Last week in his column for Real Clear Politics, celebrity pundit John Stossel (pictured left) pretended to debunk studies by the World Health Organization (WHO) and the Commonwealth Fund that found the quality of health care in the United States compares poorly to that of other countries despite the fact that America has “[…]the most costly health system in the world […]“. WHO rates America at 37 out of 191 countries, below poorer countries such as Costa Rica, Chile, Cyprus and Singapore, while the Commonwealth Fund found the US ranks the lowest when compared to five other industrialized nations, Australia, Canada, Germany, New Zealand and the United Kingdom. If you’re not familiar with Stossel, he’s a professional debunker who appears regularly on 20/20 and wrote the best-selling book Myths, Lies and Downright Stupidity with the particularly arrogant subtitle, “Why Everything You Know is Wrong.” Yet it appears that everything Stossel thinks he knows about the state of health care in America is wrong, and his column is lazy, possibly dishonest and deeply insulting.
Let’s review Stossel’s argument piece-by-piece. He begins by invoking a favorite conservative boogeyman, The New York Times, by saying of their recent editorial (registration required) on the WHO and Commonwealth Fund studies, “As usual, the Times editors get it wrong.” But then, strangely enough, Stossel never explicitly states what the Times got wrong; this is, in fact, his last statement regarding the paper or its editorial. After summarizing the results of the WHO and Commonwealth Fund studies, stopping to point out that “Michael Moore makes much of this [the results of the WHO study] in his movie ‘Sicko,’” Stossel makes what appears to be his thesis statement, “[… T]here’s less to these studies than meets the eye. They measure something other than quality of medical care. So saying that the U.S. finished behind those other countries is misleading” [emphasis added]. To be generous to Stossel, apparently what he thinks the Times got wrong is their reliance on misleading studies. But it is Stossel who is being misleading here: the quality of medical care is exactly what the WHO and Commonwealth Fund studies focus on, as the Times pointed out. For example, the Times states, “American doctors and hospitals kill patients through surgical and medical mistakes more often than their counterparts in other industrialized nations,” which is covered in the “Safe Care” category of the Commonwealth Fund study. The likelihood of my doctor accidentally killing me is a pretty obvious way to measure the quality of health care I receive, but Stossel says otherwise. Similarly, the WHO study rated countries according to five factors, one being “[… the] overall level of health system responsiveness (a combination of patient satisfaction and how well the system acts)” [emphasis added]. How well the system acts is another way of saying the quality of medical care provided. Was Stossel too lazy to read the Times editorial or the WHO and Commonwealth Fund studies? If he had read them, it would have been impossible for him to miss the fact that the quality of health care is measured. So is the great debunker purposefully trying to mislead his readers?
It’s impossible to know, but his misleading statements continue directly in his next paragraph. He says,
First let’s acknowledge that the U.S. medical system has serious problems. But the problems stem from departures from free-market principles. The system is riddled with tax manipulation, costly insurance mandates and bureaucratic interference [emphasis Stossel's].
Stossel admits here that the US medical system has “serious problems,” but he doesn’t say what those problems are. Could these serious problems be in fact the very same problems listed in the supposedly misleading WHO and Commonwealth Fund studies? Stossel never says. Stossel does say these serious-but-never-explained-problems stem from departures to free-market principles, specifically tax manipulation, insurance mandates and bureaucratic interference. What are these tax manipulations and costly insurance mandates and where do they take place? By bureaucratic interferences, does Stossel mean government bureaucracy, or the bureaucracy of insurance companies? How will a return to free-market principles help the medical system, and where is the data to support this argument? Stossel never answers any of these questions. He cites no specific instances or studies to back up his claims; instead he lazily, arrogantly and misleadingly states these things as facts and moves on. Given his dissembling so far I’m not willing to believe what he says without proof, nor am I willing to try and make his arguments for him. There may be legitimate arguments against tax manipulation, insurance mandates and bureaucratic interference, but it isn’t clear that eliminating these issues in a return to free-market principles would fix the problems in American health care anyway (whatever Stossel thinks those problems are). For instance, the WHO and Commonwealth Fund studies found that government funded health care, as far a departure from free-market principles as you can get, provide better health care for less money. There are also numerous other studies that show government-funded single-payer health coverage would save millions or billions of dollars. A study by the Lewin Group for California found that such a system “[…] would save California $343.6 billion in health care costs over the next 10 years, mainly by cutting administration and using bulk purchases of drugs and medical equipment.” Stossel should like this plan: it cuts administrative costs (AKA bureaucratic interference) and follows free-market principles such as buying in bulk and saving money.
