Health-Care Myths
By Elizabeth MacDonald
The Obama administration is now
attempting the biggest overhaul of healthcare since Lyndon B. Johnson pushed
through Medicare and Medicaid in 1965. But the health care reform
debate is riddled with misleading myths taken as fact, myths that are
torquing the debate beyond recognition, from the U.S.’s supposedly poor
infant mortality rates, who really gets medical care, the level of
uninsureds, who really pays for insurance, who actually can afford insurance
and wait times for surgeries. Most everyone agrees that the U.S. health
system is broken and that the uninsured must get coverage. But fixing the health system should be
based on the facts, not on a statistical faith-based initiative mounted to
ram through reform, where the data is either more nuanced on closer look or
the statements made are simply not true. Worth keeping in mind, as the U.S. is
already on track to compile total 10-year deficits that would surpass the
annual GDP of Great Britain, Russia and Germany for one year-combined, and as
the government is getting increasingly entangled in key industries, with
higher taxes coming on incomes, on capital and on energy. Meanwhile, the deficit spending figures
do not include Medicare and Social Security costs, reforms which are so far
on the backburner, they are off the stove. The following includes research
from Fox News analyst James Farrell. Myth: “The U.S. has one of the highest
infant mortality rates in the developed world.” Talk about stretching a point until it
snaps. This ranking is based on data mining. The U.S. ranks high on this list largely
because this country numbers among those that actually measure neonatal
deaths, notably in premature infant fatalities, unlike other countries that
basically leave premature babies to die, notes health analyst Betsey
McCaughey. Other statistical quirks push the U.S.
unjustifiably higher in this ranking compared to other countries. The Center for Disease Control says the
U.S. ranks 29th in the world for infant mortality rates, (according to the CDC), behind most other
developed nations. The U.S. is supposedly worse than
Singapore, Hong Kong, Greece, Northern Ireland, Cuba and Hungary. And the
U.S. is supposedly on a par with Slovakia and Poland. CNN, the New York
Times, numerous outlets across the country report the U.S. as abysmal in
terms of infant mortality, without delving into what is behind this ranking. The Commonwealth Fund, a nonprofit
research group, routinely flunks the U.S. health system using the infant
mortality rate. “Infant mortality and our comparison with
the rest of the world continue to be an embarrassment to the United States,”
Grace-Marie Turner, president of the Galen Institute, a research
organization, has said. Start with the definition. The World
Health Organization (WHO) defines a country’s infant mortality rate as the
number of infants who die between birth and age one, per 1,000 live births. WHO says a live birth is when a baby
shows any signs of life, even if, say, a low birth weight baby takes one,
single breath, or has one heartbeat. While the U.S. uses this definition,
other countries don’t and so don’t count premature or severely ill babies as
live births-or deaths. The United States counts all births if
they show any sign of life, regardless of prematurity or size or duration of
life, notes Bernardine Healy, a former director of the National Institutes of
Health and former president and chief executive of the American Red Cross
(Healy noted this information in a column for U.S. News & World Report). And that includes stillbirths, which many
other countries don’t report. And what counts as a birth varies from
country to country. In Austria and Germany, fetal weight must be at least 500
grams (1 pound) before these countries count these infants as live births,
Healy notes. In other parts of Europe, such as
Switzerland, the fetus must be at least 30 centimeters (12 inches) long,
Healy notes. In Belgium and France, births at less than 26 weeks of pregnancy
are registered as lifeless, and are not counted, Healy says. And some
