Statistics and Philosophy in Health Care

About a week ago I got an Email which claimed the Investor's Business Daily had made a series of claims about the comparative advantages of health care systems. Included in the claims were ones about the relative survival statistics for various diseases. As an example the Email said, IBD had claimed that the percentage of men and women who survived a cancer five years after diagnosis: U.S. 65%, England 46%, Canada 42%. When you Google IBD for those numbers they do not come up.

A lot of the statistics being thrown around in the health care debate are silly or mis-represented. That is true for both proponents and opponents of the measures under consideration in Congress. So I did some searching on my own. The British National Health Care Office says that women with breast cancer in the UK have slightly higher than an 80% five year survival rate. According to the American Cancer Society the five year rate on breast cancer in the US is 91% for whites and 78% for blacks - thus it is pretty easy to conclude that our rate is slightly (but not dramatically) higher than the Brits. Admittedly those numbers are not representative of the entire population of cancer patients but as several statisticians caution - the way individual countries count these things can produce differences in results that are not consequential.

The World Health Organization numbers (if you look at them at all closely) - which rate us 37th, are mostly bunk. They do not norm for the wide variations in population (we are a lot more heterogeneous than many countries higher than us on the list - for example ahead of the US are places like San Marino and Andorra and Monaco or even Japan where the populations are more homogeneous). Among the variables in the WHO numbers are "fairness in financial contribution" - that is certainly not an objective number. The WHO numbers also rate health expenditure per capita inversely - so we are ranked at the bottom because we spend more than anyone else. WHO publishes the rankings with a political motive. The Commonwealth Fund study ranks us as 14th - but again when you look at the data - it is suspect. The CATO Institute did a great short analysis of the WHO numbers

What a lot of this comes down to is philosophy not statistics. There is plenty of evidence that government mandates tend to distort care - Canadians use the American health system for procedures that their system cannot handle (or chooses not to handle). From the reading that I have done there are also some variances among countries based on lifestyle. My suspicion is that we are pretty good at treating some cancers because of the incidence in the population or the level of funded research.

My concern about the Reid/Pelosi proposals is not based on morbidity rates or WHO rankings but broader concerns about the increased demand that the program will produce without any apparent or real concern about increasing the supply of providers. I am also bothered that it is hard to find a government mandated program which operates with high efficiency that does not significantly distort market choices. I am also concerned that while everyone admits that malpractice costs are a major factor in distorting health care costs that neither bill does anything even close to the current California caps on damages.