Still on the subject of free-market principles, Stossel’s very next sentence reads,
Most important, six out of seven health-care dollars are spent by third parties, which means that most consumers exercise no cost-consciousness. As Milton Friedman always pointed out, no one spends other people’s money as carefully as he spends his own.
Again, Stossel lazily cites a supposed fact without giving the reader any way to determine its validity. The only other reference to this statistic that I could find (besides a previous column by Stosser) was an Association of American Physicians and Surgeons newsletter from July of 2004 that attributes the statistic to the Joint Economic Committee (JEC) without linking to the article or study in question; a search of the JEC web site was similarly fruitless. But even if this statistic is true, it’s not very clear. Who are these third parties that spend six out of seven health-care dollars. Insurers? The insured? Doctors? Whoever they are, somehow their reckless spending has led most consumers to exercise no cost-consciousness, which is where Stossel gets insulting. I’m sure the idea that they exercise no cost-consciousness must come as a surprise to the nearly 47 million Americans who are cost conscious enough to know that they can’t afford health care. But Stossel’s insult is actually directed at the insured, who, according to him, spend other people’s money frivolously. Let’s take a moment to consider the complete inanity of this argument. Does Stossel not understand how insurance works? Insurance companies stay in business because, as a whole, they collect more in payments and fees than they pay out in claims. For instance, they may pay out more than they collect from covering an individual with cancer, but they make up for it by paying out less than they collect from other individuals who never get cancer or other debilitating and expensive diseases. Therefore, while this collective form of payment might mean the insured sometimes spends other people’s money, this arrangement is completely fair to insurers; they even make a profit! In fact, the unfair aspect of this free-market system is that insurance companies actually have an incentive to deny claims, which is exactly the argument cost-conscious critics make.
Let’s move on to Stossel’s next paragraph, perhaps his laziest, which begins, “Even with all that, it strains credulity to hear that the U.S. ranks far from the top. Sick people come to the United States for treatment.” Stossel says it strains credulity to hear that the U.S. ranks so far from the top, as if this were an argument in and of itself. Ostensibly, the WHO and Commonwealth Fund studies are based on empirical evidence and scientific methods; if Stossel wants to disprove them he should show how their evidence is false or their methods unreliable. Instead, he says these studies are false because they contradict what he thinks he knows. Please note that this is the very same argument made frequently, and facetiously, by the world’s most famous fake-news correspondent, Stephen Colbert. In his now famous address at the White House Correspondents’ Association Dinner, Colbert made the following statement of President Bush and himself (although he could have been talking about Stossel as well),
Guys like us, we’re not some brainiacs on the nerd patrol, we’re not members of the factinista, we go straight from the gut […]. That’s where the truth lies. Right down here in the gut. Did you know you have more nerve endings in your gut than you have in your head? You can look it up. Now I know some of you are going to say, ‘I did look it up and that’s not true.’ That’s because you looked it up in a book. Next time, look it up in your gut. I did. My gut tells me that’s how our nervous system works.
Stossel says the idea that the U.S. ranks far from the top doesn’t sound true to him so therefore it must not be true. He does say, however, that sick people come to America for treatment, but once again he’s too lazy to give any examples of this or cite any proof of his claim. Perhaps Stossel is referring to another favorite conservative boogeyman, the idea that Mexicans come to the U.S. to take advantage of our health care system. Since Mexico came in 30 countries below America in the WHO study’s ranking, this could have been the first logical argument Stossel had made (if he had actually made such an argument).
