By
Frank, August 26, 2009
Obamacare critic Betsy McCaughey, the former lieutenant governor of New York, has pointed out that if you deduct the relatively high rate of death by violence and accident in the US, Americans have the highest life expectancy in the world. McCaughey appeared on the comedy fake news show The Daily Show prompting the Wall Street Journal Health Blog to ask:
If you ignore relatively high U.S. rates of violence, traffic accidents and the like, does the U.S. have the world’s highest life expectancy?
…
If true, it would undermine a compelling rationale for health-care reform: The U.S. spends by far the most on health care of any country in the world, yet its average life expectancy ranks below many other countries, according to data compiled by the Organization for Economic Cooperation and Development.
The argument appears to be based on a 2006 report written by the economists Robert L. Ohsfeldt and John E. Schneider and published by the American Enterprise Institute, a conservative think tank. The report, which analyzes the OECD’s life-expectancy data from 1980-1999, uses a statistical model called a regression in an attempt to adjust for the effects of traffic accidents, suicides, homicides and falls from the OECD’s rankings. The report finds that “adjusted” U.S. life-expectancy rises to first, from an unadjusted ranking of 19th of 29 countries.
The blog goes on to explain that it isn’t as simple as making the claim. The authors of the study themselves cite some apprehension, saying that the study takes into account GDP, and …
GDP? Well, including strange things in these studies is a time-honored practice among statisticians, the most prolific of liars.
Analysts have long decried this practice. The most cited statistic, from the United Nation’s own World Health Organization, is influenced by the things they include. As Cato.org noted:
WHO rankings result from an index of five health-related statistics: health level, health distribution, responsiveness, responsiveness distribution and financial fairness. Only health level and responsiveness, Whitman writes, are justifiable measures of a health system. The remaining rankings, he argues, fail to take into account differences in health outcomes not explained by spending or literacy, and instead attribute them to health care performance, creating a fertile ground for demagoguery and selective citation.
During earlier pushes to nationalize health care, Cato.org noted other irregularities in the way the statistics are gathered by WHO:
Health statistics for each country were collected from individual agencies and ministries, assuring wide disparities in definition, reporting technique and collection methodology. Indeed, the report concedes that “in all cases, there are multiple and often conflicting sources of information,” if sources at all. For the many nations that simply do not maintain health statistics, the WHO “developed [data] through a variety of techniques.” Without consistent and accurate data from within a single country, how can meaningful comparison be made among 191 different countries?
Second, the report places undue weight on statistical devices like disability-adjusted life expectancies (DALEs), which measure how long a person can expect to live in good health. The problem is, all the resources a country spends helping disabled people live longer and more comfortably do nothing to help its DALE score, so countries aiming for a good WHO ranking have no reason to spend more helping the disabled. DALEs assume that disabled people’s lives have less value than those of people without disabilities, and they make similar discounts on the lives of the elderly. Should the United States stop spending money on its disabled? On its seniors? The WHO’s criteria would give granny the boot.
Finally, on the basis of those flawed statistical measures, the WHO unleashes an emotional assault on free markets, saying that governments must hold the “ultimate responsibility” in “defining the vision and direction of health policy, exerting influence through regulation and advocacy, and collecting and using information.” WHO dismisses markets as “the worst possible way to determine who gets which health services,” arguing that “fairness” requires the highest possible degree of separation between who pays for health care and who uses it.
Analysts who study individual nationalized health care systems find problems much worse than the American system, but the statistical games played by the longevity studies masks those problems. Democrats, who embarked on a “world apology tour” this winter to assure the world we know just how badly we have done living up to our own standards, evidently believe that an American nationalized health care system can avoid the pitfalls all other systems have encountered:
Wherever national health insurance has been tried, rationing by waiting is pervasive, putting patients at risk and keeping them in pain. Single-payer systems tend to leave rationing choices up to local bureaucracies that, for example, fill hospital beds with chronic patients, while acute patients wait for care. Access to health care in single-payer systems is far from equitable; in fact, it often correlates with income—with rich and well-connected citizens jumping the queue for treatment. Democratic political pressures (i.e., the need for votes) dictate the redistribution of health care dollars from the few to the many. In particular, the elderly, racial minorities, and those in rural areas are discriminated against when it comes to expensive treatments. And patients in countries with national health insurance usually have less access to critical medical procedures, modern medical technology, and lifesaving drugs than patients in the United States.