countries don’t reliably register babies who die within the first 24 hours of
birth, Healy notes. Norway, which has one of the lowest
infant mortality rates, shows no better infant survival than the United
States when you factor in Norway’s underweight infants that are not now
counted, Healy says, quoting Nicholas Eberstadt, a scholar at the American
Enterprise Institute. Moreover, the ranking doesn’t take into
account that the US has a diverse, heterogeneous population, Healy adds,
unlike, say, in Iceland, which tracks all infant deaths regardless of factor,
but has a population under 300,000 that is 94% homogenous. Likewise, Finland and Japan do not have
the ethnic and cultural diversity of the U.S.’s 300 mn-plus citizens. Plus, the U.S. has a high rate of teen
pregnancies, teens who smoke, who take drugs, who are obese and uneducated,
all factors which cause higher infant mortality rates. And the US has more mothers taking
fertility treatments, which keeps the rate of pregnancy high due to
multiple-birth pregnancies. Again, the U.S. counts all of these
infants as births. Moreover, we’re not losing healthy babies, as the scary
stats imply. Most of the babies that die are either premature or born
seriously ill, including those with congenital malformations. Even the Organization for Economic
Cooperation and Development, which collects the European numbers, cautions
against using comparisons country-by-country. “Some of the international variation in
infant and neonatal mortality rates may be due to variations among countries
in registering practices of premature infants (whether they are
reported as live births or not),” the OECD says. “In several countries, such as in the
United States, Canada and the Nordic countries, very premature babies (with
relatively low odds of survival) are registered as live births, which increases
mortality rates compared with other countries that do not register them as
live births.” (Note: Emphasis EMac’s). The U.S. ranks much better on a measure
that the World Health Organization says is more accurate, the perinatal
mortality rate, defined as death between 22 weeks’ gestation and 7 days after
birth. According to the WHO 2006 report on Neonatal and
Perinatal Mortality, the U.S. comes in at 16th-and even
higher if you knock out several tiny countries with tiny birthrates and
populations, such as Martinique, Hong Kong, and San Marino. Myth: “About 46 mn Americans lack access
to health insurance.” There is a difference between health care
and health insurance, as Fox Business anchor Brian Sullivan points out after
researching reports on health care from the Congressional Budget Office, Blue
Cross-Blue Shield and Georgetown University. Everyone has access to health care. They may not have health insurance, but the law mandates
everyone who shows up at emergency rooms must be treated, insurance or not,
he reports. About 14 mn of the uninsured were
eligible for Medicaid and SCHIP 2003, a BlueCross-BlueShield Association
study based on 2003 data estimated. These people would be signed up for
government insurance if they ever made it to the emergency room, Sullivan
says. A whopping 70% of uninsured children are
eligible for Medicaid, SCHIP, or both programs, a 2008 study by the
Georgetown University Health Policy Institute shows. Census figures also show that 18.3 mn of
the uninsured were under 34 who may simply not think about the need for
insurance, Sullivan reports. And of those 46 mn without insurance, an
estimated 10 mn or so are non-U.S. citizens who may not be eligible,
according to statistics from the Census Bureau), Sullivan reports. Myth: “The uninsured can’t afford to buy
coverage.” Many may be able to afford health
insurance, but for whatever reason choose to not buy it. In 2007, an
estimated 17.6 mn of the uninsured made more than $50,000 per year, and 10 mn
of those made more than $75,000 a year, says Sally Pipes, author of the book,
The Top Ten Myths of American Health
Care: A Citizen’s Guide, a book that attempts to dig behind the
numbers. According to author Pipes, 38% of the U.S.
