U.S. scores dead last again in healthcare study.
—Reuters, June 23, 2010
While Republicans advocate repeal of President Obama’s sweeping health care reforms, Democrats are pulling out all the stops to build support for the legislation. And the president’s party has a not-so-secret weapon at its disposal: a network of well-funded academics and researchers working to discredit the existing health care system. The Commonwealth Fund, a liberal think tank headed by a former Democratic staffer, leads the effort.
Typical of the Commonwealth Fund is a recent study claiming that the U.S. health care system ranks last when compared with seven industrialized countries. It’s just the latest in a string of policy studies from organizations that want to see a European-style, government-run health care system brought to these shores. Democratic politicians and their allies then use those studies to bolster the case for dramatic reforms.
“Mirror, Mirror on the Wall: How the Performance of the U.S. Health Care System Compares Internationally” was widely reported. National Public Radio warned: “U.S. Spends the Most on Health Care, Yet Gets Least.” The Week asked if American health care was “Worst in the World?” The Los Angeles Times decided to entice readers with, “U.S. is No. 1 in a key area of healthcare. Guess which one.” Answer: spending.
In all this coverage, did anyone in the mainstream media raise serious questions about the study’s assumptions or methodology? Or delve into the organization behind it?
No, and no. Of course, it’s not as if these groups actually hide their leanings. Karen Davis, who was an economics professor before becoming president of the Commonwealth Fund, served as deputy assistant secretary for health policy in the Department of Health and Human Services for all four years of the Carter administration. She advocates a Canadian-style single-payer health care system. And under her leadership, the Commonwealth Fund has published a steady stream of studies that tout the joys and efficiencies of government-run health care systems.
Her agenda in the Obamacare debate? In a president’s report, Davis suggested that the Commonwealth Fund had “marshaled its resources this year to produce timely and rigorous work that helped lay the groundwork for the historic Affordable Care Act, signed by President Obama in March 2010.”
To that end, the “Mirror, Mirror” study explains that it is judging the health care systems of seven countries based “on five dimensions of a high-performance health system: quality, access, efficiency, equity, and healthy lives.” Sounds more like an online dating promo. Scratch beneath the surface and consider that last criterion: healthy lives. American health care gets marked down heavily because Americans are more likely to shoot up, drink up and eat up—not good qualities from a medical point of view, but hardly reflective of the work of our doctors and nurses.
Or what about “equity”? Whereas scholarly comparisons use objective data, the Commonwealth Fund study embraces mostly subjective values, with “equity” being the most indefinable. For left-wing groups, an equitable health care system is the highest goal, which is why the left rejoiced when President Obama nominated and shortly thereafter recess-appointed Dr. Donald Berwick to run the Centers for Medicare and Medicaid Services. One of his oft-quoted statements (“Any health care funding plan that is just, equitable, civilized and humane must—must—redistribute wealth from the richer among us to the poorer and the less fortunate”) sounds a lot like the criteria for the Commonwealth Fund study.
But how about cancer survival rates? Or access to the latest technology or the newest medicines? Or where the cutting-edge research and development is occurring? Commonwealth Fund studies don’t ask such questions.
The Commonwealth Fund isn’t the only group regularly pumping out suspect studies. Others include Families USA and the Center on Budget and Policy Priorities. They, too, always seem to find that more government control improves quality while lowering costs, and are praised in the media for it, while getting a pass on their assumptions and methodology.
For example, Families USA promotes the notion that Medicaid funds create a state-level “multiplier effect,” providing more than a dollar’s worth of economic bang for each dollar spent. That’s an important finding since the president’s reforms will see millions—maybe tens of millions of people—join Medicaid, at a time when state budgets are already stretched.
The multiplier effect is often mentioned in Washington—for example, to defend Congress’s stimulus bill, claiming each stimulus dollar would lead to a $1.50 boost in GDP (Americans are still waiting for that multiplier to kick in). But for Medicaid?
In its 2010 iteration of the Medicaid multiplier effect, Families USA writes:
For every dollar a state spends on Medicaid, the federal government contributes a matching amount of money that the state would not otherwise get. . . . This injection of new federal dollars into state economies has a measurable effect on states’ business activity, wages, and jobs. The new dollars pass from one person to another in successive rounds of spending, generating additional business activity, jobs, and wages. Economists call this the “multiplier effect.”
