The scientific process in action — Where is the evidence for governmental efficiency?

Scientific literacy isn’t the stuff found in a science textbook. That’s science literacy — and, while understanding the principles of science is important too, it’s not as important as knowing how to think and reason. Scientific literacy means the scientific process — also known as thinking critically and logically. It’s a way to carefully look at information, question ideas and test them, and make decisions based on the best information and evidence. It’s what protects us from being taken in by unsound things or letting the fallacies of logic* get the better of us. What might feel intuitively correct to us, and everyone around us, often isn’t.

The scientific process is what ordinary people do — no fancy degree required. According to Dr. Jon D. Miller, Ph.D., director of the Center for Biomedical Communications at Northwestern University Medical School in Chicago, has tracked scientific literacy for more than thirty years and said that only 20-25 percent of Americans are “scientifically savvy and alert,” and that most of rest of us “don’t have a clue.” The National Science Foundation estimates that 70% of Americans don’t understand the scientific process, or how to think.

Metacognitive research has also shown that the more emotional and the more emotionally involved people are in an idea, the harder it is to apply the scientific process and question or test their beliefs. That’s what makes the exception being seen in the debates over healthcare reform so remarkable. Growing numbers of ordinary people are questioning things they hear, going to original sources, and trying to reason through the information for themselves. Most interestingly, the questions they raise are often better than anything the experts can answer.

Thought-provoking questions and missing answers

One writer whose questions best showed the thinking process in action said that after reading everything he could find, he found a “giant morass of conflicting claims” about healthcare and that the answers to good questions never really answer the questions. “In short,” wrote Robert S. Siegel, “I have seen no evidence that would cause me to believe that either of these approaches [a government health insurance option or single payer government run health insurance] will improve health care, but good evidence that both options will become major barriers to making real improvements to health care.”

See if his questions don’t jolt us all into looking beyond the media and to think through claims more critically for ourselves, too. As he begins:

1. How do we pay for all of this now and long term?...And costs will rise. What is the plan? I don’t accept that we just have to do this and can’t slow down to figure it out. Do supporters really understand how much this will cost? Convince me that you do.

2. What are these “Cost savings” that Obama talks about? Are we relying on one big negotiating entity to drive down costs? That has worked so well for military spending over the years (that was a satirical statement). The efficiencies that are supposed to come from this plan sound unrealistic, as though no one worked through the tactical details to see if there really are efficiencies to be brought out.

a. The plan to save money by fighting obesity is cruel and unrealistic…

3. If we move to single payer health care that means one entity will directly manage all health care spending and as a result, indirectly manage the entire health care industry. Do you know of any examples where one entity, public or private, runs something as large as 20% of the U.S. economy, and does it successfully?

a. What causes people to think that a government takeover of the bureaucratically complex business of medicine is going to make it less complex?...Better? How?...

4. If government health care does not work, do we have an exit strategy?...

My fundamental question, the summation of the above ten question is this: Will the plans currently under consideration improve health care or make the system worse than it is today? If you think it will be an improvement, can you please explain why, rationally and with facts and not hyperbole?

Show us the evidence

A Wall Street Journal article also asked healthcare reform advocates to “show us the evidence.” The author shared questions being raised by seniors, based on “experience and common sense.” Seniors have “exposed a fundamental truth about what Mr. Obama is proposing: Namely, once health care is nationalized, or mostly nationalized, rationing care is inevitable, and those who have lived the longest will find their care the most restricted.”

The existence of rationing is the argument being used to support universal health coverage. Because “rationing” exists in the free marketplace, it is argued that a government healthcare system is needed. The ability to pay is being called “rationing” when it comes to health care. “Yet no one would say we ‘ration’ houses or gasoline because those goods are allocated by prices,” it said. In a free market economy and a world of finite resources but infinite wants, every good and service could be said allocated by ability to pay.

But there’s an ocean of difference between coverage decisions made under millions of voluntary private contracts and rationing via government, the author wrote. “The problem is that governments ration through brute force—either explicitly restricting the use of medicine or lowering payments below market rates. Both methods lead to waiting lines, lower quality, or less innovation—and usually all three.”

Rationing isn’t a logical reason for universal health reform. As the author points out, rationing is found in universal health care throughout Europe, which restricts access to health care to control costs. And Medicare already rations care, refusing to pay for certain drugs, procedures and care. So, it asks, why would the President want to add to our financial burdens by expanding a Medicare-like program to everyone?

A similar question was posed in another Wall Street Journal article. The author, Alan B. Miller, is a hospital service administrator, but he pointed out what the general public may not know, although it’s well-known among medical professionals: The existence of private health insurance and private pay options is what has kept public plans possible.

“Medicare works because hospitals subsidize the care they provide with revenue received from patients who have commercial insurance,” he said. “Without that revenue, hospitals could not afford to care for those covered by Medicare.” Medicare payments to hospitals only cover about 93.1% of what hospitals spend when caring for Medicare patients, according to an independent congressional advisory, MedPAC.

