SPEAKOUT: Flawed health-care study poses own risks
By Michael Tanner
Wednesday, April 23, 2008
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Recently, Families USA, a Washington, D.C., liberal advocacy group, issued a study suggesting that 360 Colorado residents die each year because they lack health insurance ("A life a day is lost for lack of insurance, advocate says," March 26). While it is almost certainly true that, all things being equal, it is better to be insured than uninsured, a greater danger is that this deeply flawed study will stampede policy-makers into taking action that will put far more Coloradans at risk.
The Families USA study was not a traditional "double blind" experiment with a control group and a treatment group. Rather, it is a retrospective analysis, which compared the rates of people who died with insurance to those who died without insurance. Since the proportion of people without insurance seemed to be higher than those with insurance, they extrapolated likelihood to project excess deaths due to lack of insurance. But there are just too many outside variables to make such interpretations valid.
Even the Urban Institute's Jack Hadley, who co-authored a similar Institute of Medicine study cited by Families USA has said that "observational studies . . . cannot answer the question of whether health insurance directly affects health outcomes." And a detailed review of the academic literature by Helen Levy and David Meltzer of the University of Chicago Harris Graduate School of Public Policy Studies found little proof of a "causal relationship" between health insurance and better health.
Similarly, a study published in The New England Journal of Medicine last year found that, while far too many Americans were not receiving the appropriate standard of care, "health insurance status was largely unrelated to the quality of care."
Of course this does not mean we should be indifferent to efforts to try to expand insurance coverage. We all want more Coloradans to be insured. However, Families USA's call for greater government control of our health-care system is a cure far worse than the disease.
One thing we know for certain is that government-run health-care systems frequently deny critical procedures to patients who need them. For example, at any given time, 750,000 Britons are waiting for admission to National Health Service hospitals, and shortages force the NHS to cancel as many as 50,000 operations each year. And in Canada, more than 800,000 patients are currently on waiting lists for medical procedures. According to Canada's Supreme Court, many of these individuals suffer chronic pain and some will die awaiting the treatment they've been promised.
Even in this country, excessive government regulations on health care cost lives. A study by Christopher J. Conover with the Center for Health Policy, Law and Management in the Terry Sanford Institute of Public Policy at Duke University found that as many as 22,000 Americans die each year from the costs associated with excess regulation.
Indeed, if Families USA is truly concerned with expanding the number of Coloradans with health insurance, they might start by attacking some of those regulations that make health insurance so expensive.
For example, Colorado currently has at least 46 mandated benefits ranging from alcoholism treatment to breast and prostate cancer screening, and even treatment by marriage therapists. These mandates in total add significantly to the cost of insurance. Some, like mental health parity, add from 10 percent to 15 percent to the cost of an insurance policy. Repealing such mandates would be one of the most effective steps that Colorado could take to reduce the cost of health insurance and thereby increase the number of people with insurance.
Or Colorado could simply allow its citizens to purchase insurance from other states if they can find a less expensive policy. If Coloradans do not wish to purchase all 46 required coverage mandates, they could purchase insurance from, say, Kansas, where there are only half as many.
Insurance is important. But expanding coverage in the right way is much more important than simply expanding coverage. One flawed report should not blind us to that fact.
Michael Tanner is the director of health and welfare studies at the Cato Institute.
Comments
Posted by SASQUATCH on April 23, 2008 at 8:35 a.m. (Suggest removal)
Peddling panic and fear, with big brother always as the solution, is all you can ever expect from libdems and big government weenies. They don't understand the benefits of markets, capitalism, competition and freedom of choice, so they offer their totalitarian and dictatorial solutions.
Funny how this same crowd never goes to HaVANA to deal with their health issues.
Posted by Froward69 on April 23, 2008 at 12:36 p.m. (Suggest removal)
as you know SASQUATCH,
I went to Mexico for dental work... you forgot the drivel you posted, and conveniently forgot for this post.
insofar as this article what it lacks is examples of where Universal care works... like France, Norway, Netherlands, Germany, Cuba, China. etc.
Posted by Gene on April 23, 2008 at 3:13 p.m. (Suggest removal)
Why
Posted by PRB on April 23, 2008 at 4:18 p.m. (Suggest removal)
SO easy to shoot down the Cato Institute's "Lies, Damn Lies, and Statistics".
Michael should feel free to add to the number of people on waiting lists HOW LONG they are on the waiting list. Citing a snapshot of 800,000 Canadians "currently" on a waiting list is meaningless. What percentage of them have been on that list more than one week? One month? One year? What's the average time on the wait list? The average for critical care, non-critical care, and elective surgeries?
Without that type of data the stats he has quoted can not be used to judge the effectiveness of state-run care any more than he argues the information this report was based on can be.
Citing the number of people who are in chronic pain and who might die in Canada without comparing the numbers in the U.S. is also misleading. How many people in the U.S. are denied critical care and end up dying? Who makes the decision on that, CEO's of insurance companies who are looking to pad their yearly bonus or government folks who either look out for our health interests or get replaced in the next election?
