How Does the U.S. Health-Care System Stack Up when compared with other countries?
The article below is a good approach to the facts involved but omits for obvious reasons something important that only a very wicked person like me would mention: American healthcare statistical averages are greatly weighed down by the large black element in the population. For reasons which need not detain us here, blacks have markedly worse life expectancies and morbidities than white Americans. An accurate comparison between healthcare statistics from one nation to another would need to compare like with like -- i.e. American whites with whites elsewhere
Richard Cohen of the Washington Post... was offended by Boehner’s comment that the American health-care system is “the best health care system in the world,”
Life expectancy at birth is a particularly limited measure of health-care performance across nations, because it generally fails to account for such important variables as lifestyle, culture, income level, and educational achievement. Life expectancy at older ages, such as at 65, gives a clearer picture — though it does not eliminate the confounding distortion of non-medical factors — and using that measure, the apparent life expectancy gap between the U.S. and other comparable nations narrows. In fact, if one goes further out on the age curve to age 80 and over, one finds that the U.S. probably leads the developed world in life expectancy.
These differences highlight the U.S.’s focus on subsidizing health care for the elderly, for whom medical interventions are more frequent, costly, intensive, and arguably more beneficial, and to whose future health non-medical factors matter less on the margin. (Their likelihood of voting is also higher…) A study published earlier this month in Demography finds that at age 55 and beyond, Americans are sicker by far than the English, yet older Americans don’t die earlier than their British counterparts: Death rates were equivalent for 55-to-64-year-olds, and beyond age 65, Americans had a slightly greater probability of survival. Why is this so? Perhaps because the U.S. health-care system diagnoses and treats illnesses (particular among the elderly) more aggressively than does the National Health Service — though, of course, all that extra screening and more intensive treatment costs more money.
The next old chestnut of international health-care comparisons that Cohen serves up is infant mortality (deaths in the first year of life). Major problems with infant mortality statistics have been pointed out by others in the past and include differences in data definition and common health-care practices. For instance, American medical practice more commonly resuscitates very small premature and nonviable-birth babies; these babies later die but are treated as “live births” in U.S. statistics. Countries such as France and Japan are likely to classify such babies as stillbirths, which aren’t counted. Infant mortality rates are also affected by outside factors such as the mother’s behavior and lifestyle (e.g., obesity, tobacco use, excessive alcohol use, recreational drug use, and marital status).
Somewhat better measures of perinatal mortality (death in the first week, plus fetal deaths that meet or exceed the minimum gestation time or weigh standards) and of birthweight-specific mortality reveal much smaller differences between U.S. rates and those of comparable nations. And, of course, I should note that Richard Cohen, who is pro-choice, mourns for infants who die “before they can get a cupcake with a single candle” but not for aborted fetuses, which have a mortality rate of 100 percent.
Next up on Cohen’s checklist is “avoidable mortality,” which purportedly estimates deaths from causes that should not occur in the presence of timely and effective health care.
The most notable proponents of this measure are British researchers Ellen Nolte and C. Martin McKee, whose 2008 study (supported by the Commonwealth Fund, which probably never met a person they didn’t think deserved more comprehensive levels of health insurance) compared trends in health-care-amenable mortality in different nations.
They concluded that the United States started with a relatively high amenable-mortality level in 1997–98 and then saw unusually small reductions over the next five years, relative to comparable nations. But, once again, there is much less here than meets the eye. For one thing, the study failed to adjust the proportionate share of deaths within given populations due to amenable mortality for changes in overall national mortality rates — in other words, the share of all deaths occurring in a given time period that were due to amendable mortality.
Even Nolte and McKee acknowledge that death is typically the result of a complex chain of processes including social and economic factors, lifestyle factors, and preventive and curative health care, and they concede that this renders the underlying concept of amenable mortality somewhat less than definitive as evidence of differences in health-care-system effectiveness.
Other critics of the Nolte/McKee approach point out that their study essentially only demonstrates how many people in each country died from an arbitrary list of particular diseases and conditions. It does not determine if individuals received care or if they could have been saved by care they did not get.
