What's Not Wrong with Health Care in the U.S.

Jan 1, 2009

Change is coming to the health care system in this country. At $2.1 trillion per year, or 17% of our Gross Domestic Product (GDP), cost should be the driver for this movement to reform our current system.

As the debate continues on in the next few months, however, a number of other arguments will be used to indict our present mix of public and private programs. Many of these arguments are based on a faulty presentation of the facts, so let’s look at the actual data and see what is not wrong with our health care system.

First of all, we hear a lot about how terrible the infant mortality rate is in the United States, with supposedly the worst in the civilized world. Is this true? Not really. U.S. health officials count all live births, while many other countries only count full-term births or infants who live at least 28 days. Obviously, premature infants, who are counted in the U.S., but not in other countries, have a much higher risk of mortality.

Second, it is repeatedly said that people in the U.S. do not live as long as in other countries. Again, this is true. However, deaths from homicide and accidents distort the picture. When the data is adjusted for these categories, life expectancy in the U.S. is as high as in other countries. Homicide and trauma certainly reflect a country’s social problems, but they tell us little about a country’s health care system.

Third, we hear that each year there are nearly 100,000 unnecessary hospital deaths in the U.S., a clear indictment of our health care quality. A panel of physicians reviewed the hospital data, however, and found that the great majority of these deaths occurred at the end of the patient’s natural life, when the outcome would have been the same regardless of what hospital staff did or did not do. In other countries, these older, desperately ill people might not even be sent to a hospital, dying instead at home, and are thus not included in national medical statistics.

A comparable study in Canada, adjusted for population size, found 200,000 “unnecessary” hospital deaths, even though political activists regularly push Canadian-style health care for the U.S.

Fourth, we hear people are often forced to declare bankruptcy because of medical bills. It turns out advocates count any bankruptcy case involving even a single medical bill, whether or not health costs had anything to do with causing the bankruptcy.

Also, people ages 55 to 65, who have more personal control over their health coverage, are less likely to declare bankruptcy, while people over 65, who are on government-run Medicare, have seen a doubling of their bankruptcy rate. In the case of the elderly, tax-funded health care has not reduced financial problems for older Americans.

Fifth, what about the 45.7 million uninsured? Who are they, and are medical costs and availability the reasons they don’t have health insurance? If we look at the actual numbers, it turns out that one-third of these people are eligible for existing government programs (Medicare, Medicaid, S-CHIP, etc.) but haven’t applied. Half of this 45.7 million are transitioning between jobs, and nearly one-fourth of the total are not U.S. citizens.

It turns out advocates count anyone who was without health coverage at any time during a calendar year.

Out of the entire 45.7 million, only about 8 million are chronically uninsured. This represents less than 5% of our total population. While an important number, it is arguably not large enough to be the primary motivator for an entire government overhaul of our health care system that would impact the other 95% of our population.

Last we are told we rank 37th in health care compared to other countries. This figure comes from the U.N.’s World Health Organization. Three of the five criteria to rate nations were biased in favor of nationalized, single-payer systems, and the U.N. admitted they had an 80% uncertainty level in their data. Amazingly, none of the five criteria included actual health outcomes, such as cancer or heart attack survival rates.

Because the U.S. does not have total, nationalized health care, our system was severely disadvantaged before the study began. Any health study that ranks Greece (#14), Columbia (#22), and Morocco (#29) ahead of the U.S. clearly has serious methodological problems.

Any debate about how to improve health care needs serious research honestly presented, not skewed data or false comparisons with other countries. Using the arguments discussed above only serves to shift our focus away from the real problems - overregulation and high costs. Only when the system re-connects patients with control of their own health care dollars, and when decisions about care are made by doctors talking with patients, not by government program managers, will we be in a position to control costs and extend coverage to the chronically uninsured.