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Jan 8, 2009

US Healthcare is First - Infant Mortality is Low

Critics of U.S. healthcare apply bias to unexamined health statistics.

USA Still #1 (NOT an Olympics Update)
The USA is Actually Number One in Health Care
08/28/07 - InsureBlog by Henry Stern

Another Royal Fisking (Mortality versus Morbidity)
A point by point rebuttal of the low USA health care ranking
08/11/08 - InsureBlog by Henry Stern

The U.S. healthcare system is repeatedly criticized for being expensive, yet delivering care that is inferior to most other countries with socialized, government run systems. This is not true.

The above posts at InsureBlog investigate the misleading statistics and bad thinking behind these claims. The quoted information below is edited and combined from those posts.

[edited] Government-run healthcare is ineffective compared to the ability of the U.S. system to treat cancer. The ranking is U.S. (first), then Canada, France, and Norway. This is despite the World Health Organization calling the French health system "the best in the world".

Most surprisingly, the MVNHS© (Most Vaunted National Health Service of Great Britain) ranked fifth (out of five!), with some of the lowest cancer survival rates in the civilized world. Keep that upper lip stiff, old chaps!

Who says so? The venerable and venerated medical journal the Lancet, as reported at Health Care BS. The Lancet is certainly not biased in favor of private health insurance.

The U.S. survival rate for prostate cancer is 91%; Britain's is 51%.

Infant mortality is often cited as a measure of health care delivery.
[edited] Socialized medicine does not achieve lower infant mortality rates than the U.S. What accounts for the bad statistics?

We count every live birth regardless of the baby's life expectancy. Under socialized systems such as in Canada and Germany (among many others), low birth weight infants under 500 grams (18 ounces), are not counted in the live-birth statistics.

Further, many socialized systems don't count babies who live less than a day. The Swedes don't count babies who are too short. We consider such infants worth saving and count them all, which lowers the statistical number for the survival rate.

Norway has one of the lowest infant mortality rates in the world. The rates for the U.S. are just as good when adjusted for low birth weight.

"Mortality" measures the rate and cause of death. "Morbidity" measures the rate and cause of sickness. Many deaths are not caused by sickness, and populations have different rates and types of illness and consequent deaths. Mortality is a poor way to rate health care systems.
[edited] A new study has been reported in medical blogs: our supposedly broken, run-down, smelly health care system gives us an international rank of 42nd in life expectancy.

[ MSNBC doesn't provide a link to the source or provide a specific citation so that we can check the story for ourselves. ]

Dr. Christopher Murray of the University of Washington is sanctimonious: "Something is wrong when one of the richest countries in the world, the one that spends the most on health care, is not able to keep up with other countries".

How are our health care statistics affected by the entry of often unhealthy immigrants? We would need a lot more information about this and many other factors to tell how much, if anything, the life expectancy numbers have to do with quality of health care.

For example, we learn from the CDC that 75% of more than 40,000 deaths each year, among persons aged 10-24 in the U.S., are related to motor-vehicle crashes (37%), homicide (14%), suicide (12%), and other injuries (drowning, poisoning, and burns - 12%). That is part of our culture, not a measure of our health care system.

Also according to the CDC, heart disease and cancer cause almost half of all deaths in the US. That does not indict the health care system. We spend enormous sums to research and treat these conditions, but because people will not stop smoking and start exercising, there is little that "the system" can do about it.

John Stossel (Why the U.S. Ranks Low on WHO's Health-Care Study) analyzes that life expectancy is a lousy measure of a health-care system. We have far more fatal transportation accidents than other countries. Our homicide rate is 10 times greater than in the U.K., eight times greater than in France, and five times greater than in Canada.

When you adjust for these "fatal injury" rates, U.S. life expectancy is actually higher than in nearly every other industrialized nation. That doesn't show a health-care problem.

Sorting Fact From Fiction on Health CareAnd, we've subtracted another 10 points for it not being government run.

08/31/09 - WSJ Opinion
by Dr. Jerome Groopman and Dr. Pamela Hartzband

People in the U.S. spend more and get better treatment than in other countries. There is no surprise in that fact.

