Wintery Knight

…integrating Christian faith and knowledge in the public square

American health care: does it cause poor life-expectancy and high infant mortality?

Probably one of the best health care policy experts writing today is Avik Roy, who writes for Forbes magazine.

Here is his latest column, which I think is useful for helping us all get better at debating health care policy. (H/T Matt from Well Spent Journey)

Excerpt:

It’s one of the most oft-repeated justifications for socialized medicine: Americans spend more money than other developed countries on health care, but don’t live as long. If we would just hop on the European health-care bandwagon, we’d live longer and healthier lives. The only problem is it’s not true.

[...]If you really want to measure health outcomes, the best way to do it is at the point of medical intervention. If you have a heart attack, how long do you live in the U.S. vs. another country? If you’re diagnosed with breast cancer? In 2008, a group of investigators conducted a worldwide study of cancer survival rates, called CONCORD. They looked at 5-year survival rates for breast cancer, colon and rectal cancer, and prostate cancer. I compiled their data for the U.S., Canada, Australia, Japan, and western Europe. Guess who came out number one?

Here is the raw data:

Health care outcomes

Health care outcomes by country and type of treatment

Click here to see the larger graph.

So, what explains this?

The article continues:

Another point worth making is that people die for other reasons than health. For example, people die because of car accidents and violent crime. A few years back, Robert Ohsfeldt of Texas A&M and John Schneider of the University of Iowa asked the obvious question: what happens if you remove deaths from fatal injuries from the life expectancy tables? Among the 29 members of the OECD, the U.S. vaults from 19th place to…you guessed it…first. Japan, on the same adjustment, drops from first to ninth.

It’s great that the Japanese eat more sushi than we do, and that they settle their arguments more peaceably. But these things don’t have anything to do with socialized medicine.

Finally, U.S. life-expectancy statistics are skewed by the fact that the U.S. doesn’t have one health-care system, but three: Medicaid, Medicare, and private insurance. (A fourth, the Obamacare exchanges, is supposed to go into effect in 2014.) As I have noted in the past, health outcomes for those on government-sponsored insurance are worse than for those on private insurance.

To my knowledge, no one has attempted to segregate U.S. life-expectancy figures by insurance status. But based on the data we have, it’s highly likely that those on private insurance have the best life expectancy, with Medicare patients in the middle, and the uninsured and Medicaid at the bottom.

I know that my readers who like to dig deep into economics and policy will love the links at the bottom of the article:

For further reading on the topic of life expectancy, here are some recommendations. Harvard economist Greg Mankiw discusses some of the confounding factors with life expectancy statistics, citing this NBER study by June and Dave O’Neill comparing the U.S. and Canada. (Mankiw calls the misuse of U.S. life expectancy stats “schlocky.”) Chicago economist Gary Becker makes note of the CONCORD study in this blog post. In 2009, Sam Preston and Jessica Ho of the University of Pennsylvania published a lengthy analysis of life expectancy statistics, concluding that “the low longevity ranking of the United States is not likely to be a result of a poorly functioning health care system.”

The funniest thing I have found when talking to people from countries with socialized health care systems, like Canada and the UK, is that they are woefully uninformed about American health care. They literally do not know about free emergency room care, which is free for anyone regardless of insurance – including illegal aliens. They do not know about our expensive Medicaid program, which helps people who cannot afford health insurance. And our very very expensive Medicare program, which provides health care to the elderly – including prescription drugs. I get the feeling that foreign critics of American health care are getting their views from amateur documentaries produced by uneducated Hollywood propagandists, or maybe from TV shows on the Comedy Channel. They certainly are not getting their information from peer-reviewed studies by credentialed scholars from top universities, like the ones cited above.

I have literally spoken to Canadians who think that people in the USA without insurance do not get treatment and just die in the streets from stab wounds. They don’t know about the emergency room rule, or about charity care, or about Medicaid and Medicare. There is a lot of ignorance up there – wilful ignorance, in some cases. And keep in mind that the average Canadian household is paying over $11,000 a year for this substandard health care! They are paying more for less, and that’s not surprising since a large chunk of the taxes that are collected for health care go to overpaid unionized bureaucrats. Naturally, when their left-wing politicians need treatment, the first place they go is to the United States, where they pay out of pocket for the better health care. But that doesn’t stop them from denouncing American health care when they are talking to voters.

