Health-Care Myths

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 16^th-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]