Actually, many economists call it a bunch of hooey. There is a long-running debate over the impact of this Keynesian multiplier effect—or whether it exists at all. But the most glaring omission, the one neither Families USA discusses nor the media question, is whether there is also a “divider effect.” Before the federal government can hand out a dollar, it has to take a dollar from somewhere else—from a taxpayer who would have spent or saved the dollar, suggesting that Medicaid spending may actually be a net drag on the economy.
And then, there are the academics. David Himmelstein, a Harvard physician, may be the most widely quoted. President Obama’s speeches include his statistics on medical bankruptcies. His most recent study—concluding that 62 percent of all bankruptcies in America are due to medical debt—has been widely reported by the media and was even discussed approvingly at a recent hearing by House Judiciary Committee chairman John Conyers: “This surge in medical bankruptcies demonstrates why health care reform is urgently needed right now.”
There’s just one catch: The study isn’t worth the paper it’s written on. Northwestern University professor David Dranove and a coauthor analyzed data from a previous Himmelstein paper on the topic, finding that medical bankruptcies had been overstated by a factor of three to one. In fact, Canada—with its socialized health care system but similar laws—has a higher bankruptcy rate than the United States, calling into question Himmelstein’s basic assumptions.
Himmelstein isn’t exactly hiding his bias. He cofounded Physicians for a National Health Program and has spent decades writing about the benefits of government-run health care. And though he publishes frequently on American health care, his papers and studies are often controversial and similar: They conclude that the U.S. system is cruel.
But is it? No one would question that the American health care system has problems, but is it really that bad? Drop the ideological prism of the Commonwealth Fund and its allies, and ask a simple question: How good is American medicine?
A reasonable way to judge a health care system is to look at outcomes—how people fare after diagnosis or when stricken with illness. Although there is a dearth of such data, cancer offers an opportunity to make an international comparison: The illness is common; every Western country collects good data; and cancer is a research and treatment priority.
How does the United States fare? Excellently, two major studies suggest. First, a working group associated with the European nongovernmental organization Confederation for Relief and Development completed a study comparing five-year cancer survival rates for several malignancies. Combining the efforts of some hundred researchers and drawing data from almost 2 million cancer patients in 31 countries, the study, published in the August 2008 issue of The Lancet Oncology, is groundbreaking.
While France excels in treating women’s and Japan in men’s colorectal cancer, the U.S. clearly leads other nations in overall survival. These international results replicate those that appeared in a broader cancer review of Europe and the United States. For the 16 types of cancer examined in that paper:
♦ American men have a five-year survival rate of 66 percent, compared with only 47 percent for European men. In Europe, only Sweden has an overall survival rate of more than 60 percent.
♦ American women have a 63 percent chance of living at least five years after a cancer diagnosis, compared with 56 percent for European women; only five European countries have an overall survival rate of more than 60 percent.
Looking at specific cancers yields striking results:
♦ For men, the bladder cancer survival rate in the United States is 15 percent higher than the European average.
♦ For American women, the uterine cancer survival rate is 5 percent higher than the European average; for breast cancer, it is 14 percent higher.
♦ The United States has survival rates of 90 percent or higher for five cancers (skin melanoma, breast, prostate, thyroid, and testicular), but there is only one cancer for which the European survival rate reaches 90 percent (testicular).
While cancer isn’t the only important disease, it does serve as a good proxy for the overall performance of a system. And when hard data are compared, the U.S. system shines.
In the recent Commonwealth Fund study, Canadian health care bests the U.S. system. But a quick review of the literature suggests American patients fare better: They are more likely to survive cancer and a heart attack, and they do better after a transplant operation.
And what about Canadians’ universal care and access to free preventative services? In a review of survey data, economists June and David O’Neill find that Americans have greater access to preventive screening tests and higher treatment rates for chronic illnesses. Even more surprising: Canadian poor (covered by the public system) are less healthy relative to the nonpoor than their American counterparts. You’ll see none of these results in the latest offering of the Commonwealth Fund, of course.
American health care is far from perfect. It needs reforms. And, yes, some of the harshest criticisms offered by the Obama White House are true: Costs are rising; quality is uneven; transparency is limited. But a meaningful analysis needs to weigh strengths against weaknesses, not promote a partisan agenda disguised as academic research.
Merrill Matthews is a resident scholar at the Institute for Policy Innovation. David Gratzer, a licensed physician in Canada and the United States, is a senior fellow at the Manhattan Institute.