Higher infant mortality rates?

One of the other common arguments you hear from uninformed people outside the USA is the higher infant mortality rates argument.

Here’s an article by Stanford University professor Scott Atlas to explain why the argument fails.

Excerpt:

Virtually every national and international agency involved in statistical assessments of health status, health care, and economic development uses the infant-mortality rate — the number of infants per 1,000 live births who die before reaching the age of one — as a fundamental indicator. America’s high infant-mortality rate has been repeatedly put forth as evidence “proving” the substandard performance of the U.S. health-care system.

[...]n a 2008 study, Joy Lawn estimated that a full three-fourths of the world’s neonatal deaths are counted only through highly unreliable five-yearly retrospective household surveys, instead of being reported at the time by hospitals and health-care professionals, as in the United States. Moreover, the most premature babies — those with the highest likelihood of dying — are the least likely to be recorded in infant and neonatal mortality statistics in other countries. Compounding that difficulty, in other countries the underreporting is greatest for deaths that occur very soon after birth.

[...]The United States strictly adheres to the WHO definition of live birth (any infant “irrespective of the duration of the pregnancy, which . . . breathes or shows any other evidence of life . . . whether or not the umbilical cord has been cut or the placenta is attached”) and uses a strictly implemented linked birth and infant-death data set. On the contrary, many other nations, including highly developed countries in Western Europe, use far less strict definitions, all of which underreport the live births of more fragile infants who soon die. As a consequence, they falsely report more favorable neonatal- and infant-mortality rates.

[...]Neonatal deaths are mainly associated with prematurity and low birth weight. Therefore the fact that the percentage of preterm births in the U.S. is far higher than that in all other OECD countries — 65 percent higher than in Britain, and more than double the rate in Ireland, Finland, and Greece — further undermines the validity of neonatal-mortality comparisons.

You can listen to a podcast with Dr. Atlas here, from the Library of Economics web site.

If you want to read more about how American health care compares with health care in socialized systems, read this article by Stanford University professor of medicine Dr. Scott Atlas. And you can get his book “In Excellent Health: Setting the Record Straight on America’s Health Care” from Amazon.

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Quebec citizens dissatisfied with expensive government-run daycare

IMFC researcher Andrea Mrozek writes about a new survey in the Montreal Gazette.

Excerpt:

For 16 years, the Quebec government has been providing highly subsidized daycare. Canada-wide and indeed internationally, this $7-a-day system is praised as a leading example and the path to follow.

The question is whether Quebecers actually feel that way.

Our recent poll about Canadians’ daycare desires shows some interesting results in Quebec (imfcanada.org/daycaredesires/Quebec). When asked what Quebecers ideally prefer for children under age 6, a competent caregiver or a parent, 70 per cent of Quebecers say a parent.

In short, a clear majority of Quebecers believe that the best place for children under 6 is with a parent — in spite of having a provincially funded system that gives preference to daycare centres.

A second surprising result also emerged. When given options about how governments should help parents with child care, almost half of Quebecers polled (45 per cent) said money should go directly to parents. This option was placed next to other options like subsidies to childcare centres, child-tax deductions or providing funding exclusively for families in need, among others.

Surprisingly, more Quebecers believed that money should go directly to parents; by way of contrast, 25 per cent of Canadians outside Quebec said governments should provide cash payments directly to parents.

These poll results leave us with a lot to think about with regard to how governments enact childcare policy. Seven in 10 Quebecers believe the best place for a child under six is with a parent. Yet the government’s public policy on that point does not remotely reflect this desire.

In fact, when the government introduced its policy of subsidized daycare, other family funding and programs were cut. Scholars have shown how other family benefits were cancelled as Quebec ramped up spending on institutional daycare.

