Here is the second post in my series debunking healthcare myths. I’ve put it below the fold because it’s really long. I’ll also, at some point, put up some addenda my dad came up with to the first post.
The Myth: Despite huge spending, the performance of the US Healthcare system is far worse than comparable nations.
Bad Policy Based On The Myth: Everything. Our supposed lack of performance is used to justify making our system like everyone else’s.
The Reality: I’m not going to sit around and say that the performance of our healthcare system is perfect. But the standard metrics severely understate its performance. There are two general measures people use to argue that our healthcare system stinks.
In all the comparisons below, I’m going to making a G7 analysis — comparing our country to a peer group consisting of Canada, France, Germany, Italy, Japan and the UK. That’s not exactly fair to us, as our population is larger than any three of those nations combined, our borders larger than all but Canada and our population as diverse as if you put all six nations in a blender, plus added a few African and Asian ones.
But it’s all we’ve got. I’m using this comparison because I don’t think it’s really constructive to compare a vast nation of 300 million people to, say, the 30,000 rich people living in Monaco. It also wouldn’t be fair to compare us to Russia or China because, while they match us in size and diversity, they’re way behind in development and wealth.
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Traditionally, there are two measure of healthcare quality — lifespan and infant mortality. They’re useful and liked because they are relatively easy to measure and compare. The surest sign of civilization’s march has been people living longer and babies surviving. Moreover, they’re good general population indicators. Rich people don’t live to be 300 or have 70 healthy babies, so they won’t skew the statistics.
The argument that the US’s healthcare system lags is based largely on these two measures. But they both have problems.
Life Expectancy: Wikipedia lists the values from theCIA factbook. The US comes in 30th in the world. Bad, right? Well, not really. There are a number of tiny rich countries in that mix. Let’s look at our peer nations:
Japan: 82.1
France: 80.6
Canada: 80.3
Italy: 79.9
Germany: 79.0
UK: 78.7
USA: 78.1
Japan it the outlier here. Given that racial genetics may play a role in life expectancy (five of the top six regions or nations are in East Asia), that may not be informative. Europe has a typical lifespan of 80. We’re two years behind.
Now that sounds bad. But consider this:
Homicide rate (per 100,000):
USA: 5.7
UK: 2.0
Canada: 1.9
France: 1.6
Italy: 1.2
Japan: 1.1
Germany: 1.0
The US has 3-6 times the homicide rate of our peer nations. That’s not the fault of the healthcare system. In fact, I would argue that our healthcare system is holding that down significantly. Our nation’s trauma providers are exquisitely trained and highly skilled (and don’t require insurance).
Now homicides will only cut a tiny sliver off the average lifespan because, even in America, the rate is pretty low. But consider that the homicide rate comes with lots of related but survivable gunshot wounds, stabbings and beatings that can give someone a lifetime of bad health. That’s not to mention the stress of living in high-crime areas. Murder per se doesn’t lower our lifespan, but as a proxy for crime and violence, it’s very telling.
There’s also OECD data on motor vehicle deaths:
USA: 15.5
France: 13.7
Italy: 12.9
Germany: 9.8
Canada: 9.6
Italy: 8.8
They didn’t have data on the UK. Again, the US leads the pack. And again, our trauma system is almost certainly keeping that rate way down. And again, those deaths come with many more life-shortening injuries and are a proxy for an accident-prone culture.
Then there’s the AIDS rate, from the CIA:
USA: 0.6
Italy: 0.5
France: 0.4
Canada: 0.3
UK: 0.2
Germany: 0.1
That also comes with related potentially life-shortening baggage — AIDS rates track the rates of other STDs as well as generalized risky behavior.
But all of the above is just nibbling at the edges. Here are the big factors.
Drug use. I can’t copy the data but follow the link. The US has high rates of alcohol, tobacco, marijuana and cocaine use. According to the study — and I admit the figures look a bit hysterical to me — Americans are eight times as likely to have used cocaine as Europeans, twice as likely to have smoked pot, more likely to have smoked tobacco and just as likely to drink. Again, those numbers look suspiciously high to me. But, although drug abuse is rising in Europe, it is clearly not close to what it is in the US.
Could the drunk, the high and the coked out be dragging down our lifespans? Could they be putting a huge burden on the system? You’d have to be a fool or a Democrat to answer anything other than “yes” and “yes”.
But again, this is just jabbing at the myth that our nation’s lifespan indicts out healthcare system. Time for the knockout blow — the OECD’s data on obesity rates (percentage):
USA: 30.6
UK: 23.0
Canada: 14.3
Germany: 12.9
France: 9.4
Italy: 8.5
Japan: 3.2
This, as far as I’m concerned, should make everyone take a step back from the lifespan numbers. We live four years shorter than Japanese people — and we’re ten times as likely to be obese — not overweight, obese. We live two fewer years than our European and Canadian peers — with obesity rates that are 1.5-3 times as high.
And really, that’s what it comes down to. We are a nation filled with fat, accident-prone, gun-toting, drug-abusing, alcohol-swilling couch potatoes. The only nation in our peer group that comes anywhere close to us in self-destruction is the UK. Their wonderful socialized medical care system has bought them a whole seven extra months of life — and at the expense of increasing attempts by the UK government to control people’s lifestyles.
Woo-hoo.
