Wednesday, August 29, 2007

Misleading Mortality Statistics

Stef on Debate Anything says that America's poor standing in international league tables on infant mortality is evidence of the weakness of the U.S. healthcare system. This response is a slightly edited version of my reply.

I've been hunting a single and comparable trans-national healthcare metric for at least five years. As my last topical post indicated, anecdotes often are more reliable than the stats--and only partly due the systemic bias of almost all healthcare surveys designed by those receiving socialized medicine. By the way, that same flaw pervades both socialized medicine and single-payer systems: they tend to downplay the quality of care and double count universality (by rewarding both access and equity).

While hunting for THE answer, I've become convinced the U.S. is near the low (good) end of infant mortality, despite press and progressive pessimists. A few brief points:
  1. Different stats for different states: The U.S. defines "live births" more broadly than most European countries (The OECD definition says the U.S., Canada and the Nordics use the same measurements, but the rest of Europe doesn't); in particular low birth weight babies who figure into American, but likely not Continental statistics. This lowers U.S. rankings but not our standard of care. As Bruce McQ observes, "ironically, US statistics are, in a way, a result of our technological advances, advances that have given more marginal babies a chance for survival than they have had at any other time in our history."

  2. Diversity makes a difference: EU nations are largely (or were until recently) homogeneous. America's strength is as a mongrel, but that means some Americans -- immigrants, for example -- aren't as healthy as, say, Swedes. As Gregg Easterbrook noted in his odd, but interesting, The Progress Paradox, we could reduce the number of families living below the poverty line by more than half merely by barring immigration. It's reasonable to presume the same approach also would lessen the number lacking healthcare insurance. But if that's not the preferred policy choice, doesn't that suggest both that it's difficult to compare healthcare here with healthcare there AND that our current system might not be as flawed or as expensive as the "healthcare is a fundamental right" liberals suggest?

  3. Some aspects of government run heathcare would be healthy--at the expense of freedom: Unfortunately, national healthcare can be offensively coercive--Britain recently began to require smokers to prove that they've quit before the NHS will begin medical care. That's acceptable in a competitive system like America -- switch doctors or insurance companies -- but such demands by a state-run monopoly amount to unreasonable discrimination. Personally, I like the freedom to smoke a cigar. . .oh, about once a year. And as I've previously argued, including culture-specific stats like suicide rates in trans-national healthcare comparisons says more about a lower priority for liberty among survey designers than it does about healthcare.

  4. Dictators lie: The late, unlamented, Nicolae Ceausescu insisted AIDS was a capitalist disease, and so outlawed HIV testing--improving Romanian health statistics, but not actual health. The New Soviet Man enjoyed low mortality--except for Kulaks, intellectuals and newborns who "did not count as a live birth or as an infant death extremely premature infants (less than 1,000 g., less than 28 weeks gestational age, or less than 35 cm in length) that were born showing signs of life but failed to survive for at least 7 days." Cuban healthcare for ordinary Cubans is worse than almost any other Western Hemisphere country. Yet, in the yearly fly-to-Geneva rankings, Cuba gives great stat--because Castro lies; the fact that only Michael Moore was fooled is kinda . . . Sicko.


Assistant Village Idiot said...

A woman I work with just delivered a baby at 23 weeks. Still alive, 9 weeks later. I wonder how many of those survive in Cuba.

I would cynically suggest that Michael Moore may actually know the truth. But the truth of having his people, with his ideas, gathering more power is more important to him than details like facts.

@nooil4pacifists said...


I would cynically suggest that your cynicism is accurate.

OBloodyHell said...

> only Michael Moore was fooled

??? Michael Moore ???


How can a fool be fooled...?

Or is it "How can he be anything but....?"

...I forget.