Continuing in his fact free vein, Stossel betrays an insulting bias held by the celebrity press corps that doesn’t get much attention. Stossel asks, “When was the last time you heard of someone leaving this country to get medical care? The last famous case I can remember is Rock Hudson, who went to France in the 1980s to seek treatment for AIDS” [emphasis Stossel's]. Really? The last time Stossel heard of anyone leaving America to get medical care is from over twenty years ago? Earlier in his column, Stossel said much is made of the WHO study in Michael Moore’s Sicko. Such a statement would suggest that Stossel has seen Moore’s film, or is at least familiar with the major details. If so, Stossel should know that Moore took 9/11 rescue workers to Cuba for health care. Did Stossel not actually see Sicko, or is he just conveniently forgetting an example that would ruin his argument? Another medical procedure Americans are having overseas is weight-loss surgery, which is not commonly covered by insurance companies in the U.S. despite recent studies showing such surgeries save lives. But let’s go back to Stossel’s statement that the last time he heard of anyone leaving the U.S. to get medical care was Rock Hudson in the 80s. A frequent critique of the news from media watchdog The Daily Howler (which was a major inspiration for this blog entry) is that the celebrity punditry, including Stossel, is obsessed with trivia and its own interests. This could perhaps explain why the only example Stossel could come up with of an American leaving the U.S. for health care is a gay actor whose AIDS diagnosis forced him out of the closet. Apparently the example from the movie that isn’t even out yet on DVD yet that Stossel pretended to be familiar with just a few paragraphs earlier wasn’t sexy enough. But then, that movie critiques the American medical system, and as The Daily Howler pointed out, pundits like Stossel “[…] already have excellent health care.”
Moving right along, Stossel says he’s going to “count the ways” the WHO and Commonwealth Fund studies are wrong, but then he focuses only on the WHO study while still not managing to get it right. Stossel says, “The WHO judged a country’s quality of health on life expectancy. But that’s a lousy measure of a health-care system” because it doesn’t take into account fatal injuries from traffic accidents and homicides. Stossel concludes, “When you adjust for these ‘fatal injury’ rates, U.S. life expectancy is actually higher than in nearly every other industrialized nation” (He also points out, “Diet and lack of exercise also bring down average life expectancy.” Although Stossel is not willing to concede that American health care sucks, he is apparently willing to admit that Americans are fatter, more violent and more prone to accidents than other counties. USA! USA! USA!) But besides the fact that Stossel doesn’t show us the math for adjusting fatal injury rates into U.S. life expectancy, he’s wrong that the WHO study measured nations’ quality of health care only by life expectancy (although I’m also not completely sold that such a measure would be “lousy.” Certainly good health care is a factor in longer life?). The WHO study states,
To assess overall population health and thus to judge how well the objective of good health is being achieved, WHO has chosen to use the measure of disability-adjusted life expectancy (DALE). This has the advantage of being directly comparable to life expectancy and is readily compared across populations.
So what, you ask, is disability-adjusted life expectancy, and how is it different from life expectancy? It’s extremely technical, but I’ll do my best to summarize (I know this is normally the job of reporters, but we bloggers are picking up the slack these days). The key word is “disability”: the years a person suffers from a debilitating health problems (injuries, blindness, AIDS, malaria, etc) are subtracted from overall life expectancy. Note that this measures not only how long a person lives (which would be affected by the fatal injuries Stossel discussed) but also the quality of a person’s life, which would be affected by the quality of health care provided to them.
Also, DALE is only one of five indicators WHO used to measure health care, but Stossel only bothers to tell you about one other: “[The] Distribution of Health in the Populations.” WHO states, “It is not sufficient to protect or improve the average health of the population, if – at the same time – inequality worsens or remains high because the gain accrues disproportionately to those already enjoying better health.” Stossel has a real problem with this, asking,
What has that got to do with the quality of health care? […] The problem here is obvious. By that criterion, a country with high-quality care overall but ‘unequal distribution’ would rank below a country with lower quality care but equal distribution.
