Monday, August 04, 2008

Infant Mortality Comparisons.

That I'm not a fan of socialized medicine probably doesn't come as much of a surprise to the readers of this blog. While I don't want to get into a big debate about the pros and cons of government run health care per se (that's a post for another day) I did want to draw attention to this article that the wife emailed me last night.

One of the long standing arguments in favor of government run health care is that certain populations within a society gain access to medical services that they wouldn't get in a private model (I should mention as an aside that the United States emphatically does NOT have a private health care system but rather a mixed one of private and public providers each of whom service patients based on various criteria ranging from ability to pay to it's converse-need.). Whether that's really true or not is I think more open to debate than people realize. For every American twentysomething who didn't get health insurance and now finds themselves with a crippling illness there is a European who can't get a kidney transplant unless they fly to America for one and pay for it themselves. For fans of government run health care, this sort of thing tends to be rather embarrassing. So much for the government taking care of your health care needs in exchange for all those high taxes.

One thing that socialized medicine did do indisputably well though, was was combating infant mortality...or so it seemed. I vividly remember being taught as a child in the 1970's and 80's that countries with government run health care systems had much lower rates of infant mortality than the United States. Supposedly the difference was caused by greater foreign emphasis on low-cost prenatal care given away freely by the state as opposed to the more American approach of throwing lots of money at someone who was already sick. While one model might be better or worse for an individual depending on their circumstances, in the aggregate the statistics indicated that that the socialized medicine model was better for society.

The problem is that none of it is true.

Each country calculates infant mortality statistics their own way. As a result you're lucky if you wind up comparing things as similar as apples and oranges. In the United States we count babies as "live births" if they show any sign of life whatsoever (breathing, heartbeats, movement) and any subsequent deaths are counted. Not so elsewhere. Most other countries don't consider babies below a certain weight or size as viable (and thus outside the sample for infant mortality statistics). Not only does this distort comparisons of health care systems, but there is reason to believe that it undermines incentives to save premature infants.

Socialized medicine may have some strong arguments in it's favor, but quality of care isn't one of them. It defies reason to believe that the vast sums spent by this country account for nothing. Couple that with a healthy fear of screwing up thanks to America's tort lawyers and the notion that our doctors and nurses are being outperformed by a bunch of europeans who have an incentive structure for workplace excellence comparable to the one we see in action at the Department of Motor Vehicles becomes laughable.


Harry Hook said...

There's a lot to commend both systems, but I was always led to believe that insurance fraud was a major problem concerning US healthcare. Here in the UK, we have our elected representatives to bugger things up. So, my advice is... wherever you are... stay healthy.

Mike Stajduhar said...

Fraud is definitely an issue but the the primary difficulty is that the people making treatment decisions are not the ones making payment decisions.

Imagine if autos were like health care. You, like most Americans have insurance so you go to the dealership to buy a new car. All you think you need is say a Ford...basic transportation but the dealer points out how much safer you'll be if you get the BMW. Besides your insurance will pay for why not? In fact if he doesn't recommend the BMW and you get injured because your car wasn't optimally safe he'll get sued. Needless to say this leads to a lot of folks wind up getting the BMW version of health care which leads to an inflationary spiral in insurance costs.

It didn't used to be this way. Before the Second World War (and for a good while after) most Americans paid for their health care expenses out of pocket much as you would a plumber or house painter. In addition, the prudent would acquire "Major Medical" insurance would would cover large unforeseen medical costs.

Just as WWII ushered in the National Health Service, the modern system in the U.S. is also a result of the war. From 1942-45 the U.S. had wage and price controls in an effort to limit wartime inflation. The top income tax rate was over 90% and there was a huge labor shortage. How then do you lure workers to to your shipyard as opposed to the aircraft factory on the other side of town?

Henry Kaiser was the first to figure it out. He realized that if he gave his employees non-financial benefits, most notably free babysitting and health care, he could steal workers from his rivals and build all those landing craft that the Marines made so famous at places like Iwo Jima. Thus the modern American system of employer provided health insurance was born. Interestingly the Kaiser's shipyard is long gone but the company he set up to run the health care part of the business Kaiser Permanente is still going strong.