Monday, June 08, 2009

Me And McCaughey

Traveling is hazardous to your health because polite guest manners sometimes require that you sit silently while watching Fox News (instead of hammering the television screen to smithereens as all ethical people would do). That happened to me last Saturday evening. I was stuck listening to Betsy McCaughey frightening us to death by implying that WE ARE ALL GONNA DIE if Obama changes the U.S. health care system at all.

My blood pressure rose enough to cause bright red steam to come out of my eyes and nostrils, true, so perhaps McCaughey has a point. Her other points are biased ones, though. Here's an example:

Gigot: The Obama administration is making a kind of a core argument on health-care reform. It's saying if we insure more people, bring more people under government subsidies, we can save money. Save money--is that possible?

McCaughey:: No, it is very important that everyone has coverage. But it will not save money. Once people are insured, according to the nonpartisan Congressional Budget Office, they will use about 70% more health services than they currently do. The most problematic area of this effort is this: The president wants to slow the flow of dollars into the health-care system.

Gigot: Right.

McCaughey: That's going to force cuts in hospital budgets, fewer nurses on the floor, less diagnostic equipment available, and waits for treatment.

Note Gigot's first misleading summary. Nobody argues that giving more people health insurance would reduce the costs of health care, rather the opposite. But that's what Gigot says. Once you erect a strawperson it's easy to light it with a match and that's what McCaughey does.

In fact, the Obama plan I have read (which may be changing, of course) aims to cut costs by preventive care, by better use of technology and - most importantly - by increasing competition through a public insurance alternative. These proposals may not work, true, but to confound them with the increases in access is just unethical.

Then McCaughey goes on to argue that Cuts Must Be Made And They Will Cause Your Death, without giving any evidence on that. In any case, nurses are already scarce in quite a few hospitals and waiting times for treatment can be long even in a merry capitalist market. Besides, I thought that cutting the fat is what corporations always love doing? Why is it suddenly the case that there is no fat? Note also all those uninsured people who are already kept waiting and waiting and waiting for basic health care services.

Another example of McCaughey's remarkable method of presenting evidence in a biased way is this:

Gigot: But if you talk to the Obama administration people, they say, Look, we spend 18%, almost one out of every five dollars of this whole economy, on health care. And they say, That's too much, because the costs are rising. We've got to get this under control.

McCaughey: Well, actually--

Gigot: Are you saying that's not the right direction for policy?

McCaughey: No. Americans spend more on health care than Europeans, for example, because they earn more. Ninety percent of the difference in spending is due to higher per capita incomes in the United States. And we spend more, but we also get more. For example, American women have mammograms more frequently. Their breast cancer is detected sooner and treated faster, and they have much better survival rates than in most parts of Europe.

This is fun! McCaughey got that ninety percent figure from Uwe Reinhardt's 2001 article, I think, but she doesn't explain it correctly. It's true that health care spending is correlated with income. After all, richer countries can afford to spend more. But this doesn't mean quite what McCaughey implies. Here's a more recent graph from Reinhardt:

What does it mean? This:

You'll notice that there is enormous variation in health spending per capita in different countries within the O.E.C.D. But the graph also indicates that there exists a very strong relationship between the G.D.P. per capita of these countries (roughly a measure of ability to pay) and per-capita health spending. The dark line in the graph is a so-called regression equation (whose precise mathematical form is shown in the upper left corner).

That line tells us something important about the relationship between a country's wealth and its health care spending.

Just knowing the G.D.P. per capita of nations helps us explain about 86 percent of the variation in how much different countries pay for health care for the average person. Canada, for example, on average spent only PPP$3,678 on health care per person in 2006, which is about 55 percent of the amount the United States paid per person. But Canada's G.D.P. per capita in 2006 was also smaller than the comparable United States figure, although not that much smaller (it was 84 percent of the American level).

The line helps us estimate that roughly $1,141 of the $3,036 difference between Canadian and American health spending per capita – or 38 percent — can be explained by the underlying difference in G.D.P. per capita alone.

An additional insight from the graph, however, is that even after adjustment for differences in G.D.P. per capita, the United States in 2006 spent $1,895 more on health care than would have been predicted after such an adjustment. If G.D.P. per capita were the only factor driving the difference between United States health spending and that of other nations, the United States would be expected to have spent an average of only $4,819 per capita on health care rather than the $6,714 it actually spent.

I love this stuff, I do. What about her second point that Americans get more from their health care system than Europeans do? Some do, of course, and medical research in this country is excellent. But over forty million people have no health coverage, and the U.S. doesn't do as well in all conditions as it does for breast cancer.* Then there's that little matter of lower life expectancies in the U.S. than in the comparison countries, though of course the reasons are complicated and not only about the health care systems.

You can read through the rest of the McCaughey interview and find lots of other similar points, including the blind assumption that all technology in health care is good and useful and saves lives, however it is used and even if it only helps with diagnosis but not with the consequent treatment. Then you can have red steam coming out of your eyes, too.
*I think some of the breast cancer success story has to do with the very active publicity campaigns and political work carried out by volunteers in that field in the U.S.. Note also that a recent study compared the U.S. with several other countries in terms of disease management for a wide range of diseases. This study (which I can't find to link to right now) found that the U.S. did well in some fields, especially in breast cancer, and not so well in some other fields.