Indeed, what does the unequal distribution of quality health care matter to a man as mighty as John Stossel? After all, he has good health and good health care. Just check out the luster of his signature mustache! Why should he care if almost 16% of his fellow citizens don’t even have health care? I’d rather waste billions of dollars and see millions of Americans suffer from the effects of low-to-no quality health care than have that most dirty of epithets applied to this fine country: Socialist.
In case you couldn’t tell, I was being sarcastic. But Stossel wasn’t. Nor is he overly concerned with the 47 million uninsured Americans statistic (although he rounds down to 45 million. Clearly, those extra two million people aren’t important!). Stossel says we shouldn’t be concerned with uninsured Americans because it’s the government’s fault, requiring costly insurance mandates for “[…] coverage that many people would not choose.” Finally, Stossel makes a real argument about insurance mandates. According to an article by the National Council for Policy Analysis (NCAP), insurance mandates are laws that require insurance companies to cover “[…] procedures not usually included in basic health care plans.” Although the NCAP boldly states that “[…] actuaries, insurers and health economists agree that virtually all mandates increase the cost of health insurance,” they also note “the magnitude of their effects has been subject to debate.” Stossel doesn’t tell you about the debate, nor does he tell you that many mandates are for coverage many people would choose. Another NCAP article says that mandates,
[…C]over everything from the serious to the trivial: heart transplants in Georgia, liver transplants in Illinois, hairpieces in Minnesota, marriage counseling in California, pastoral counseling in Vermont and deposits to a sperm bank in Massachusetts.
Stossel may have about insurance mandates if they’re being used to guarantee coverage of hairpieces, but if insurance companies are refusing to cover life saving heart and liver transplants Stossel may be advocating throwing the baby out with the bath water. In fact, insurance mandates sound a lot like government regulation for the insurance industry. In the energy sector, Enron successfully lobbied for adherence to free-market principles in the form of deregulating the industry, which led not to a windfall of savings for consumers by skyrocketing energy prices and an energy crisis. I don’t see the wisdom is similarly deregulating the insurance industry.
But is it a problem that 45 (or 47) million Americans are out of insurance or not? Right after arguing that this problem is the government’s fault due to costly insurance mandates (and “forbidding us to buy policies from companies in another state,” Stossel says, although I have no comment on that one), Stossel says it isn’t a problem because,
Thirty-seven percent of that group [the uninsured] live in households making more than $50,000 a year, says the U.S. Census Bureau. Nineteen percent are in households making more than $75,000 a year; 20 percent are not citizens, and 33 percent are eligible for existing government programs but are not enrolled.
You probably won’t be surprised to hear Stossel doesn’t link to these statistics, and yes, I searched the U.S. Census Bureau web site unsuccessfully to find them. However, I don’t see why we should be comforted by the fact that solidly middle-class Americans don’t have health insurance (the real median income for the U.S. in 2006 was $46,326). If you’re without insurance and suffer an injury or are diagnosed with a disease that requires long hospital stays and expensive tests, surgeries and treatments, you could eat up your yearly salary very quickly. I suppose we can take comfort in the fact that 20% of the uninsured are freeloading non-citizens (Mexicans, probably), and another 33% percent are eligible to freeload off the government but are too lazy to do so (again, sarcasm). Especially since we could insure everyone in the United States, non-citizens included, for less than what we pay to only insure some of the population now.
Stossel concludes his column by saying, “For all its problems, the U.S. ranks at the top for quality of care and innovation, including development of life-saving drugs. It “falters” only when the criterion is proximity to socialized medicine.” Needless to say, even if this were true it doesn’t mean a lot to people without health care or people struggling with the bills for the insurance they already have. But then, given all his lazy dissembling, Stossel should apply that subtitle to himself, “Everything You Know is Wrong.”