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.

Yvonne does it Again

A couple of years ago I wrote a letter to New York Magazine about Yvonne's restaurant on Route 28 past Phoenicia. I said then that dinner at Yvonne's is like a visit to your French grandmother's house, and if you're not French then you're in for a great treat. Yvonne retired two years ago and my wife and I were in mourning/withdrawal in '06, but behold, she reopened in '07 better than ever. The duck is amazing, but I often get the beef bourguignon, the steak, the cassoulet, the boar and several other dishes. Yvonne makes amazing cold cream of fruit soups (last week's was cream of peach) that never cease to blow me away.

On Saturday, rather than a July 4th barbecue, Sharad Karkahnis, Phil Orenstein, Raquel Lacomba Walker and I had dinner at Yvonne's. Personally, I had a blast. Let's hope for many more years!

IF YOU'RE HUNGRY, EAT NCATE

The Steven Head case has a number of important implications. Thirteen months ago, I spoke at a hearing of the Department of Education concerning recognition of the National Council for the Accreditation of Teacher Education (NCATE) as an agency that the government recognizes to accredit education schools. I noted that NCATE has been at the nexus of declining educational achievement in the United States.

In a blog today, Phil Orenstein points out that declining educational attainment is due to the "social justice" education that NCATE advocates:

"I have discussed this with immigrant co-workers and colleagues who are the product of fine technical institutions from Argentina to Israel who lament that the engineering schools and manufacturing programs of America are a joke. The dumbing down of competitive skills, workplace values and discipline in the postmodern academic world has put U.S. scientific and technical education to shame as compared with foreign countries."

The indifference to objective knowledge, factual learning and rigor is characteristic of the anti-foundationalism prevalent in the humanities and in the education schools today. NCATE has adopted failed anti-foundationalist ideology, which it enforces through its accrediting standards. In turn, NCATE's approach to education makes young Americans unemployable. Americans of future generations will starve because of NCATE, but at least they will have NCATE to eat.

Phil Orenstein's point amounts to this. When American jobs leave America, NCATE, the education system and their advocates in the education schools are in no small part to blame.

Steve Head, a Man for All Seasons, Needs Legal Advice

I have previously blogged about Steve Head's courageous pro se lawsuit against the National Council for the Accreditation of Teacher Education, NCATE.

Head had run afoul of the dispositional assessment requirement at San Jose State University College of Education (SJSUCE). His multicultural instructor (sic) told him that he was unfit to teach because he defended the United States in class. Much like an incident at Brooklyn College several years ago involving student Goldwyn and Professor Parmar, SJSUCE used quack "dispositional theory" to fail Head. Head then sued.

Head brought a pro se case to federal court through a section 1983 lawsuit. California State University (CSU), of which SJSUCE is a part, filed a motion to dismiss. The federal San Francisco Northern California District Judge William Alsup agreed with CSU's right to throw out students based on dispositional assessment. Judge Alsup threw out Head's case.

Since then, Head appealed, still pro se, to the 9th Circuit. The briefs (opening, CSU's response, and Head's reply) are filed as of July 2.

Head's is the first federal case and first federal appellate case to consider the constitutionality of using outright quackery, namely dispositions theory, to discriminate against a student. The fight illustrates that the problem with public schools lies partly in their political and legal regulation and partly in the judiciary's willingness to kowtow to their political power, to include NCATE's.

This is a first-impression case that defines the limits of permitted, non-disruptive, classroom speech that challenges the inculcation/indoctrination divide at a time when it is most important in our national life.

Steve's fight is not over multiculturism but rather the use of multiculturalist rhetoric as ideological litmus. Steve's "F" grade was not based on his failure to learn the required materials but due to his professor's dislike for his thoughts, which are entirely mainstream.

The 9th circuit has a reputation for being liberal but also a reputation for defending First Amendment rights such as those Head claims. Typically, pro se appeals in the 9th circuit are assigned to a pro se office in which they are quietly sabotaged by forbidding the pro se litigant to appear before the appellate bar, and instead substituting an in-house lawyer to make oral arguments ostensibly on behalf of the pro se litigant. These steps are implemented in a way engineered to sabotage the case for the sake of reducing 9th circuit caseload and of kowtowing to powerful interests such as teachers' unions and the educationist establishment. What does Judge Alsup care if the schools have let our children down?

Lawyers shy away from representing such cases, I suppose, because they know that if they ever attempted to argue effectively on the record in oral argument, they would run the risk of being blacklisted by judges. In any case Mr. Head finds himself in the situation of having fought CSU legally to a standstill in federal appellate court over whether dispositions, which lack validation, violate first amendment rights of education students.

Head is now in search of a lawyer to represent him to take the heat. He is also looking for amicus briefs and for help with legal fees which he has largely borne himself in the last 3 1/2 years in his fight for better quality public education and students' constitutional rights.

Those interested in helping him may contact him via my e-mail address (mailto: mlangbert@nyc.rr.com).