If you're trying to follow the health care debate, you know there are some "truths" which have been repeated so frequently, and with such vehemence, that they have become gospel. How often have you heard "the costs are skyrocketing" or "our system is broken" or "Americans overwhelmingly support reform"? Here's a heads-up: Some of these are simply baloney.
For instance, those pushing reform have described our healthcare system as "broken," thus in desperate need of overhaul. The primary evidence for this claim is a report issued by the World Health Organization in 2000 which ranked the U.S. 37th in overall "health performance" despite being number one in spending. (It is noteworthy that the WHO no longer publishes such a ranking -- deeming the process "too difficult.") Betsy McCaughey, in a recent talk before the Manhattan Institute, noted that the rankings were heavily weighted towards social goals, and less towards the effectiveness of medical care. In other words, the WHO studied the distribution of medical attention, and the fairness in financial contribution, placing as much weight on such issues as on actual performance.
Further, according to Princeton professors Uwe Reinhardt and Tsung-mei Chung, the rankings "are not based on the actual values achieved by the nation, but on the ratio of the achieved values to the values that ought to have been achieved, given the country's educational attainment and spending." They point out that the rankings, in effect, were determined by the opinions of those surveyed. In short, this is hardly a scientific assessment.
Even against this bias, the U.S. ranked number one in "responsiveness" -- that is in actually delivering care, but got hammered on "fairness of financial contribution." The country that scored highest on that metric -- Colombia -- ranked 82nd on responsiveness. Would you rather be treated in Colombia or in the U.S.?
The WHO publishes reams of data that may more accurately describe the medical care a country receives. For instance, life expectancy is a decent proxy for the overall level of health and healthcare in a country. The life expectancy of those born in the U.S. was 78 years in 2007, up from 77 in 2000 and 75 in 1990. This figure is not at the top of the heap -- Japan's sushi-eaters can hope to live to 83, for instance, while a number of Western countries (Iceland, Italy and Australia among others) are at 82, but it is certainly respectable and better than most. The Russian Federation, for instance, has a life expectancy of only 66 years. Another gauge of a country's medical support is infant mortality. In the U.S., the WHO says, 4 out of every 1,000 births ends in death; only a handful of countries report a lower figure. Statistics show that 99% of births in the US are attended by "skilled health personnel" -- a figure only surpassed by Turkmenistan, Uzbekistan and Tuvalu, among others. (Do we detect the challenges confronted by the WHO's data collectors?)
Myth number two about our healthcare system is that the growth in spending on healthcare has accelerated in recent years. In fact, in 2007 -- the most recent year for which we have data -- health care spending decelerated, to 6.1% from 6.7% in 2006. More interesting is that the rate of growth has dropped every year since 2002, and that the average increase so far this decade -- 7.4%, though modestly ahead of the growth rate in the 1990s, trails far behind the 11.3% increase rate of the 1980s and 12.7% of the 1970s. Health care spending may be growing too rapidly, but it is not accelerating.
Myth number three about health care spending is that the increases in outlays portray a system "out of control" and bloated by greed and inefficiency. In fact, some argue that the growth in the sector stems directly from the aging of the population and advances in medical technologies. Knee replacements are expensive, but they are also now commonplace. Lipitor and other statin drugs cost a great deal, but they also prolong life and can eliminate heart disease. (The unfortunate reality is that prolonging life costs money, too.)
According to the Kaiser Family Foundation, from 1997 to 2007 the number of prescriptions purchased in the US rose 72%, while the population grew just 11%. Over half of Americans take one prescription drug on a regular basis; one in five takes four or more. Overall, prescription drugs account for only 10% of the healthcare dollar, but this category has grown faster than overall spending. The reality is that Americans choose to spend money on the best treatments available.
Our fourth healthcare myth is that Americans overwhelmingly want to see the system changed. It just ain't so. A Gallup poll conducted late last year showed that 49% of respondents wanted to maintain the current system, while 41% wanted it to change. In a more recent Rasmussen poll, only 50% of all voters are in favor of the president's reform plan. A mere 12% of respondents think their healthcare coverage will improve under the proposed overhaul, while 37% expect their coverage to be worse. The remaining 37% do not expect to see any change. In other words, 74% of Americans do not see healthcare reform improving their own situation.
The fifth myth is that Americans are deeply concerned about extending health insurance to those not covered. In fact, a recent Kaiser Foundation poll found that 54% of Americans are not willing to pay more -- either in higher health insurance premiums or higher taxes -- to increase the number of Americans that have coverage. As a country, we are concerned about the rise in healthcare expenditures, and are heartbroken when we hear of people who have been denied medical treatment, but we do not want to pick up the tab for them.
The United States does have to confront the reality that some people in this country are crushed by medical costs, and some receive inadequate treatment. But the debate over how to remedy these problems should be framed by facts, not myths.
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