Are We Having A Conversation Yet?

Some health-care thoughts on the disingenuity of the president and his administration from Ann Althouse.

[Late Sunday night update]

Mark Steyn also has some health-care thoughts:

there he was, reassuring the crowd that the provision for mandatory “end-of-life counseling” has “gotten spun into this idea of ‘death panels.’ I am not in favor of that.” Well, that’s good to know. So good that a grateful audience applauded the president’s pledge not to kill them. He has no plans, as he put it, to “pull the plug on Grandma.”

The problem with government health systems is not that they pull the plug on Grandma. It’s that Grandma has a hell of a time getting plugged in in the first place. The only way to “control costs” is to restrict access to treatment, and the easiest people to deny treatment to are the oldsters. Don’t worry, it’s all very scientific. In Britain, they use a “Quality-Adjusted Life Year” formula to decide that you don’t really need that new knee because you’re gonna die in a year or two, maybe a decade-and-a-half tops. So it’s in the national interest for you to go around hobbling in pain rather than divert “finite resources” away from productive members of society to a useless old geezer like you. And you’d be surprised how quickly geezerdom kicks in: A couple of years back, some Quebec facilities were attributing death from hospital-contracted infection of anyone over 55 to “old age.” Well, he had a good innings. He was 57.

He also points out the asininity of using life expectancy as a figure of merit for different systems, as so many proponents of a government takeover so disingenuously do:

“Life expectancy” is a very crude indicator. Afghanistan has a life expectancy of 43. Does this mean the geriatric wards of Kandahar are full of Pushtun Jennifer Lopezes and Julia Robertses? No. What it means is that, if you manage to survive the country’s appalling infant-mortality rates, you have a sporting chance of eking out your three-score-and-ten. To say that people in Afghanistan can expect to live till 43 is a bit like saying the couple at No. 6 Elm Street are straight, and the couple at No. 8 are gay so the entire street is bisexual.

Which brings us to the United States and its allegedly worst health system in the developed world. Here’s the reality: The longer you live in America, the longer you live. If you’re one of those impressionable “Meet The Press” viewers who heard New York Mayor Michael Bloomberg bemoaning U.S. life expectancy, and you’re thinking, “Hey, I’m 77. Just about at the end, America-wise. Maybe it’s time to move up north or over to Europe, and get a couple of bonus years,” don’t do it! If you’re old enough to be a “Meet The Press” viewer, your life expectancy is already way up there.

America is the Afghanistan of the Western world: That’s to say, it has a slightly higher infant-mortality rate than other developed nations (there are reasons for that which I’ll discuss in an upcoming column). That figure depresses our overall “life expectancy at birth.” But, if you can make it out of diapers, you’ll live longer than you would pretty much anywhere else. By age 40, Americans’ life expectancy has caught up with Britons’. By 60, it equals Germany’s. At the age of 80, Americans have greater life expectancy than Swedes.

How can this be?

He explains. Hint: it’s not because we have socialized medicine.

16 thoughts on “Are We Having A Conversation Yet?”

  1. How can this be?

    It’s because we spend a ton of money on medical care right to the very end. Why is this a bad thing? What else should we spend money on? Again, it’s only an issue when you’re spending money from the public coffers and *someone* needs to turn-off the spigot…just don’t call it a Death Panel!!!!

  2. One of the Dem/Left assumptions about “health care” is that it’s a dwindling, non-renewable resource. That if one person uses an amount of “health care”, that means someone else has to go without. They never talk about increasing the amount of available care, or ways to encourage providers to increase the supply.

    Says something about their mindset and assumptions about the way the world works.

  3. Eh, the current GOP leadership is fighting Obama care by scaring seniors about threats to their entitlement.

    Ross Douthat, today:

    That’s why Republicans find themselves tiptoeing into an unfamiliar role — as champions of old-age entitlements. The Democrats are “sticking it to seniors with cuts to Medicare,” Mitch McConnell declared. They want to “cannibalize” the program to pay for reform, John Cornyn complained. It’s a “raid,” Sam Brownback warned, that could result in the elderly losing “necessary care.”

    Well, okay, but now we have TWO parties telling seniors their entitlements are sacrosanct.

    If the GOP defeats Obama by embracing entitlements more vigorously than Obama, have you really won?

  4. PS – Douthat on the coming “pivot”

    Maybe Republicans will be able to cast themselves as the protectors of entitlements today, and then impose their own even more sweeping reforms tomorrow. That’s the playbook that McConnell, Brownback and others seem to have in mind: first, save Medicare from Obama; then, save Medicare from itself.

    But for now, their strategy means the country suddenly has two political parties devoted to Mediscaring seniors — which in turn seems likely to make the program more untouchable than ever.

    And if you think reform is tough today, just wait. We’re already practically a gerontocracy: Americans over 50 cast over 40 percent of the votes in the 2008 elections, and half the votes in the ’06 midterms. As the population ages — by 2030, there will be more Americans over 65 than under 18 — the power of the elderly and nearly elderly may become almost absolute.

