Beyond Those Health Care Numbers

New York Times: Beyond Those Health Care Numbers

WITH the health care system at the center of the political debate, a lot of scary claims are being thrown around. The dangerous ones are not those that are false; watchdogs in the news media are quick to debunk them. Rather, the dangerous ones are those that are true but don’t mean what people think they mean.

Here are three of the true but misleading statements about health care that politicians and pundits love to use to frighten the public:

STATEMENT 1 The United States has lower life expectancy and higher infant mortality than Canada, which has national health insurance. ...

STATEMENT 2 Some 47 million Americans do not have health insurance.

"...the 47 million includes about 10 million residents who are not American citizens. Many are illegal immigrants."

The number also fails to take full account of Medicaid, the government’s health program for the poor. For instance, it counts millions of the poor who are eligible for Medicaid but have not yet applied. These individuals, who are healthier, on average, than those who are enrolled, could always apply if they ever needed significant medical care. They are uninsured in name only.

The 47 million also includes many who could buy insurance but haven’t. The Census Bureau reports that 18 million of the uninsured have annual household income of more than $50,000, which puts them in the top half of the income distribution. About a quarter of the uninsured have been offered employer-provided insurance but declined coverage.

Of course, millions of Americans have trouble getting health insurance. But they number far less than 47 million, and they make up only a few percent of the population of 300 million.

Any reform should carefully focus on this group to avoid disrupting the vast majority for whom the system is working. ...

STATEMENT 3 Health costs are eating up an ever increasing share of American incomes.

In 1950, about 5 percent of United States national income was spent on health care, including both private and public health spending. Today the share is about 16 percent. Many pundits regard the increasing cost as evidence that the system is too expensive.

But increasing expenditures could just as well be a symptom of success. The reason that we spend more than our grandparents did is not waste, fraud and abuse, but advances in medical technology and growth in incomes. Science has consistently found new ways to extend and improve our lives. Wonderful as they are, they do not come cheap.

Comments

[Brother Maynard]

I don't think it works to diminish the size of the problem and then assume they skew the statistics enough to have national effect. i.e., exclude a bunch of the 47 Million to reduce the number, then suggest that the remainder skews the stats enough that they affect the national mortality/expectancy rates enough to make them fall short of Canada's.

Similarly, if the increased costs of US health care were evidence of success, their impact on the 250 Million for whom it "works" should result in an a much better mortality rate than Canada's where costs are much lower.

I wouldn't say the Canadian health care system isn't broken, but I would still take it over the American one.

Having said that, the basic premise of citing a single statistic and matching it with another to claim a causal relationship is farcically oversimplistic... the NYT should know better.

[Bob Robinson]

Brother Maynard,
The NYTimes didn't write that editorial. It was written by N. Gregory Mankiw, a professor of economics at Harvard. He was a former chairman of President George W. Bush’s Council of Economic Advisers, and is advising Mitt Romney in his presidential campaign. While Mankiw is a respected economist, he definitely has a Republican slant on these issues!

[samlcarr]

Agreed on the statistics. But, healthcare on the whole I think needs to be looked at as something other than as just one more industry. Nationalised options are inefficient in other ways, so that's not entirely the solution.

Arguing that increased sophistication requires private enterprise seems to me to beg the question. Most of the research that produces the new technology actually comes out of the teaching hospitals and most of their grant funding does come from the government.

Furthermore, there should be a distinction drawn between what s essential and what is not. The two should not be treated on par businesswise.

[Michael W. Kruse]

Bob's right that this an op-ed piece, so don't blame the NYT. They have enough issues. :) While Mankiw clearly has a perspective, he does give factual data and I find most of it compelling and consistent with government data.

Those who what government funded healthcare are claiming there are 47 million Americans "without" healthcare. The implication of the "without" is repeatedly cast as "without" because of unaffordability or exclusion.

Mankiw points out that the number of Americans without healthcare is more like 37 million (10 million aliens subtracted). Many of these other 37 million are people who could afford to pay for it and have opted not to, or they are eligible for government programs but have chosen not to sign up. Other studies I've read give similar numbers and one report based on Census data suggests there are probably less than 8 million Americans for whom access to healthcare is a problem.

Bottom line, I think chronic lack of access to healthcare is exaggerated.

[Michael W. Kruse]

“Furthermore, there should be a distinction drawn between what s essential and what is not. The two should not be treated on par businesswise.”