The World Health Organization (The WHO) is sponsored by The United Nations. It compares healthcare statistics for many countries.

The U.S. government and public is debating the need for change in healthcare. Many people oppose private, free-market healthcare and support socialized restrictions and control. They repeat three statistics from The WHO to show that we need this drastic change. They argue that U.S. healthcare is both less effective and more expensive than in other countries, and so it cries out for reorganization to deliver better results while saving money.

These statistics are flawed and are repeated without simple investigation. They do not show poor U.S. healthcare when we look below the surface. Here are the claims, and the major flaw for each:

  • U.S. infant mortality is higher than in Europe.
    The statistics on infant mortality are confused by the U.S. standard of including all live births where there is a single breath. More premature and sick newborns are included, and so more deaths are recorded. Results for comparable births are as good or better in the U.S.
      See the details above and the reports below of delayed and denied childbirth services in Britain.
  • U.S. life expectancy is lower than in European countries with socialized healthcare.
    The statistics on life expectancy are confused by much higher accident and injury rates in the U.S., and by more heart disease. The inclusion of more infant death also pulls down the average lifespan.
      The outcomes for individual disease treatment, as in cancer, are better in the U.S.
  • The U.S spends the most per person compared to other countries, but ranks only 37th in the WHO ranking of overall quality of its healthcare.
    The WHO's definition of overall quality is confused and biased by a social judgment unrelated to the quality of the healthcare delivered.

See above for details about the flawed statistics for life expectancy and infant mortality.

The WHO Quality Rank

The WHO quality rank is probably the worst of the three statistics. The WHO directly includes confusing factors.

Drs. Groopman and Hartzband [edited]:

The WHO ranks U.S. healthcare as 37th in the world in quality. This statistic is surprising and inaccurate.

Consider that The WHO ranks the U.S. as first among all countries in "responsiveness":

  • Respect for persons -- Dignity, confidentiality, and autonomy for individuals and families to make decisions about their own care.
  • Client Orientation -- Prompt attention, access to social support networks during care, quality of basic amenities, and choice of provider.

This is what Americans rightly understand as quality care, and they worry it will be lost in the upheaval of reform.

The U.S. ranks 37th overall primarily because we lack universal coverage, and care is a financial burden for many citizens.

So, all of the details of U.S. healthcare are great, the individual services and results that people value. But, the statistic for "quality" is confused by a social judgment.

U.S. care is better and more expensive. The WHO lowers the U.S. rank for "quality" because of expense and not being provided as a government service. Then, critics cite the lower rank to claim that U.S. healthcare delivers less, despite spending more. This is ironic and fraudulent.

Misleading Ranking Makes for Unhealthy Debate
10/21/09 - WSJ by Carl Bialik

This flawed statistic still pops up:  U.S. health care ranks 37th in the world.

This ranking is particularly misleading. The World Health Organization, the WHO, released it nearly a decade ago, based on even older, incomplete statistics. This ranking judges healthcare systems for cultural, behavioral, and economic problems that aren't controlled by health care.

Philip Musgrove is an economist and is now deputy editor of the journal Health Affairs. WHO hired him as editor-in-chief of the report that accompanied the rankings.

He calls the figures "so many made-up numbers" resulting in a "nonsense ranking." He edited the text but did not fully understand the methodology until after the report was released. He later wrote an article in 2003 for the medical journal Lancet criticizing the rankings as "meaningless."

The underlying health data for each nation generally weren't available. So, WHO researchers looked at more widely available data, such as literacy rates and income inequality.

For example, the researchers related health data to literacy in countries where both numbers were available. Then, they assumed that the same relationship applied to countries where the literacy rate was available, but basic health data was not. They could not be sure that these relationships held true in other countries.

Healthcare in a Wealthy Country

Most of the U.S. population is wealthy enough to buy high quality healthcare, higher than in Europe. They are expressing this private preference mostly by buying expensive health insurance, and by supporting public plans such as Medicare.

