Do people in Saudi Arabia and Costa Rica really get better medical care than Americans do? Is the federal government truly a model of administrative efficiency?
Such statements don’t pass the giggle test of most rational people, but they have become mantras for "ObamaCare" backers.
One dubious claim is that despite much higher health-care expenditures per person, the U.S. lags behind most modern nations in health-care outcomes. The claims are often based on a World Health Organization report whose findings, upon further investigation, are astonishingly incomplete.
For instance, when life expectancy figures are adjusted for "fatal injuries" such as car accidents and violent crime, the U.S. life expectancies exceed those of nearly every industrialized nation, including France and the U.K., which often rank far above the U.S. in the WHO reports. Moreover, inconsistent measures across countries skew comparisons on infant mortality rates. The definition of a "live birth" and infant death registrations vary greatly among nations included in the report. Other factors, such as the rate of teen pregnancy and the mother’s lifestyle choices, also affect infant mortality rates but are not adjusted for.
A more accurate reflection of medical-care quality would include how sick patients fare after contact with the system. One such measure would include cancer survival rates, in which the U.S. ranks consistently on top of all other industrialized nations. Breast cancer survival rates are up to 13 percent higher here than in the U.K., and prostate cancer survival rates are more than 50 percent higher.
Another misleading assertion is that private health-insurance administration costs far exceed the administrative costs of government-run health programs such as Medicare. Indeed, the Centers for Medicare and Medicaid Services claims to spend less than 2 percent of Medicare outlays on program management.
Such comparisons, however, are considerably inaccurate. The CMS neglects to consider the administrative cost of collecting taxes to pay for Medicare, the sole responsibility of the IRS, along with several other administrative duties absorbed by different government agencies. Similarly, private plans are often subject to taxes as high as 5 percent of premiums, a cost not borne by Medicare. And the CMS figures ignore the cost of fraud and abuse in Medicare — something private insurers spend millions trying to root out. These kinds of selective administrative cost considerations allow for such bogus comparisons between government and private insurance.
Perhaps the most puzzling claim comes from "Medicare-for-all" advocates and their emphasis on preventive and primary care as central to reform. Standard Medicare doesn’t even pay for a yearly physical; it covers only a one-time preventive physical exam that must occur within 12 months of joining Medicare. Medicare recipients often opt for a supplemental "Medigap" policy to cover these basic needs.
It’s important to understand the real causes of the current health-care system’s failings. The concern most frequently referenced is the rising cost of health insurance and premium cost disparities among men and women. Insurance rates have increased nearly twofold over the rise in wages — but why is it that so many other goods and services in our economy have become more affordable over time, while health-care costs have risen so sharply? As any good doctor knows, don’t recommend treatment without first developing an accurate diagnosis.
It is arguable that part of the reason health-insurance premiums have gone up so dramatically is that the government has inundated the market with insurance mandates and shut down competition by not allowing the purchase of health insurance across state lines. In North Carolina, nearly half of all state mandates have been adopted in the last decade; in that same time-frame, health-insurance premiums here doubled. Because of these government-imposed barriers to entry, the largest insurer has more than 70 percent of North Carolina’s market share.
Breaking down barriers to entry in the health-insurance market would inspire competition. Additional choices would result in competitive pricing and a diversification of insurance options that would allow both men and women to choose plans tailored to their specific needs — certainly more so than the one-size-fits-all public option.
To be sure, health-care reform is overdue. But misleading talking points and failure to understand the current problems plaguing the system serve to distort, not enhance, the debate.
This article was originally published in the News & Observer on Friday, Oct. 16