Sam, I’m thinking that the division may need to be between preventative and basic healthcare versus catastrophic healthcare. I think creating competition for preventative and basic healthcare services would both improve services and reduce costs. The government could further encourage such care by making healthcare expenditures deductible from folk’s gross income tax base. Then people could shop for catastrophic healthcare insurance with some basic catastrophic coverage made available to the poor. I think some split along these lines would begin to sort out a lot of things.

[Light]

There is a big difference between not having health insurance and not having health care. There is also a lot that goes on that simply doesn't compute in the collected stats. For instance, my family uses natural and alternative methods to keep us healthy, NONE of which is covered by health insurance. So I guess you could then say we don't have "health care."

Here's another interesting number for you - as our spending on food (as a percentage of household income) has gone down in the past generation, our health care costs have gone up. The government subsidies that give us cheap corn and soy (much of it genetically modified) result in much poorer quality food and thus skyrocketing rates of chronic disease. I firmly believe that healthcare needs to start with what we put in our mouths, and it's not processed, fortified, or pasturized foods. Nor is it a pill for every ailment. True health begins with REAL food - raw milk, chemical-free produce, chicken (and eggs) who really do roam around outside and eat grass and bugs, grass fed beef, etc. - the way God intended it. Unfortunately, this food is unaffordable (because it's not subsidized) to the ones who need it most, the poor,and it's also generally not accesible by those in poorer neighborhoods. Burdensome regulations designed for industrial agriculture squeeze out the small producers. In most places in the US today, despite its healing properties and despite it being practiced for centuries, it's illegal for a farmer to sell you milk straight from the cow.

Until the powers that be stop letting Big Pharma and Big Ag make all the rules, the most healthful choices for Americans will be muscled out to make way for profits made without integrity.

[Michael W. Kruse]

You raise some good points, Light, about the broader context. One complicating problem is that widespread use of lower yield organic methods means would mean substantial increases in the amount land needed for agriculture. That creates other environmental problems. Not minimizing your concerns. Just highlighting that the solutions are often complex.

You point that healthcare is about more than isurance is a good one.

[Light]

One recent study from the Univ of Michigan refutes that perception. "Researchers from the University of Michigan found that in developed countries, yields were almost equal on organic and conventional farms. In developing countries, food production could double or triple using organic methods" - full story is here at http://www.ns.umich.edu/htdocs/releases/story.php?id=5936.

Conventional agriculture also creates significant environmental problems, such as pesticide and nitrogen runoff. Because today's US agriculture has essentially become monoculture, healthy topsoil is vanishing at a frightening rate, and much of the soil is essentially sterile except for the chemicals we pour into it to keep things growing. Mineral content in fruits and vegetables, compared to years past, has shrunk. Another new study shows that organic produce brings with it significantly more nutrition.

I am still learning. Until a year ago, I was oblivous to issues like these. I began to pay attention to this stuff when conventional medicine, with one of the best insurance plans available today paying for a parade of specialists, failed to help us resolve one of my children's chronic health issues. So we went alternative. We began looking to our diet, which led us to look at agricultural practices, factory farming, and on and on and on. My child's story has a happy ending - alternative healthcare healed our son in a matter of 4 weeks after he had been suffering daily for well over a year.

It has been an eye-opening journey, and the most "duh" moment was when we realized that our personal health is inextricably linked to the health of our land and the wholesomeness of our lifestyle.

I agree with you that solutions are indeed complex. In this country, I believe it will take a huge paradigm shift. What we have now is not health care, but sick care. Sickness and disease are extremely profitable. There is no obvious, easy profit in wellness, and it takes a greater investment of time, balance and wisdom - something we Americans are sadly in short supply of. My greatest concern is that our regulatory environment, combined with the power of entrenched interests like Big Pharma and Big Ag, will hinder us from exploring and enacting truly innovative wellness solutions.

[samlcarr]

Since we're also talking about agriculture, seems to me that productivity has not been a problem in the U.S. for a very long time.

The total agricultural yield for major crops is carefully reverse regulated with heavy subsidies not to farm. The situation on the acreage front may change now that ethanol is on the go but I don't foresee that there will be any change as as far as subsidies goes...

At the same time the craze for value addition means that anything natural will be processed and reprocessed till it is unrecognizable before it reaches the consumer and that's a good way to destroy whatever natural goodness was there to start with.