Many regulations require health insurance to include services such as accupuncture, chiropracty, hair replacement, and health-club membership. These increase insurance payments without delivering additional, equally valued benefits to most people. Public plans like Medicare are going broke as people request more services that they do not personally pay for. These are problems that should be investigated and solved, I think through less and smarter regulation.

Let's not be confused. The quality of U.S. healthcare as commonly understood is the best in the world, when you consider results for treating disease. That cannot be used as a reason for sweeping healthcare "reform". The best healthcare costs more. That seems about right, and is not an indication of system failure.

The writer Mark Twain said:  "There are three kinds of lies: lies, damned lies, and statistics." Statistics can be selective, biased, and misstated, especially in the debate about healthcare.

Bed shortage forces 4,000 mothers to give birth in lifts, offices, and hospital toilets.
08/26/09 - Daily Mail UK OnLine. (Via Don Surber)

[edited] Surber:   Here is how free, socialist health care works in England. I thought their infant mortality rate was so much better. I mean, they would not lie about something like that. They spend half what the United States spends.

The London Daily Mail:   Almost 4,000 women (up 15%) gave birth outside maternity wards lacking midwives and hospital beds, instead in places like lifts (elevators), toilets, and caravans (mobile homes). Overstretched maternity units shut their doors to an additional 553 women in labor last year.

Tory health spokesman Andrew Lansley:   The Labor Party has cut maternity beds by 2,340 (22%) since 1997. Birth rates have risen 20% in some areas.

Ten-Month Wait For The Maternity Ward
08/25/09 - SteynOnLine by Mark Steyn

Bureaucrats are dispassionate about applying policy.

[edited] Patients Together questions the time pregnant women must wait for their first appointment at Dublin, Ireland maternity hospitals. A woman three months pregnant was told to wait until she was 7 1/2 months.

A young mom talked to the health service shortly before giving birth on the sidewalk outside Leicester's Royal Infirmary. "They said they were not sending an ambulance, and that I had had nine months to sort out a lift."

Grandmother Disgusted by Filthy Hospital - Nursed and Bathed Other Patients
01/30/10 - DailyMail.co.uk - Via Don Surber

[edited] Janet Halsall, 74, stayed three days at Hinchingbrooke Hospital in Huntingdon, Cambridgeshire for a liver scan. Staff repeatedly ignored pleas for help and left patients to ‘fend for themselves’.

She bathed, washed, and tucked in the frail, elderly patients. They were left without water, and the kitchen area was disgusting. One lady repeatedly complained to staff that she was cold. Halsall searched a cupboard for a blanket.

She washed one lady who needed help to clean herself, and took another pensioner to the toilet after staff continually ignored her requests, saying they were ‘too busy’.

Halsall: "Never before have I seen so many people rushing around, working so hard but achieving nothing."

Katherine Murphy is Director of the Patients Association. "Unfortunately, we hear far too many examples of the kinds of things described by Janet Halsall."

The comments by readers add to the story.

Canadian Wait Times For Surgery and Medical Treatments Are at an All-Time High
02/07/10 - 10/15/07 - CBC News (Canada)
Via Advice Goddess


Canadians wait longer than Americans, Germans, and Swedes for cardiac care, although not as long as New Zealanders or the British. Economists estimate the cost of this wait at $1,100 to $5,600 annually per patient."

Tasha Kheiriddin is the Quebec director of the Fraser Institute: Quebec has one of the shorter waits among the provinces. Yet, its 19.4 week wait shows no improvement. Spending more money in this [government run] system has not decreased wait times. In fact there is the opposite result, so we have to look at other solutions. Inefficiencies in the public system are the obstacles.

Canadian's have spent more money to achieve better service by its national health care system. Resources go somewhere. They are not going toward delivery of better service. So, they are going toward government bureaucracy, regulation, and procedure. There is no competition to the government, so the patients and population have no way to pressure the system to do better. No way other than ending the government monopoly on health care delivery in Canada.

1 comment :

JWO said...

On infant mortality you can also add that under socialized systems there is less fertility treatment and so fewer multiple births.
Also different ethnic groups have different rates of multiple births. Interestingly Hispanics in the USA have lower rates of multiple births and lower rates of infant mortality that the overall population despite have less access to healthcare.

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