“In effect, everyone with insurance is subsidizing the Medicare shortfall, which is growing larger every year,” Miller wrote.

Myth of government efficiency

There is no evidence that, as the claim goes, “by eliminating duplication, reigning in millionaire doctors, wasteful medical corporations, and gouging insurance companies, national healthcare will be better and more affordable.” There is no evidence that putting healthcare in the hands of the federal government and increasing the size of government, makes for more cost-effective healthcare or reduces healthcare spending. Far from it.

As James Simpson, an economist and former university instructor, was with the White House Office of Management and Budget (OMB) 1987 to 1993, wrote today in American Thinker, since the creation of Medicare and Medicaid in 1965, these programs have grown to cover increasingly more people and programs. Today, more than a third (36%) of all healthcare spending in the United States goes to government programs, Medicare and Medicaid. “Corrected for inflation, total federal and state government spending on healthcare has increased by 1,791 percent since Medicaid and Medicare funding began in 1967. That is a real annual growth rate of 44 percent, over 10 times the annual rate of economic growth for the same period!

Growth of public health care spending has far outpaced private spending, both in real dollars and per person. According to Centers for Medicare & Medicaid Services data, total private healthcare expenditures (in billions of dollars) increased 58% between 1960 and 2007, while public expenditures have increased 152.31%. Per capita, private healthcare expenditures increased 35.95%, while public healthcare spending per person increased 95.25% — nearly three fold more. Despite nearly 50 years of evidence, there is no support for claims that government managed healthcare is more efficient.

Using historical government data from the Office of Management and Budget, here is what the growth in government spending on healthcare since 1950 looks like, in billions of dollars:

Or, to see the growth in government healthcare spending as a percentage of the entire gross domestic product, which includes all industries in the nation:

It’s not unlike the Massachusetts’ experiment of the healthcare reform measures now being proposed for all of our country. Massachusetts’ plan is increasingly being propped up by federal funds (that’s us, the nation’s taxpayers), as it falls into insolvency. Government healthcare expenditures on free and subsidized insurance have doubled in just the past two years, while denying claims for medical care at nearly four times the rate of private insurers, cutting benefits, and raising premiums. With the state’s universal coverage program threatening to bankrupt businesses and patients, last month, the Massachusetts’ Special Commission on the Health Care Payment System proposed capitation and a complete restructuring of the healthcare system trying to contain costs, including a new executive branch that will decide how much money will be allotted to each type of patient.

The National Health Services in the UK is currently facing its most severe financial crisis in its history.

Canadian doctors with the Canadian Medical Association have been speaking out for years about the plight of its healthcare system, with expenses quadrupling in the last twenty years, more than one million people on waiting lists for care and five million with no access to a family doctor, and shortage of doctors with Canada ranking 26^th out of 28 countries in doctors per population. “We have one of the most costly and least efficient health systems of any industrialized country,” said Dr. Robert Quellet last year when he was elected to head the CMA.

Today’s news reports that the new incoming president of the CMA says the entire Canadian medical profession agrees that their system is imploding, that patients are getting less than optimal care, and that things are more precarious that even many Canadians may realize. “They have to look at the evidence… and realize what Canada’s doctors are trying to tell you,” Dr. Anne Doig said. At their annual meeting in Saskatoon today, the solution they are proposing is a move to more private health care delivery.

There is no evidence to support that the massive nationalized healthcare reforms being proposed will work to save costs or improve healthcare for all.

The evidence doesn’t exist.

© 2009 Sandy Szwarc

* There are a lot of fallacies of logic at work that make reasoned discussions about healthcare reform darn near impossible. But Mr. Miller touched on one of the biggest. “It is important that we take the time to fix only the parts of our system that need repair,” wrote Mr. Miller.

Did you guess the logical fallacy?

It’s the straw man fallacy. As Dr. Michael C. Labossiere explains, the straw man fallacy is committed when the actual situation is ignored and substituted by a distorted, exaggerated or misrepresented version. An example is overstating the number of uninsured and using it to call for a complete restructuring of our entire healthcare system, put the entire healthcare industry and everyone’s insurance under the federal government, and nationalize over 17 percent of the GDP — rather than accurately identify the uninsured and find a way to help what turns out to really be about 4 percent of the population.

As we’ve examined, the number of uninsured people is exceedingly smaller than popularly claimed. Nor is there any credible evidence to support claims predicting that tens of thousands of Americans are dying every year because they don’t have health insurance. In fact, a 1994 study by researchers at the National Heart, Lung, and Blood Institute at the National Institutes of Health found that people on public programs had higher mortality than either the uninsured or those with private insurance. But if the problem of the uninsured weren’t exaggerated, how likely would the country support a massive government takeover of their healthcare system?