Saturday, July 7, 2007

Response to David Hogberg's Analysis of the Mortality Rate/Health Reform Nexus

David Hogberg, Ph.D. of the National Center for Public Policy Research argues that life expectancy and infant mortality rates are not good indicators of the quality of the American health care system.

His point is worth considering because arguments for increased government involvement in the financing of health care often rest on the claim that US mortality rates are not lower than other countries', but our health care costs are higher. There is little argument that our health care costs are considerably higher than all other countries'. According to Dr. Hogberg, health care spending does not extend life. If Dr. Hogberg is correct, then current debate about health reform is misguided. If he is correct, it would be better to de-fund our health system rather than continue to subsidize a system that is very expensive and does little to extend life.

Health costs' not increasing mean life expectancy implies either that a small percentage of people incur the costs and their lives are extended, but they are too few in number to influence the mean; or that medical care is a sham and does not extend life. In either case, it would suggest that our current system is a failure, and the reason is that modern medicine does not work well.

If medical care does not improve life expectancy, questions that ought to be asked are:

-"Why are physicians licensed?"
-"Why are tax exemptions given to health plans?"
-"Why are hospitals not closed down from a plethora of fraud suits?"

Perhaps they should be. If the health care system does not extend life, then the promise of modern medicine has been vastly exaggerated. The question isn't socialized medicine versus private medicine. The question is, do we pay for bogus treatments or not?

In addition, Dr. Hogberg argues that life expectancy is not a good indicator of the quality of health care systems because it does not control for interaction with the health care system. Many people die without having seen a doctor. But on this point Dr. Hogberg begs the chief criticism of the American health care system: lack of access. Unless there is reason to believe that random events like sudden death heart attacks or sudden death car accidents occur at greater rates in the United States, the question of access is the chief concern of proponents of a national health plan. Access in America is the worst in the industrialized world, so saying that lack of interaction explains high mortality rates concedes the critics' chief point. It is anything but an argument for not using mortality as a measure of the quality of health care.

If many people are not obtaining access to the US system, then, argue critics, that is a serious problem that Dr. Hogberg seems to explain away. If there is limited access say by poor people, then the system has an access problem. Saying that lack of interaction excuses the system from criticism begs the question of why access in the US is poor, despite the extremely high costs (roughly 50% more than many other industrialized countries').

However, Dr. Hogberg's point that the health care system does not affect mortality is potential dynamite. If not, why have a health care system at all? Dr. Hogberg suggests that "a health care system has, at most, minimal impact on longevity." If this is so, I am puzzled as to why we are spending 16 percent of our gross domestic product on it. Shouldn't people assume that when they receive cancer treatments that the treatments will have an effect on extending their lives? What part of health care spending is the part that we should assume doesn't extend life?

If there is any merit to Dr. Hogberg's argument, it would seem that there needs to be considerable reevaluation of why we are spending 16 percent of gdp on health care. There needs to be validation of what the system is accomplishing. Where is the data? Are we spending more on cancer treatments than other countries, and if so, do those treatments prolong life? If not, why are we spending money on the treatments?

Christian Scientists limit their exposure to physicians and the health system. How different is the life expectancy of Christian Scientists from those who visit physicians?

Dr. Hogberg claims:

"A health care system has, at best, minimal impact. Thus, life expectancy is not a statistic that should be used to inform the public policy debate on health care."

Far from defending the current system, Dr. Hogberg seems to imply that it is fraudulent. This may be the case. I am puzzled, though, why the public does not make greater demands for validation of current treatment approaches, and why the public continues to be happy with a system that has minimal effect on life extension (if that is the case). Perhaps as a nation we need to revert to the common sense of earlier generations and demand results. Physicians who do not heal should not be paid.

If health care does not extend life, government should be removed from it. Since they are fakes, doctors do not deserve to be licensed, and the public should not support health care through subsidies of hospitals, tax exemptions or deductions for employer plans. Validation statistics should be published, just as McDonald's publishes the calories in a big mac with cheese, so we can validate whether there is anything to health care's life extension potential.

Not only should the system not be nationalized or socialized; it should be debunked. The public should demand that health care justify itself by proving that its treatments work. Dr. Hogberg suggests that they do not.

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