President Obama is ready to drop over one trillion dollars on a health care reform initiative. Let me be clear. Every human being is entitled to basic health care. Our current health care system is not doing an adequate job of providing basic health care to every American. However, I am not an impulse shopper. I want to know what I am getting for my money. We do not know what we are getting with this health care initiative, because the health care is yet to be determined by a Benefits Advisory Council. Let me clarify what we do know and more importantly what we do not know.
Health insurance is not the same thing as health care. Right now, all anyone is talking about is making sure those 50 million Americans without insurance get health insurance. Great. Now tell me what will be different because those 50 million people have insurance. For every sob story you can tell me about how someone didn’t have insurance and couldn’t get some sort of care they needed I can tell you another sob story about how a government or insurance company bureaucracy prevented someone from getting the care they needed. Anecdotes are not reliable data. What is the metric that we can measure and say we are getting our one trillion dollars worth of benefits?
The June 27, 2009 issue of The Economist ran a cover story about American health care reform. They point their finger at America spending one out of every six dollars on health care. Then they point out that American infant mortality, life expectancy, and survival-rates for heart attacks are worse than other developed countries. My response is “So?” Tell me why these metrics are important and how they will be different after health care reform. What this article fails to mention is that Americans have better survival rates for common cancers, better preventive cancer screening, and better care for chronic disease. Everyone has to die of something. Maybe Americans die from heart attacks because they are surviving the cancers. I don’t know. But neither does the President or the Congress. They are trying to spend one trillion dollars and they don’t even know what the problem is they are trying to fix.
First look at health care spending. The Economist claims Americans spend twice as much as any other “rich” country. What is included in that health care spending number? I can tell you what America includes but I don’t know what the UK, France, Germany, or Costa Rica includes. There is no standard international definition of health care. Every country has its own algorithm for calculating health care spending. Comparing the self-reported figure from one country to the self-reported figure of another country is comparing apples and oranges. Did you know that when foreigners come to America and spend money in our hospitals for health care it gets added into our health care spending statistic and not their home country’s health care statistic? Did you know that American health care spending does not differentiate essential health care from elective health care? Braces for the kids, contact lenses, Viagra, fertility treatments, Botox injections, herbal supplements and weight loss products you buy at the drug store are all included in our spending tabulation. So is our “excess” spending a problem with efficiency or just the perks of prosperity? I don’t know and neither does the President or the Congress.
Now consider infant mortality. We already have extensive programs to provide prenatal care to anyone who needs it. Do we have too many teenage pregnancies? How will health insurance change that? There are already free clinics and Planned Parenthood clinics ready to hand out contraceptives to any teenager that asks for them. Do we have too many mothers who smoke, use drugs or alcohol, or have poor nutrition so that we have more low birth weight infants? Will health insurance make expectant mothers stop smoking, stop using drugs or alcohol, and eat better? Do we have an excess of twins, triplets, or more due to the rampant use of in vitro fertilization thus again creating more low birth weight infants which increases infant mortality? What exactly is driving our infant mortality rate and how will health insurance make a difference? I don’t know and neither does the President or the Congress.
Why is our life expectancy lower? How much lower is it? Do we have more cases of AIDS? Do we have more young people dying due to accidents or violence? Do we have fewer abortions of seriously disabled unborn children so their eventual death after birth drives our life expectancy average down? Is this a meaningful metric? I don’t know and neither does the President or the Congress.
The Economist reports our survival rate for heart attacks is lower, but it doesn’t indicate how our rate of having heart attacks compares with other countries. Because we do better at taking care of chronic illnesses like elevated cholesterol and cardiovascular disease, maybe we are preventing all the little survivable heart attacks and only the massive deadly ones still plague Americans. I don’t know and neither does the President or the Congress.
The point of this is that there are a lot of anecdotes and statistics being thrown around with no thought as to their relevance. Before the Congress spends one trillion dollars on health care, I want them to have a very clear idea of what they are buying, what it will do, and how they will measure its effectiveness Good stewardship demands this. Health care reform should not be rushed because of political expediency.
You can check out more of my writing on health care issues under the American Health Care serial post link on the right sidebar.
UPDATE: please take a look at my response to Peter Singer's argument for health care rationing.