Returning to Cohen — he alludes to another cliché of health-care mythology: the free-riding uninsured people who postpone treatment until they land in overcrowded and expensive emergency rooms. The statistical reality is that among the under-65 population, the uninsured are no more likely than the insured to visit the emergency department, nor are their visits more likely to be triaged as non-urgent. On the other hand, persons under 65 with Medicaid coverage are more likely to have multiple visits to the ED than those other two categories. Adults with Medicaid accounted for most of the increase in ED visits from 1997 to 2007.
In the 2006 National Hospital Ambulatory Medical Care Survey (NHAMCS), it was easy for the reader to see in the ED summary that those covered by Medicaid visit the ED more often than the uninsured (82 visits per 100 persons, as opposed to 48 per 100 persons). But the 2007 version has a different format, and it is now much harder to find figures for the visit rates to the ED per 100 persons based on payment source/insurance coverage. (Any connection between a new HHS administration selling expanded Medicaid coverage and this change from longstanding report format must be purely coincidental.) By the way, did you know that the number of visits to emergency departments actually decreased between 2006 and 2007, from 119.2 million to 116.8 million? Yes, I must have missed reading that headline in the mainstream health media, too.
Thoughtful observers might consider the possibility that an increase in ED visits primarily reflects broader delivery problems (e.g., physicians who don’t do evening or weekend hours, or answer e-mail, provider resistance to low-cost clinic competition, etc.) rather than increases in the number of uninsured Americans. They might also wonder whether the new health-care law’s plan to increase coverage primarily through expansion of Medicaid will help or aggravate the problem of emergency-care overuse. But Richard Cohen only had enough space, or attention span, to use the uninsured-in-the-emergency-room image as a throwaway line.
Cohen’s paragraph on the use of Bethesda Naval Hospital by some anti-Obamacare members of Congress is another miss. Criticism of the special health-care perks that members of Congress can get for a $500-or-so annual fee may be justified to some extent. They essentially receive personalized, all-that-you-want primary care from official congressional physicians on call in the Capitol, and this ties them in to quick, no-fuss referrals to specialists and admissions at Bethesda Naval — and, despite some disavowals on the record, when members check in to Bethesda, they do receive VIP-like treatment.
However, this is not dissimilar to the executive health-care benefits enjoyed by top officials in private corporations or by government officials in countries with national health-care systems. (It’s good to be the king!) Moreover, the same deal could not be extended to all, under either a private market or a public program, without either breaking the bank or putting practically everyone first in line (and therefore right back in the middle). In any case, taking advantage of such benefits, arguably in part on the taxpayers’ dime, is nothing new in Congress, and sometimes is no guarantee of quality care.
Essentially, Richard Cohen’s column is an overwrought, highly politicized reaction to the periodically shallow rhetoric of some Republican officeholders who refer to U.S. health care as the best in the world — which, in some respects, U.S. health care is: for instance, in cancer detection and treatment and in a number of relatively sophisticated procedures for life-threatening illnesses. But that’s not the point. The real issues are (1) how to improve it, particularly in terms of more consistent quality and greater affordability; and (2) how to refrain from worsening it, along with the economy, through a harmful prescription (Obamacare). Some Republicans have focused more on #2 than #1, which is equally important but more complex, but correcting their emphasis is hardly the most important mission we face.
Deficit Reduction baloney
By Thomas Sowell
Another deficit reduction commission has now made its recommendations. My own recommendation for dealing with deficits would include stopping the appointment of deficit reduction commissions.
It is not the amount of money that these commissions cost that is the issue. It is the escape hatch that they provide for big-spending politicians. Do you go ahead and spend the rent money and the food money-- and then ask somebody else to tell you how to escape the consequences?
If President Obama or the Congress were serious about keeping the deficit down, they could have had this commission's recommendations before they spent hundreds of billions of dollars, handing out goodies hither and yon to their pet constituencies.
I don't know why people agree to serve on these bipartisan commissions, which save the political hides of the big spenders after they have run up huge deficits. Back in the 1950s, there was a saying: "If you didn't invite me to the take-off, don't invite me to the crash landing."
Deficit commissions make it politically possible to spend money first and get somebody else to recommend raising taxes later. They are a virtual guarantee of never-ending increases in both spending and taxes.
