October 12, 2009

Absence of Reason in the U.S. Health Care Debate

healthcare_graphImage by jonathantellerelsberg via Flickr

Reason appears to be largely absent from the current debate over health care reform in the U.S., and this is true for both sides: the far right and the center right. In this post, I want to briefly address what I see as the single most obvious sign of reason's absence. There are many others, but I am picking this one because it is so simple I would expect anyone to understand it. What I'm talking about is the chasm between public perceptions of the relative standing of U.S. health care quality and the well publicized facts about how health care in the U.S. compares to that of other nations.

This post was prompted by a simply poll I encountered on Facebook. The question was: "Do you think the United States has the best health care system in the world?" My initial reaction upon reading the question was that it didn't matter what I thought because the facts are quite clear.
  • According to the World Health Organization, the U.S. health care system ranks 37th out of 191 countries. (While we were #1 in responsiveness, our score suffered from our lack of universal health care. That is, we would have scored much higher if our health care system wasn't so damned expensive.).
  • Health care costs in the U.S. far exceed that of any other nation.
  • Using any of the common statistical indices of health (e.g., life expectancy, infant mortality, etc.), the U.S. falls well below other developed nations.
So, what exactly does it mean to say that we have the best health care system in the world? If one defines "best" as most expensive without regard to quality, then the U.S. would have the best health care system in the world. However, this is not how most of us would define it. By "best," we tend to be interested in outcomes. Here, it is quite clear that the U.S. ranks far lower than most developed countries.

The question of what one thinks about health care is still valid. Perhaps questions like this are intended as indirect measures of irrationality. What are we to make of those who answered "yes" to the Facebook poll? Some may not have taken the question seriously. Among those who did, those answering "yes" would have to be thoroughly misinformed, lying, or some combination of these possibilities.

The reasoned approach would reflect the data. Conclusions would be based on facts rather than opinions. When so much is at stake in this debate, it is sad that idiocy once again prevails.