabilities for extending the end of life ... sure wish we had a way to motivate people to stay healthy so we would not need so much of the end of life medical heroics.

10:48 AM, September 19, 2009  
Anonymous J.A. said...

Statistics can be highly misleading, e.g. "rate of infant mortality" and "life expectancy" include factors not stated in the results. The higher rate of infant mortality is partly based on lifestyle choices, including women aborting their babies, sometimes if not often in what could be perceived as a birth control method. The lower life expectancy also includes factors not considered in the ranking schema, yet which do have an effect on the rankings and little or nothing to do with healthcare.

2:18 AM, October 12, 2009  
Blogger Kayar Silkenvoice said...

Hi JA, thanks for your comment. First, I find it interesting that you say that infant mortality statistics are influenced by abortions. This is incorrect. Infant mortality rates are calculated based upon the rate of deaths of infants carried to full term and who die in childbirth or in the first year or so of life. If abortion did factor in then one might consider that the US infant mortality rate is actually lower than it would be if all pregnancies were carried to full term, as many of those infants would not be receiving adequate prenatal care. You are right that the lower life expectancy includes factors that are difficult to account for in the overall schema, however, including the complications resulting from our comparatively rich lifestyles -- however, as a wealthy nation with supposedly the best health care in the world, we shouldn't need to make excuses as to why our stats are lower. The best sports teams, the best companies, and the best employees are all determined by metrics. Saying that the quantitative metrics don't account for some qualitative measures is beside the point. The US does not have a level playing field. The cards are stacked in our favor and we still don't measure up using the most basic statistics. That is sad. But what is sadder is the constant round of justification, rationalization, and excuses for the lack of corrective actions.

9:47 AM, October 12, 2009  
Anonymous Rob said...

Hi, I think J.A. has a valid point about life expectancy being related to the unhealthiness of lifestyle of many Americans: the results of this aren't a reflection on the quality of U.S. health care.

I think that infant mortality is a valid comparative statistic though.

This is irrelevant though. The claim that "the US has the best health care in the world" is really the claim that it's "the best health care in the world for those who can afford it, like me". If you're one of those who can afford it, and your own well-being is your paramount interest, you don't really care if someone else's care will improve, you only care that yours might decline.

Change is scary.

However, the really paranoid stuff, that the government is composed of immoral people who are itching to form "death commissions" to murder citizens through inaction, I simply don't understand. Ok, the idea of "death commissions" are bad, but what does that have to do with the implementation of universal coverage? If people want to protest "death commissions", our current system already has these in the form of the policy rescission practices that insurers use to deny coverage and kill citizens in the interest of profit. Health care reform is in part to STOP this type of activity, not to expand on it.

I would like to see universal coverage in this country, both because caring for fellow human beings is a moral good, and because failure to take care of fellow citizens is destabilizing to society. Once universal health coverage is achieved, the best way any given individual can help ensure his own access to good health care is to make sure that his fellow citizens are as healthy as possible. The well-being of others is in our own self-interest.

Hopefully this concept could exist in a positive manner and wouldn't simply degenerate into "being fat is immoral".

6:51 PM, October 26, 2009  

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