Health care: Watch those dangerous ‘facts’
By Bill Settlemyer
President and CEO, Setcom Media
As the debate about health care grows, it is becoming even more of a challenge to sort out “the facts” and deliver an honest analysis of the challenges and the realities of health care in America.
In fact, there are so many “facts” out there that you can select your own and support just about any viewpoint with little fear of contradiction. Gregory Mankiw, a Harvard University economics professor, recently published an opinion piece in The New York Times to make just that point, though perhaps not entirely in the way he intended.
The headline of his column was “Beyond Those Health Care Numbers,” and he says that of the “scary claims” being thrown about in the political debate, the ones that are false are not as dangerous “as those that are true but don’t mean what people think they mean.” He gives
three examples:
Statement 1: The United States has lower life expectancy and higher infant mortality than Canada, which has national health insurance.
True, he says, but much of the difference is related not to disparities in health care but to societal factors, such as higher U.S. death rates among men in their 20s from accidents and homicide. He also cites our higher obesity rates stemming from “lifestyle choices” and our patterns of food consumption, and he notes a correlation between teenage motherhood and low birth rate babies, saying that the higher teen pregnancy rate in the U.S. explains much of the higher infant mortality rate here.
For the most part, I’ll agree with Professor Mankiw on this one. Yes, there are other areas in addition to health care where we fail to measure up to other countries. Poor educational performance is one, and that alone most likely contributes a great deal to our higher homicide and teen pregnancy rates.
Action can be taken on these challenges and other public health issues. S.C. House Speaker Bobby Harrell provided a good example of what can be done when he and other legislators sponsored and passed a bill requiring healthier food choices, nutrition education and regular physical education classes in the state’s public schools. Public policy measures that focus on wellness and prevention need to be seen as a vital part of a successful health care system, and the General Assembly deserves a big “thumbs up” for this one.
Statement 2: Some 47 million Americans do not have health insurance.
A true statement according to the Census Bureau, says the professor, but that includes 10 million people who are not American citizens, many of them illegal immigrants who “would probably not be covered” even if we had national health insurance. Also included, he notes, are people who are eligible for Medicaid and have not applied for it, “but who could always apply if they ever needed significant medical care.” (Helpful hint: Wouldn’t that be a little too late? “Hi, I’ve just been severely injured in an auto accident and I’d like to apply for insurance coverage… .”)
And finally, he points to a Census Bureau report saying 18 million of the uninsured have annual household incomes of more than $50,000, and adds that “a quarter of the uninsured have been offered employer-provided insurance but declined coverage.”
Professor Mankiw concedes that “there are millions of Americans who have trouble getting health insurance,” but says they make up only a small percentage of the U.S. population.
In my view, this is a neat “sleight-of-hand” way to get around the fact that there really are somewhere around 47 million people without health coverage at any given time. And the consequences of that particular fact are dire for our society and our economy.
On an individual level, personal tragedies happen every day in the form of hard-working people losing their homes and their savings to crushing medical costs.
On the societal level, there are tremendous losses in economic and social productivity when people are caught in the trap laid by our failure to create a system that covers everyone either through private insurance or some form of government program.
In the final analysis, it really doesn’t matter whether someone is an American citizen or an immigrant, legal or illegal, nor does it matter that he or she has “chosen” (a questionable assumption in many cases) not to purchase insurance or seek access to Medicaid if eligible for that program. The social and economic impacts are the same, and they are barriers to our success as a nation.
Statement 3: Health costs are eating up an ever-increasing share of American incomes.
Yes, our health care costs a lot, says Professor Mankiw, but maybe that’s evidence of the success of our health care system. We’re spending more because medical science has produced many new but often expensive ways to extend and improve our lives. As our incomes rise and our prosperity increases, perhaps we are just choosing to shift our spending from TV sets and automobiles to life-enhancing medical care.
For an economist, the good professor doesn’t seem to have much of a grasp of the facts about personal income. Recent reports indicate that middle-class households have been losing ground or barely holding their own in spending power since the last recession, while most of the income gains have gone to corporate profits and higher-income individuals.
The professor’s premise that “our incomes are growing” and “we” can therefore spend this prosperity on better health will likely puzzle and bemuse the breadwinners in the typical middle-class American household.
That said, there’s no question that one of the reasons we’re spending more on health care is that advances in medical science are doing so much more to extend life and prevent disability and suffering. Who among us would choose not to take advantage of these medical miracles if we could afford them?
But that’s certainly not the whole picture. Everyone (except, perhaps, Professor Mankiw) knows we pay much more for prescription drugs here than in most other countries. And there are large “frictional costs” in our current health care system related to underwriting and claims processing by private insurance companies as compared to Medicare and Medicaid and national health care programs in other countries.
If we really had an effective “system” to promote wellness, good nutrition and preventive care to everyone residing in this country, there would be massive savings through the reduced need for the very expensive care provided to people (insured or not) who would otherwise suffer both from acute and chronic illness.
Facts? When it comes to health care, I got a million of ’em, and so does everyone else. What matters more is finding solutions, and that’s where we’ve got to focus our attention, not on efforts to fog the picture by firing salvos of “facts” back and forth across the political divide.
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