Anyone want to calculate the administrative overhead of doctors offices having to work with dozens of insurance companies and figure out how to submit costs to each of them? $millions/year=1,000s of lives. Anyone ever calculate the average cost to keep people alive and divided that into the total salaries of the executive management in U.S. insurance companies? How many lives could be saved if the $30,000,000 salary of a CEO could be replaced by $250,000 salary of a top-notch administrator in a state-run medical insurance system? Hell, pay them $500,000 and we'd still have more people getting critical treatment than under the current system.
As far as mandates go, the free market is great without them as long as you don't get any of the things your insurance company has decided not to allow. And before you claim "that's what the free market is for", maybe you should take into consideration why mandates were created in the first place: because all insurers in a given market will have the same things excluded from their plans because otherwise they can't compete on simplistic $/month basis which is the most information most people have time to consider when choosing insurance, and it's the most common selection criteria of companies looking out for their bottom line. Not to mention the fact that insurance in any given market often becomes monopolistic when not regulated (by regulations which are also anethema to the Cato Institute).
This article is just a propaganda piece funded by the U.S. insurance industry via this "think tank". The only fear-mongering is coming from the big-business mouth-pieces on their payroll.
Posted by DonaldJohnson on April 23, 2008 at 4:23 p.m. (Suggest removal)
Tanner is correct. It's impossible to prove that the lack of health insurance causes more deaths. Often those without health insurance are uninsured because they are chronically ill and can't work for physical or mental health reasons. So when they die, you can't blame a lack of insurance for their deaths. They would have died with health insurance, as most of us will. Tanner has published a number of interesting articles on health insurance at www.catoinstitute.org.
This supports Tanner's position:
http://blogs.wsj.com/health/2008/04/2...
Posted by DonaldJohnson on April 23, 2008 at 4:36 p.m. (Suggest removal)
Why do politicians who complain about rising health insurance premiums, which cause more people to self-insure, support mandates demanded by a few providers who stand to make big money because the mandates help them sell their services?
The answer is pretty simple. First, it's not hard for alternative care providers to make friends with legislators who can help them, especially if they contribute to those legislators' campaigns. Second, if a legislator or a member of his/her family has received care for a particular illness or from a particular specialty, it is very common for them to side with the providers involved when the providers and their lobbyists ask for legislation that requires insurers to cover the particular procedure or type of care provider. It's all intellectually corrupt, because mandates turn health insurance into health savings plans where the insureds' pay a fee to the insurers for holding their money for them.
Eliminate mandates. Require all insurers to offer mandate-free catastrophic health insurance with optional additional services that are priced to reflect the risks involved. Don't allow bundling of alternative, primary care or preventive services. Make insurers sell the additional insurance, and make consumers decide for themselves what kind of insurance they will buy.
Such a reform would lower health insurance premiums by 50% and the number of uninsured by 25% to 40%, I'm guessing.
I blog on health care, stocks and economics at:
www.businessword.com
Posted by alcambell_9 on April 24, 2008 at 9:32 a.m. (Suggest removal)
A bureaucracy that rules health care would fast become like the bureaucracy that rules the IRS. An Overbearing, confusing, convoluted, power triping monster havng a life of it's own. Example, the IRS has created tax codes that even they cannot understand not to mention the EPA requiring over 700 different regulations and applications if you want to drill for oil or the hundred of regulation and applications if you want to build a fence on our borders to keep illegals out, which I must admit is a waste of money, but never the less you can see my point. Government always complicates anything they get involved in to the point of abtraction, then continues to complicate it past the understanding of anyone including themselves.
Posted by PRB on April 25, 2008 at 10:53 a.m. (Suggest removal)
alcambell_9
Clearly you haven't even thought about the level of complication created by the beaurocracy created by having probably hundreds of private insurance companies, dozens of which any particular doctor has to understand and deal with on a daily basis. I've met with doctors who have dropped out of that rat-wheel and refuse to deal with insurance companies. "Here's the information on what I treated you for and you're on your own to submit the claim." The overhead doctors have is putting them out of business (along with insurance costs).
I really have no idea why people are willing to put the day-to-day decisions on who gets treatment and who doesn't in the hands of bean counters who have only one concern: profit. They intentionally create "complication to the point of abstraction" because it keeps you and me from understanding our ability to get things taken care of.
The IRS is complicated not because it's a beaurocracy, but because people who have money have jiggered the system through their influence in Congress to create all kinds of rules and loopholes so they can keep more of their money. If we got rid of those loopholes, exceptions, and "porkbarrel" style sweetheart deals for certain people, the IRS would be simple.
PRB
Posted by Sweetpickle on April 25, 2008 at 9:11 p.m. (Suggest removal)
John McCain has suffered with government controled health care
all his life. Look what it's done to him.
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