Some may think the Quebec program is very popular simply because so many parents use it. That may not be the case. Anytime a government provides a service at lower-than-market costs, it provides an incentive to use that service. The reality is that child care is actually very expensive, regardless of who provides it. When the government provides it, we are all paying for it through increased taxes.

In our poll, we asked simple and somewhat idealistic questions as to where children under 6 are better off. “What is best for children” is not necessarily the same as asking about what is possible for families. The two ought not be confused, of course. There might be many parents who think their presence would be better for their kids, but they simply cannot afford to stay home. Personal circumstances are just that, personal, and they vary from family to family.

Still, there should still be a place for idealism — for a blue-sky view of how we would like things to go. And public policy should assess opportunity costs and unintended consequences. Where public policy is divorced from citizens’ desires, it does taxpayers a disservice. In effect, it means taxpayers are paying for something they would rather not use.

Quebec is the most liberal province in Canada, and it only survives because it receives massive transfers of wealth from the other business-friendly provinces. But that doesn’t stop them from sneering at their enablers, or from passive expensive socialist programs. But they do serve as a lesson to us – government doesn’t do child care better than moms and dads. And we shouldn’t be paying them massive amounts of money them to do things that they don’t do well. The ideology of feminism isn’t more important than the needs of children.

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Crime in Canada reaches lowest level in 40 years due to Conservative party policies

Prime Minister Stephen Harper

Prime Minister Stephen Harper

From the National Post.

Excerpt:

New figures show Canada’s crime rate dipped to its lowest level in 40 years last year, the very year the federal government enacted some of its harshest tough-on-crime policies.

Just under two million criminal incidents were reported to police in 2012, about 36,000 fewer than the previous year, according to a Canadian Centre for Justice Statistics study on police-reported crime.

The decline is primarily attributed to decreases in non-violent crimes. In fact, 2012 marked the ninth consecutive year that both the volume and severity of crime was down.

According to the study, 543 homicides were reported across the country, 55 fewer than in 2011. Youth crime was also down.

“As a result, the homicide rate fell to its lowest level since 1966,” the report concluded.

Relaxing gun control laws was also likely a factor:

Although crime rates have been falling for years, the federal government passed a controversial omnibus crime bill early last year. It set a number of mandatory minimum penalties for drug trafficking and sex crimes against children and got tough on pot producers, young offenders, Canadians imprisoned abroad seeking a transfer to a Canadian institution and ex-cons seeking a pardon.

The government also scrapped the controversial long gun registry last year.

A gun registry is nothing but a promise that the government will confiscate weapons later. When the registry goes away, people feel safer about buying guns. The more citizens who are legally armed, the worse it is for criminals.

I’m posting this to show that unlike our own government, some governments are actually doing things that work to solve problems. But all of this goes back to qualifications. Stephen Harper has the BA and MA in Economics. He is an economist, so he understands how laws and policies influence human behavior. That’s why when he makes a policy, he gets the results he wants to get. He actually knows what he is doing. He is actually doing work that he knows how to do. It can happen.

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Is environmentalism good for the environment?

Although I am not a global warming alarmist, I am concerned with conservation. So, all things being equal, I think it’s a good idea not to pollute the environment unnecessarily. Now, you might think that environmentalists agree with me on that.

Let’s take a look at this article by Bret Stephens from the Wall Street Journal where he writes about how a train that was transporting shale oil was derailed and then exploded. (H/T Dennis Prager)

Excerpt:

The derailed 72-car train belonged to a subsidiary of Illinois-based multinational Rail World, whose self-declared aim is to “promote rail industry privatization.” The train was carrying North Dakota shale oil (likely extracted by fracking) to the massive Irving Oil refinery in the port city of Saint John, to be shipped to the global market. At least five people were killed in the blast (a number that’s likely to rise) and 1,000 people were forced to evacuate. Quebec’s environment minister reports that some 100,000 liters (26,000 gallons) of crude have spilled into the Chaudière River, meaning it could reach Quebec City and the St. Lawrence River before too long.

Now the question is, why is it that trains are used instead of pipelines, when pipelines are safer than trains?