uninsured population earns more than $50,000 per year. That means 38% of the uninsured likely
make enough to afford health insurance, but for undetermined reasons choose
not to buy it. Myth: “Most of the uninsured do not have
health insurance because they are not working and so don’t have access to
health benefits through an employer.” Not so fast–the data is more nuanced and
revealing upon closer look. According to the CBO, about half of the
uninsured in 2009 fall into one of the following three categories. Some
people will be in more than one of those categories at the same time: *Nearly one out of three, 30%, will be
offered, but will decline, coverage from an employer. *Nearly one out of five, 18%, will be
eligible for, but not enrolled in Medicaid; and *More than one out of seven, 17%, will
have family income above 300% of the poverty level (about $65,000 for a
family of four); What is potentially the real number for
the poor uninsured? According to a 2003 Blue Cross study, 8.2 mn Americans
are actually without coverage for the long haul, because they are too poor to
purchase health care, but earn too much to qualify for government assistance. [Source: CBO, "Key Issues in Analyzing
Major Health Insurance Proposals," December 18, 2008, http://www.cbo.gov/ftpdocs/99xx/doc9924/12-18-KeyIssues.pdf] Myth: “The estimated 45 mn people without
health insurance lacked health insurance for every day of the year.” The CBO’s 45 mn estimate reflects
individuals “without health insurance at any given time during 2009.” But that does not mean that all 45 mn
people spend every day of 2009 without insurance. It is a point estimate - on
any particular day, there will be 45 mn individuals without health
insurance. [Source: CBO, "Key Issues in
Analyzing Major Health Insurance Proposals," December 18, 2008, http://www.cbo.gov/ftpdocs/99xx/doc9924/12-18-KeyIssues.pdf] Myth: “Government-run universal health
care would increase the international competitiveness of U.S. companies.” The Congressional Budget Office
disagrees. “Replacing employment-based health care
with a government-run system could reduce employers’ payments for their
workers’ insurance, but the amount that they would have to pay in overall
compensation would remain essentially unchanged,” the CBO says. “Cash wages
and other forms of compensation would have to rise by roughly the amount of
the reduction in health benefits for firms to be able to attract the same
number and types of workers.” [Source: CBO, "Key Issues in
Analyzing Major Health Insurance Proposals," December 18, 2008, http://www.cbo.gov/ftpdocs/99xx/doc9924/12-18-KeyIssues.pdf] Myth: “The cost of uncompensated care for
the uninsured significantly increases hospital costs.” Hospitals provided about $35 bn in
uncompensated care in 2008, the CBO says. Uncompensated care represented only
5% of total hospital revenues. In addition, half of the $35 bn in
uncompensated hospital costs were offset by Medicare and Medicaid. And the cost of uncompensated care for
the uninsured is “unlikely to have a substantial effect on private payment
rates,” the CBO says, adding that shifting costs from uninsured to private
insurance premiums is “likely to be relatively small.” [source: CBO, "Key Issues in Analyzing
Major Health Insurance Proposals," December 2008, http://www.cbo.gov/ftpdocs/99xx/doc9924/12-18-KeyIssues.pdf] Myth: “Nationalized health care would not
impact patient waiting times.” Waiting time for elective surgery is
lower in the US than in countries with nationalized health care. In 2005, only 8% of U.S. patients
reported waiting four months or more for elective surgery. Countries with nationalized health care
had higher percentages with waiting times of four months or more, including
Australia (19%); New Zealand (20%); Canada (33%); and the United Kingdom
(41%). [Source: Commonwealth Fund, "MIRROR,
MIRROR ON THE WALL: AN INTERNATIONAL UPDATE ON THE COMPARATIVE PERFORMANCE OF
AMERICAN HEALTH CARE," by Karen Davis, Cathy Schoen, Stephen C.
Schoenbaum, Michelle M. Doty, Alyssa L. Holmgren, Jennifer L. Kriss, and
Katherine K. Shea, May 2007, http://www.commonwealthfund.org/~/media/Files/Publications/Fund%20Report/2007/May/Mirror%20%20Mirror%20on%20the%20Wall%20%20An%20International%20Update%20on%20the%20Comparative%20Performance%20of%20American%20Healt/1027_Davis_mirror_mirror_international_update_final%20pdf.pdf] Myth: “Insurers cover less today than
they did in the past.” No they’re covering more costs. According
to the CBO, consumers paid for 33 % of their total, personal health care
expenditures in 1975. But by 2000, consumers’ personal share had fallen to
17%, and it declined to 15% in 2006. [Source: CBO, "Key Issues in
Analyzing Major Health Insurance Proposals," December 18, 2008, http://www.cbo.gov/ftpdocs/99xx/doc9924/12-18-KeyIssues.pdf] |