December 7, 1999
By Linda Gorman
For a classic example of how advocacy journalism and advocacy research combine to produce pure propaganda, see “Insured face less risk” in the November 29 Colorado Daily. Staff Writer Terje Langeland wrote about a study done by CU-Boulder professor Richard Rogers. It concluded that an adult under the age of 65 who lacked health insurance was 35% more likely to die between 1986 and 1995 than “a similar adult” with health insurance.
The opening paragraph set the tone. “Despite an ongoing economic boom,” it said, “the United States continues to rank toward the bottom among industrialized nations” in “important” quality-of-life indicators such as “poverty, literacy, infant mortality, and life expectancy.”
Ignore the fact that when consumption rather than cash income is used to measure poverty less than 2% of the U.S. population qualified as “poor” by the end of the 1980s. In an article on medical care, one cannot ignore the fact that the myth of “high” U.S. infant mortality rates was exploded in 1995 by demographer Nicholas Eberstadt in the book The Tyranny of Numbers.
Different countries use different definitions of a “live birth.” The United States uses the guidelines from WHO’s International Classification of Diseases. Here, all infants evidencing any signs of life are considered live. There were 24,000 infants weighing less than 1 kilogram at birth in 1988. Such babies have poor survival rates.
Switzerland, for example, defines infants as living only if they are at least 30 centimeters long at birth. It does not include 1 kilogram babies. Countries may also underreport infant deaths. According to Eberstadt, “In Australia, Canada, and the United States, more than a third of all infant deaths take place on the first day; in Sweden and Japan, where infant mortality rates are currently lowest, such deaths account for about a quarter of the total.”
Medical care quality makes a big difference when it comes to survival rates of infants with low birthweights, and by birthweight, U.S. medical care shines. “By comparison with other Western societies enjoying especially low rates of infant mortality, U.S. babies at any given birthweight appear to have unusually good chances of surviving the perinatal period, regardless of race.”
After carefully reviewing data on poverty, income, family structure and mortality, Eberstadt concluded that “the life style or behavior patterns attendant upon the American mode of illegitimacy,” not poverty or lack of health care, “were particularly injurious for newborn infants.”
The Colorado Daily article said that Rogers et. al. found “the finding on health insuranceespecially alarminggiven that in 1986, some 31 million Americans in the 18-64 age group lacked health insurance.” Researchers acquainted with the literature on using population surveys to infer health insurance coverage know that the estimate of 31 million comes from the Current Population Survey. It is notoriously high.
Other surveys suggest that only 2 to 4 percent of the U.S. population remains uninsured for more than two years. About 50% of those people live in households with incomes of $50,000 or more. U.S. numbers on the chronically uninsured compare favorably with those in Canada, a national health care paradise. In British Columbia, an estimated 2 to 5 percent of the population is uninsured.
Evidence suggesting that people without health insurance are denied medical care is slim. Hospital patients without insurance have 99% the amount spent on them that insured patients do. Claims that people cannot “afford” heath care must also be approached with caution. 1988 data from the Bureau of Labor Statistics Consumer Expenditure Survey suggest that U.S. households with incomes below $20,000 spent far more on alcohol, entertainment, and tobacco than they did on health care.
Nor is it clear that mortality rates for adults under 65 say much about their medical care. The major causes of death for people this age are cancer, heart disease, accidents and HIV infection. Bad habits like smoking, poor diet, lack of exercise, heavy drinking, and promiscuous sex can affect the risk of dying from each of those causes. One must show that people with such bad habits are not also more likely to choose to go without insurance before one can claim that the lack of insurance is what kills them.
The article ends with Professor Rogers’ claim that “National health insurance would be one way to remedy these problems.” While certain specific reforms would do much to improve medical care in the U.S., nationalization is not one of them.
If government health care is so good, why was health in the USSR so bad? Why do almost 20% of the British, all covered by the government, buy private insurance? And why does Quebec, whose health bureaucrats make cancer patients wait as long as 5 months for radiation treatments, send its patients to Burlington, Vermont?.
 W. Michael Cox and Richard Alm. 1999. Myths of Rich and Poor. New York: Basic Books. p. 16.
 Nicholas Eberstadt. 1995. The Tyranny of Numbers: Mismeasurement and Misrule. Washington, DC: The AEI Press, p. 54.
 Ibid., p. 64.
 The survey results come from the Survey of Income and Program Participation. For a brief summary and references see the summaries by the National Center for Policy Analysis, Dallas, Texas. “The Myth of Universal Coverage:” NCPA Brief Analysis 103, 14 February 1994, http://www.ncpa.org/ba/ba103.html, and “Health Insurance and the Uninsured” NCPA Health Care Issues, 1997, http://www.ncpa.org/health.pdh46.html.
 “The Myth of Universal Coverage.” 14 February 1994. Brief Analysis No. 103. National Center for Policy Analysis, Dallas, Texas. http://www.ncpa.org/ba/ba103.html.
 Nicholas Eberstadt. 1995. The Tyranny of Numbers: Mismeasurement and Misrule. Washington,DC: The AEI Press, p. 53.
 “Lesson’s from Britain’s National Health Service.” The Fraser Institute. http://www.fraserinstitute.ca/publications/books/health_reform/lessons.html
 David Spurgeon. 5 June 1999. “Canada sends patients with cancer to United States.” British Medical Journal, 318:1507. http://www.bmj.com/cgi/content/full/318/7197/1507/a.
Linda Gorman is a Senior Fellow with the Independence Institute, a free-market think tank in Golden, Colorado, https://i2i.org. This article originally appeared in the Colorado Daily (Boulder), for which Linda Gorman is a regular columnist.
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