    Defeating Obama today may mean winning the battle but losing the war.

  5. I’d still like to see the numbers that prove all or most of the 2+ year variance is due to infant mortality. However, assuming that is true, why is our infant mortality higher? Could it be that we have more uninsured mothers who get less pre-natal care then in other countries?

    Also, what happens in America to people at age 65? The answer is that they go on socialized medicine (Medicare). Is it possible that once on that system they get better health care?

    See, the other way to spin this (and I admit – I’m spinning, since I don’t have the data either) is that people in poor health die off in America before 65, while in European countries these same folks “limp along” longer.

  6. A big chunk of our higher infant mortality is that we deliver severely underweight babies and fight to save them. Many other countries simply terminate or don’t take extraordinary methods to save the baby outside of the womb. Abortions and miscarriages don’t count towards infant mortality.

  7. Douthat just echoes what I said before. The GOP is transforming into the moderate Baby Boomer party (they’re the old “conservatives” now) while the Dems, at the national level, have been taken-over by the extreme left wing, more in line with the idealistic Gen-Xers. The fight over medical resources has become this year’s battleground.

  8. “Could it be that we have more uninsured mothers who get less pre-natal care then in other countries?”

    How about more babies than other developed countries and more high risk pregnancies going full term?

  9. Bill Maron & Pro Libertate – we’re all making assertions regarding infant mortality, myself included. I’d like to see some actual data. Does anybody have a cite to a statistical analysis?

  10. Titus,

    I am both idealistic and a Gen-Xer, and I am not a leftist. My ideals are libertarian, federal, and republican (n.b. lower case r). These g-d**n leftist twits may be of my age cohort, but their “ideals” are more a romantic attachment to the idea that the State can be effective at improving the life of the citizen — so long as “their side” controls the State.

    The leftist twits of my age cohort act on their totalitarian impulses. I resist mine. Big difference.

  11. I am both idealistic and a Gen-Xer, and I am not a leftist. My ideals are libertarian, federal, and republican (n.b. lower case r).

    To be clear, I’m in no way saying that all Xers are left-of-center. On the contrary, I think libertarianism (small l) is where the Gen-Xers usually sit on the “right” side of the spectrum (that is, social liberalism tends to dominate with Xers of all stripes). Nor are all Boomers XYZ — I was really talking about who’s in control of the parties now.

    Really, what divides Americans (and has since the inception) is individualism vs. collectivism. It’s a zero-sum game — every liberty held by the people is power denied to the collectivists. This divide is much clearer with Xers than with Boomers (who are more divided on social issues).

  12. It’s been demonstrated in the past that the reason has a higher infant mortality rate is that we try to save more premature births, and succeed, but those who die add to our count.

    They aren’t counted in other countries rates, they just don’t make any atempt to save them.

  13. It’s been demonstrated in the past that the reason has a higher infant mortality rate is that we try to save more premature births, and succeed, but those who die add to our count.

    I’ve been looking for a cite to support this. The only reference I’ve found is to an NY Times report which references the CDC.

    Only, reading the link and the CDC stuff I don’t think it says what you think it says.

    http://www.cdc.gov/omhd/AMH/factsheets/infant.htm

    There was another more interesting one on the huge differences in mortality rates based on class and race though.

    http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1615523

  14. I love Steyn, I loved the story of the old lady with the Gout that her home GP never spotted.

    Funny thing that, but as Rand is oft heard to say, data is not the plural of anecdote.

    I have an elderly British lady I use for reference purposes like this. She recently was diagnosed with an under-active thyroid – of course, she had to get to the point where she was almost too ill to get to the Doctors before she mentioned all the symptoms she’d been having, because, well, you know she’s getting on a bit and wouldn’t want to cause a fuss…

    Once she told the Doctor she did, in the space of a few weeks, get the thyroid fixed, saw a cardiologist about the arythmia that that caused and get that fixed too.

    I’ve a few anecdotes about that generation.

    The net net is still the same. The US gets roughly the same level of service for more than twice the cost.

  15. The net net is still the same. The US gets roughly the same level of service for more than twice the cost.

    What does this really mean? Does it mean that an annual check up in England cost $50, while one in the US costs $100? Does it mean that the US spends a lot on medical R&D, while other countries spend comparatively little and get a bit of a free ride? Does it mean that you are more likely to get a private or semi-private room when admitted to a hospital in the US vs. getting placed on a ward in Canada? Does it mean that we could cut the Medicare and Medicaid budgets in half and see no impact? Does it mean that in the US, citizens are more likely to get the latest treatments? Without clear metrics, this kind of statement is meaningless.

  16. Without clear metrics, this kind of statement is meaningless.

    I think that’s what they’re aiming for, much like the 40, no 50 million uninsured number which includes everyone under the sun (such as people who qualify for public assistance but haven’t signed up).

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