Infant Mortality Rate: Again, we go with the CIA factbook, per thousand births. The US ranks in the 40’s, which sounds really bad until you again look at the hard numbers:
USA: 6.3
Italy: 5.6
Canada: 5.1
UK: 4.9
Germany: 4.1
France: 3.4
Japan: 2.8
Michael Moore’s beloved Cuba comes in at 5.9. Given the condition of Cuba’s hospitals, if you believe that number coming out a communist country, I have a credit default swap to sell you. The Soviets, to keep their infant mortality numbers down, just wouldn’t report a death if it happened within a week of birth. I wouldn’t be surprised if the same is going on with Cuba.
Now, the US is last in our peer group and any infant mortality is too high. But the people running around saying we have third world infant mortality rates have no idea what they’re babbling about. The current worldwide infant mortality rate is 42.6. There are a dozen nations where it’s near 100. Get a God-damned grip.
Of course, there’s a problem with the numbers listed above. They may be wrong because different nations track infant mortality differently — possibly different enough to make a difference on the two per thousand level. The US uses one of the most aggressive and thorough measures of infant mortality in the world. Thanks to laws like the Born Alive Infant Protection Act, we consider any baby who so much as draws a single breath as a live birth. And we often go to heroic, expensive and ultimately futile efforts to save them. We could lower our rate significantly by just giving up and counting them as stillborn, if lowering our mortality rate is what matters to you.
Aside, from that, there’s the US’s teen pregnancy rate, which tops our peer nations according to UNICEF. I can’t find any data on it, but I suspect our high rate of fertility treatments may also bump up our rates.
There’s also this: the fertility rate per woman and birth rate per 1000 people, from the CIA:
USA: 2.1/14.2
France: 1.9/12.7
UK: 1.7/10.7
Canada: 1.6/10.3
Germany: 1.4/8.2
Italy: 1.3/8.4
Japan: 1.2/7.9
It’s awfully easy to keep down infant mortality rates when no one is having any kids. The Japanese are having half as many kids as we are. Is it any wonder they have more resources to devote to them? (Note this is not an argument for low birth rates as every country listed, except the US, is below replacement level.)
That’s not even including all the stuff I mentioned in the lifespan section. Substance abuse and violence are going to raise the infant mortality rate. Obesity indicates bad lifestyles — do you think a nation of fat people are good at taking their pre-natal vitamins and getting plenty of folic acid? I didn’t think so.
It is highly likely that our slightly higher infant mortality rate is again reflective of our lifestyle and not our healthcare system. Considering that the glorious UK issued a scathing report on their maternity wards, I wouldn’t be holding them up as a way to keep babies from dying.
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So if infant mortality and lifespan are poor measure of healthcare quality, what should we use?
Well, I spent some time at Moorewatch bashing the WHO’s healthcare report, but I do think there’s something useful in there. In particular, their measure of healthcare responsiveness.
According to the WHO, this metric surveys how well the healthcare system responds to crisis. It seems like a far more reasonable way to ask the question we want answered — considering the circumstances, how well is the healthcare system doing?
I’ll be using the same data Michael Moore used in his infantile movie. It’s a couple of years old but (1) I suspect little has changed; (2) the WHO indicated they were going to change their methodology, probably to cover up what I’m about to show you; and (3) I really really don’t want to spend another week interpreting and transcribing another damned WHO report.
This is not some random source I’ve pulled out of my backside. This is the document that many liberals have used to argue for socialized medicine. If the WHO has any bias, it is against the US system. Their overall ranking of healthcare systems (in which we famously rank 16th, not 37th) has 62.5% of its weight in measures of “distribution”. In short, the WHO ranks us low because our system is not socialized.
So if anyone was going to say this place stinks, it’s the WHO, right? So what do they have to say? How does the US rank in responsiveness? How well does the WHO say we deal with health care problems?
We’re #1. And it’s not even close. The WHO gives the following responsiveness numbers for our peer nations:
USA: 8.1
Germany: 7.1
Japan: 7.0
Canada: 7.0
France: 6.8
Italy: 6.7
UK: 6.5
We’re way ahead. The #2 nation on the list is Switzerland. They’re at 7.4. The difference between the US and Switzerland is as yawning a chasm as the difference between Switzerland and Finland (ranked #19). Moore’s Cuba, by the way, ranks a cozy 115th.
I’ve put up a figure up at Right-Thinking that shows the trend line of responsiveness against healthcare costs from the WHO’s data. What you’ll see is very interesting — a rapid rise in healthcare responsiveness at low levels of spending and then a leveling off at about $500 per capita to a straight line that represents the developed world. The more each country spends, the better its healthcare responsiveness. The US lies right along that line, but way further along it that anyone else.
This is drifting a little bit, but you will see, from that graph, why the arguments for healthcare reform are a little problematic. The Church of Universal Healthcare is arguing that we can move our data point down in cost without sacrificing any quality (and even improving it), thus making us a huge outlier on the cost-responsiveness trend line.
Good luck with that.
Now, again, I’m not saying our healthcare system is perfect. While it’s responsive and can provide excellent care, there are many who find themselves getting poor care. I think we could be an outlier on the trendline with some changes. However, it’s worth noting that those getting the worst care are almost certainly Medicaid and Medicare patients.
That’s not an argument for socialized medicine.