And Where All The Health Care Providers Are Above Average

No Patient Left Behind, anyone?

At least the columns are getting posted closer to on time (and I got my taxes done and mailed by this morning). I needed to prepare something for a panel discussion on health care last Thursday, so hence this column, but I never got the chance to trot out my statistics. Which was probably for the best, all considered. Still, it sure seemed like my story about the woman who called my congressional office during the 1993-94 health care debate and told the poor kid who answered the phone, "You tell Congressman Coppersmith I don't want any of that government health care. My Medicare works just fine," has now become part of the standard Len Kirschner Power Point lecture. Of course, if I hadn't wanted anybody to steal that story, I shouldn't have said it.

My proposed headline was "Statistics Versus Anecdotes in Health Care and Education," but the editor went with the old "A&R" (appearance and reality) as we used to call that routine in college. Note that health care in The Tribune is two words. Apparently, that's how they do it in France and Japan. At least we're benchmarking our spelling (although not against the British, we don't like NHS). "On" health care? Should it have been "In"?

PERCEPTION TOPS REALITY ON U.S. HEALTH CARE
East Valley Tribune, Apr. 15, 2007

Lots of people believe the United States has the best health care system in the world. Very few believe the United States has the best education system in the world.

Most people have no problem agreeing with the first statement, despite fairly lackluster statistics, based either on anecdotal data or just from hearing about our superiority so many times that it's got to be true, right? Even with miserable personal experience, people just assume that other countries must have it worse.

But when it comes to education, people also ignore their own personal experience (or those of their kids), and listen to the negative drumbeat. But in education, they're focused on our fairly lackluster statistics, accepting those numbers as proving that students in other countries do better.

Our health care statistics are pretty grim. Compared to other leading industrial countries, we have significantly worse infant mortality, lower overall life expectancy, and lower life expectancy at age 65. In health care, we're the opposite of Lake Wobegon; all our statistics are below average.

Worse, we spend more -- much more -- than other countries with better overall results. In 2003, the U.S. spent 15.2 percent of gross domestic product on health care; France spends 10.4 percent. Other advanced industrial countries spent less in percentage terms, and much less in absolute terms. We now spend more money on the governmental part of the system than countries with universal coverage, yet some 46 million Americans under age 65 have no health insurance.

Defenders of the status quo argue that these health statistics are too crude, because infant mortality and life expectancy depend on poverty, environmental, and lifestyle factors. (That's a tendentious argument, because if more people had health care coverage, then there wouldn't be as much poverty, and doctors can help change lifestyles, too.) But even if you use "disability adjusted life years" or other more technical statistical measures, the U.S. pays a lot more money and gets a lot less health than Japan or northern Europe.

More sophisticated defenders of the status quo acknowledge these numbers, but claim that these measures don't reflect our advantage in high-tech medical technology. They claim governments in other countries limit health spending, cutting back on technology, so their citizens really get less than we do.

But the statistics don't back up that claim, either. As Jonathan Cohn noted in The New Republic, Japan has single-payer, but also has more CT scanners and MRI machines, per person, than the U.S. France and Britain in particular seem to have less technology, although Germany and Switzerland seem comparable to the U.S. when it comes to medical gizmos. But while their citizens seem to get fewer machines, they do get a lot more time with their doctors. The French, on a per capita basis, have more physician office visits, more prescriptions, and longer hospital stays. Cohn reports that the average woman in France giving birth gets to stay in the hospital for nearly 5 days, even for a perfectly routine delivery. Go ask a new mother here what she got, and be prepared for a long story of a far shorter stay.

Meanwhile, you can come up with similar scare stories from abroad and miracles at home in education. Look at the number of foreign students coming here to study. Check out our Nobel Prize recipients, those high school kids winning science fairs and scholarships. Those anecdotal stories tell us just as much about how the overall education system performs as evaluating health care by looking at wait times for elective hip replacement surgery in Quebec, or that the U.S. does better than France and Sweden in treating breast and prostate cancer (while ignoring that they do better than we do in treating cervical, ovarian, skin, and stomach cancer.)

Why do we want our kids, overall and statistically, to outperform students in Japan -- but not our health care? Other countries spend less, cover everybody, and their people are healthier. We demand our schools measure up to the rest of the world, but when it comes to health care, we act like everyplace else doesn't exist.