Health care anecdotes and statistics

Someone named Megan McArdle has a post on why I shouldn't fuss about my brother's death, that "in any system, there will be people who are failed by that system."

She doesn't like

"argument through anecdote", where the data plays a distant second fiddle to the heartrending stories about x person who didn't get good treatment. So single-payer advocates drag out some American woman who didn't get a breast exam until it was too late, and opponents counter with the Canadian guy who died on the waiting list to see an oncologist.

This is infuriating. First of all, 90 plus percent of what I've read since becoming involved in this issue are articles chock full of incredibly boring data — as in Health Affairs. Personal anecdote doesn't convince me. I'm enough of a wonk that data convince me. Not anecdote. Although at a certain level, anecdote becomes data. For the most part, though, the books and articles on single-payer may use an anecdote as a classic WSJ lede style, where the writer "hooks" a reader with a real life example of why this issue is important in human terms. But if that anecdote is not then followed up by facts and analysis it's nothing.

From what I've seen, single-payer advocates do a great job of follow-up with facts and analysis. Single-payer enemies don't. They ignore huge, basic chunks of information, and they explain away any statistic that doesn't go their way. Longer life expectancies in countries that spend half as much on healthcare as we do? Pish posh. Means nothing — because, see, we have more car accidents, or more poor people, or we're fatter.

The fact that a single-payer healthcare system would help save people with all three of those conditions is conveniently ignored.

Ezra Klein has comments on this woman's debate with Jonathan Chait of the New Republic. Chait, by the way, is hardly a single-payer advocate.

Ezra points out another tactic that pro-profit/market people like this woman use: ignorance and/or lies. She suggested that waiting lines are longer on the continent than in the U.S. Which is just not true. Nothing anecdotal about the statistics on this. So is it ignorance or lying? Ezra writes:

She then suggests that moving to a French or Canadian system would require walking back the medicine we actually provide, telling people they can't have MRIs anymore. That's similarly incorrect. Care utilization in France and Germany is as high — and in France, higher — than it is in America. But they pay less per unit of care. And the technology isn't radically different. Germany actually has more CT scanners per million than we do, while the French have three less. The French and the Germans both have more physicians per capita and more acute care beds. Oh, and the French and Germans pay less, and don't have 47 million uninsured.

All this information — and more! — can be found in various data-heavy books on the subject, like Thomas Bodenheimer and Kevin Grumbach's wonderful Understanding Health Policy. The thing is, they tend to point towards the same conclusions Jon Cohn's book does, albeit with fewer anecdotes. One reason I spend less time arguing health care with libertarians these days is that it doesn't seem productive. If you really don't want to believe that other system's in the world are better, you won't.

One of the comments for Ezra's post is so funny and right on that I want to share it:

The conservative argument goes like this:

We can't have national health care because in countries that do, they have to wait 40 years for a hip transplant!

Liberal: No, as you can see, from the statistics here, not only are there not significant wait times, but wait times for those surgeries in America are larger.

Conservative: But what about the fact that in socialist countries there is only 1 MRI in the entire country, located in the basement belonging to the Prime Minister's mistress, requiring a 500 mile commute that grandmothers with cancer have died waiting to get access to? That's why we should never have national health care in America!

Liberal: No, actually, in many countries with national health care systems, the number of available MRIs per capita is equal or close to the number available in the United states.

Conservative: Oh yeah? Well look, Stalin was a socialist, and that resulted in the gulags and the deaths of millions? Is that what you want?

At the point, the average liberal will realize that no amount of facts marshaled in the defense of national health insurance is going to convince the conservative/anarcho-capitalist of the wisdom of the program and that the entire discussion is going to revolve around the conservative throwing out fallacious claims and the liberal correcting them with actual facts.

That's from Dean Christakos.