Why provide political cover? Leave the big spenders out there naked in front of the voters! Either the elected officials will change their ways or the voters can change the officials they elect.
There is no special information or wisdom available to unelected deficit commissions that is not available to elected officials. Nor are they more far-seeing than politicians.
The biggest immediate tax issue is whether the Bush tax cuts will be extended for everyone. Here, as elsewhere in politics, sheer hogwash reigns supreme.
The first big cut in income taxes came in the 1920s, at the urging of Secretary of the Treasury Andrew Mellon. He argued that a reduction of the tax rates would increase the tax revenues. What actually happened?
In 1920, when the top tax rate was 73 percent, for people making over $100,000 a year, the federal government collected just over $700 million in income taxes-- and 30 percent of that was paid by people making over $100,000. After a series of tax cuts brought the top rate down to 24 percent, the federal government collected more than a billion dollars in income tax revenue-- and people making over $100,000 a year now paid 65 percent of the taxes.
How could that be? The answer is simple: People behave differently when tax rates are high as compared to when they are low. With low tax rates, they take their money out of tax shelters and put it to work in the economy, benefitting themselves, the economy and government, which collects more money in taxes because incomes rise.
High tax rates which very few people are actually paying, because of tax shelters, do not bring in as much revenue as lower tax rates that people are paying. It was much the same story after tax cuts during the Kennedy administration, the Reagan administration and the Bush Administration.
An old fallacy pops up again
Economist DON BOUDREAUX has been writing to the New York Times again:
Complaining about America’s trade deficit, Robert Lighthizer claims that foreign investments in the U.S. necessarily “will leave our children dependent on foreign decision makers” (“Throwing Free Trade Overboard,” Nov. 13). What jingoistic jabber!
When, for example, Ikea builds a store in Milwaukee, America’s trade deficit rises. But this investment in America by foreigners doesn’t make our children more “dependent on foreign decision makers.” Ikea cannot force Americans to shop or to work at Ikea; it must compete against other retailers and employers. Ikea has the same power over Americans and over “our children” as does Levitz and La-Z-Boy – which is to say, zilch.
In addition, Americans who supply the land and labor Ikea employs to build this store can use their proceeds to start their own firms or to invest in existing American businesses. To the extent that they do so, not only are both America’s trade deficit and capital stock thereby increased, but whatever decision-making ‘power’ Ikea gains in the U.S. by opening a store here is offset by the additional decision-making ‘power’ and prosperity Americans gain because Ikea’s operations in the U.S. enabled these Americans to make investments that would otherwise have not been undertaken.
Rangel: Guilty: "Rep. Charles B. Rangel (D-N.Y.) was found guilty Tuesday of breaking 11 separate congressional rules related to his personal finances and fundraising efforts for a New York college. The eight-lawmaker subcommittee that handled the trial — which reached a unanimous verdict on 10 of the counts — now sends the case to the full ethics committee for the equivalent of sentencing.”
The (real) Party of No : "Liberal pundits called Republicans the ‘party of no’ for their opposition to Obamacare, Cap and Trade, etc. I think it’s good to say ‘no’ to bad ideas. Congressman Ron Paul has been right to make a career of that. I wish Republicans supported him years ago. Now that Obama’s fiscal commission has come up with some reasonably good ideas, Ross Douthat points out that the Dems have become the ‘Party of No,’ even to the point of defending corporate welfare …”
GOP senator deals setback to nuclear treaty: "An agreement between the United States and Russia to slash their nuclear arsenals was in danger of collapse Tuesday after an influential Republican senator said it should not be voted on this year. With a terse statement, Sen. Jon Kyl, R-Ariz., dealt a major setback to President Barack Obama’s efforts to improve ties with Russia and to his broader strategy for reducing nuclear arms worldwide.”
High speed rail that isn't: "On Oct. 28, the Department of Transportation gave out $2.4 billion in grants to high-speed rail projects. This is on top of the $8 billion that was included in the American Recovery and Reinvestment Act, commonly known as the "stimulus" package. If you think this money will usher in a new era of European-style trains, think again. Most of these projects are simply for slight upgrades to the network... in all of their cheerleading, high-speed passenger rail proponents never mention what is perhaps the most damning fact about these projects. Most are not even considered high-speed by international standards."
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