Selling a Lie

I frequently find myself wondering what, exactly, is the difference between advertising and lying, and doubly so for political advertising.  Well here we are, in the midst of a debate about whether to nationalize a large portion of this nation's health care, and the baloney is flying fast and furious.  Here are two big whoppers I heard on the radio yesterday afternoon, on the same show, from the same guy:

1. The health-care insurance industry has no competition, so we need the government to compete with it.
2. America is 2nd-worst in the world in infant mortality.

One wouldn't expect the first lie to fool anyone, but I heard a version from the White House a couple days ago, so I assume the script has been market-tested.  Thus I must state the obvious: The 'health-care insurance industry' is composed of many doctors, hospitals, and health insurers, all competing with each other.  Where is this supposed lack of competition, and how would government 'compete' with an entire industry? 

In fact, a large part of the problem with the cost of health-care can be traced to current government mandates and restrictions and the ridiculously-low rates that Medicare pays to doctors and hospitals.  They have no choice but to raise their rates elsewhere to make up the difference.  And where I live, the State has actually limited the number of hospitals that can exist in the area.  Seriously: One hospital chain wanted to open a new hospital a couple miles from my house, but it took an act of the State Legislature to permit it!  There is your competitive shortage — mandated by government.  (I'll leave the outrageous cost of malpractice insurance due to lying bastards like, oh, John Edwards, for another day.)

On the second point: America is frequently rated twentieth-best or tenth-best in the world in infant mortality, depending on what organization is doing the analysis and how careful they are to compare 'apples to apples.'  But even the 'tenth-best' figure is wildly unfair to the United States.  The worse figure comes from an advocacy group (guess what they're advocating for!) that apparently can't be bothered to account for the differences, country-to-country, in the definition of a 'live birth.'  In many countries — including Ireland, which is certainly not third-world — a baby that never takes a breath on its own is not considered to have been born alive.  In the US, that baby might put on forced oxygen and counted among the living and then, if it dies despite the best efforts of modern medicine, as an infant that didn't make it.  The UN accounts for this difference in definition, thus rating the US much higher than in some other 'studies.'

But even the UN doesn't fully account for the apples and oranges: In the US, a distressed pregnancy in which the fetus is almost certain to fail will often be treated by emergency Caesarean section, thus turning the distressed fetus into a distressed premature baby with poor chances for survival.  But yet we try and we count it as a live birth, and thus our extraordinary efforts count against us in the infant-mortality statistics.  This is the danger of any such social-science statistic: The unaccounted variables are often far more important that even the researcher knows.

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There are other dubious measures of health-care quality that I have seen over the years, usually ending with the conclusion that the US needs a single-payer system.  A close look at the criteria behind these studies is always repaid.  Invariably, a major criterion is 'equality of access' or 'fairness' by which the researchers mean that everyone gets equal medical treatment; the poorest get treatment equal to the rich, or (conversely) the rich get equal treatment with the poor.  The World Health Organization was not above this sort of circular reasoning in a 2000 report, as described by economist Glen Whitman: 

It is entirely possible to have a health care system characterized by both extensive inequality and good care for everyone.  Suppose, for instance, that Country A has health responsiveness that is “excellent” for most citizens but merely “good” for some disadvantaged groups, while Country B has responsiveness that is uniformly “poor” for everyone.  Country B would score higher than Country A in terms of responsiveness distribution, despite Country A having better responsiveness than Country B for even its worst-off citizens.  The same point applies to the distribution of health level.

The rub is that WHO's fairness and distribution measures accounted for 62.5% of a nation's score in the least biased of WHO's two metrics ('Overall Attainment').  Outcomes — 'Health Level' and 'Responsiveness' — accounted for only 37.5%.  This is not a serious measure of quality.  Worse, the underlying data had only an 80% Confidence Interval, meaning that the US could have ranked anywhere from 8th to 24th in 'Overall Attainment'.  And worst, in a second metric ('Overall Performance'), WHO attempted to adjust 'Overall Attainment' for how well WHO estimated the nation should do, including such beside-the-point considerations as life-style choices, thereby reducing the report to incoherence.  The US dropped to 37th place in the Overall Performance metric.  Canada dropped to 30th.  (OK, I understand how American mega-hamburgers could affect 'Overall Performance,' but what about Canada?  Was it the beer, or the hockey?)

Such studies are, simply put, loaded; the conclusion is written into the criteria along with other conflating (economic, political, and utterly nannyish) considerations.  I don't know whether to attribute this flaw to incompetence, intellectual dishonesty, or outright dishonesty on the part of the 'researchers,' but the result is the same.