Let’s see why:

The reason oil is moved on trains from places like North Dakota and Alberta is because there aren’t enough pipelines to carry it. The provincial governments of Alberta and New Brunswick are talking about building a pipeline to cover the 3,000-odd mile distance. But last month President Obama put the future of the Keystone XL pipeline again in doubt, telling a Georgetown University audience “our national interest will be served only if this project does not significantly exacerbate the problem of carbon pollution.”

[...]Like water, business has a way of tracing a course of least resistance. Pipelines are a hyper-regulated industry but rail transport isn’t, so that’s how we now move oil. As the Wall Street Journal’s Tom Fowler reported in March, in 2008 the U.S. rail system moved 9,500 carloads of oil. In 2012, the figure surged to 233,811. During the same period, the total number of spills went from eight to 69. In March, a derailed train spilled 714 barrels of oil in western Minnesota.

Predictable, you would think. And ameliorable: Pipelines account for about half as much spillage as railways on a gallon-per-mile basis. Pipelines also tend not to go straight through exposed population centers like Lac-Mégantic. Nobody suggests that pipelines are perfectly reliable or safe, but what is? To think is to weigh alternatives. The habit of too many environmentalists is to evade them.

Investors Business Daily has more on the benefits of pipelines:

Railways suffer spills 2.7 times more often than pipelines, according to the Washington-based Association of American Railroads. If that seems self-serving, the State Department, citing a 2012 study from the free-market Manhattan Institute, said trains spill 33 times more oil than pipelines.

[...]“The evidence is so overwhelming that railroads are far less safe than pipelines,” says Charles Ebinger, director of the Brookings Institution’s energy security initiative.

Brookings is a left-leaning think tank, and they agree: pipelines are safer than trains.

It does make sense, I think, for Christians and conservatives to ask ourselves sensible questions about the environment. How do we make air clean enough? How do we make water clean enough? How do we avoid impacting nature unnecessarily? But I think this story about the train should help us realize that fundamentalist environmentalists are not the best people to be making these sorts of policy decisions. These decisions should be made by rational thinkers, who can consider all sides of an issue and think critically about the needs of everyone concerned. This is not a problem for secular leftist idealists who are more motivated by blind faith than by facts.

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Canada repeals Section 13 law that criminalized politically incorrect speech

Canada Political Map

Canada Political Map

Sun News reports on some good news up north.

Excerpt:

An Alberta MP has succeeded in his bid to repeal a section of the Canadian Human Rights Act long seen by free-speech advocates as a tool to squelch dissenting opinions.

Conservative MP Brian Storseth saw the Senate give third and final reading late Wednesday to his Bill C-304 which repeals Section 13 of the Human Rights Act, an act that had been used to, among other things, attack the writings of Sun News Network’s Ezra Levant and Maclean’s columnist Mark Steyn.

Section 13 ostensibly banned hate speech on the Internet and left it up to the quasi-judicial human rights commission to determine what qualified as “hate speech.” But, unlike a court, there was no presumption of innocence of those accused of hate speech by the commission. Instead, those accused had to prove their innocence.

With elimination of Section 13, producing and disseminating hate speech continues to be a Criminal Code violation but police and the courts will adjudicate rather than human rights tribunals.

Storseth drafted his bill in 2011 and enjoyed support from the highest levels in cabinet.

“Our government believes Section 13 is not an appropriate or effective means for combating hate propaganda,” Justice Minister Rob Nicholson said in late 2011. “We believe the Criminal Code is the best vehicle to prosecute these crimes.”

Last summer, Storseth’s bill cleared the House of Commons in a free vote and, now that it’s through the Senate, it will get royal assent and Section 13 should soon disappear.

Brian Lilley comments: (H/T Blazing Cat Fur)

To put it bluntly, the means you can’t take someone through the federal human rights apparatus over hurt feelings via a blog post or a Facebook comment.

Now the bill is passed and will become law but like many acts of Parliament it will not come into force for a year.

Still after a long hard battle to restore free speech in Canada, this is a victory.

Canada just became a little more free. Congratulations to Stephen Harper and the Conservative Party of Canada for undoing a harmful policy enacted by the radical left.

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