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Sunday, October 25, 2009

Apples are Apples, Oranges are Oranges, and Never the Twain Shall Meet

In the current national debate over health care reform, how many of us have listened to politicians, pundits, and journalists and even well meaning friends and family members spew out ominous sounding statistics describing just how terrible America's health care system is compared to other more progressive countries?

I'm sure all of us have heard at least more than just a few times how America is ranked 37th in the world in health care according to the World Health Organization (WHO) or how America is lagging far behind other industrialized and supposedly enlightened--and by inference, 'better'--countries in infant mortality, preventable mortality, and life expectancy despite the fact that we spend more than any other country as a percentage of GDP on health care.

Well, today I had the chance to listen to these same statistics during a presentation on why America should move to a single payer system from some of my classmates in our economics class. It was a well prepared presentation with great graphics and impressive graphs and all the usual rhetoric that is associated with those that argue for a single payer system or other radical change in our current health care system.

At the end of the presentation, there was some spirited debate around the pros and cons of a single payer system in America. One of my questions to the presenters was "do you know the populations of the countries you are comparing us to"? Surprisingly, none of the six presenters could answer the question despite their obvious facile knowledge of the "wonderful" health care statistics that each of those countries had.

I then pointed out to them that the average population of the European nations they had compared us to was about 50 million (ranging from 9 to 87 million) compared to 350 million in the US and that it was rather disingenuous to compare economies of scale in delivering and administering health care between countries with 9 to 87 million people (Sweden, Spain, France, England, and Germany) and ours with 350 million. I reminded them that apples were apples and oranges were oranges and that they were comparing apples to oranges.

During the presentation and the ensuing debate, I kept thinking about one of my old medical school professors who used to say that "statistics were for liars", meaning of course, that if one looked hard enough, anyone could find statistics or at least an 'expert' to support any point of view.

Unfortunately, the time allotted for questions and debate after the presentation was not long enough for me to ask the next most obvious questions regarding their research and statistics which would have included the methodology used by the WHO in making the rankings, the benchmarks or indicators used to make the rankings, the presence or absence of assumptions and confounding variables, and the presence or absence of potential scientific and/or political bias in the methodology.

In all fairness to my classmates, I did not know the answers to these questions and although I had heard these statistics spewed out over and over again during the recent national debate, I had never critically questioned the data. Like so many others, including my classmates, I had just naturally assumed that since the pundits and politicians and other 'experts' were spewing this information out as gospel, it must have been verified and validated.

When I got home from class and actually looked up the data, I was quite surprised to find that the data and statistics presented by my classmates (and the current administration) was from the last WHO report on national health care systems almost a decade ago in 2000. I was equally surprised--and disturbed--to find out that the WHO stopped comparing and reporting on national health care systems because "of inherent problems with methodology and definitions".

In fact, equally disturbing was the fact that the 2000 report was renounced and criticized by the 'editor-in-chief' of the report itself, after he learned the actual methodology used to generate the report!

The intent of this posting is not to denigrate or marginalize the work or the values and beliefs of my esteemed classmates--unlike the current administration's strategy used with those with whom they disagree. In all fairness to them, this was an assignment that was prepared in 2 to 4 weeks and I certainly do not expect them to have become expert economists or health care analysts in our first year of our MBA program--especially, considering that none of them come from a health care background.

What is bothersome to me is that our politicians, pundits, and other media experts are spewing out this information as if it is the Gospel according to Matthew, Luke, John, and Obama. Now while I can understand our politicians 'tailoring the statistics' to their individual agendas, it is deplorable that the so called 'experts' in the media who are supposed to be ever critical and objective, are parroting these same statistics that are grossly outdated, compiled through questionable methodology, rife with statistical and political bias, and just plain horse dung!

If we are to have any kind of meaningful debate in this country regarding health care reform, we need to all play by the same rules which means understanding the common rules and definitions used in any scholarly debate--that is we must always be objective, be always critical of the data, be ever vigilant for potential bias (scientific and political), and we must always remember to leave our personal, religious, and political agendas at home! In short, if we are going to talk fruit--let apples be apples and oranges be oranges and never the twain shall meet (except maybe in fruit salad).

For more discourse on this subject, I have included two recent articles from the New York Times and the Wall Street Journal below.

John R. Vigil, MD, FACPE
Fellow, American College of Physician Executives
CEO and Medical Director,
Doctor On Call

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