Researching Researching the Health Care Debatethe Health Care Debate

Wharton SchoolWharton School

October 23, 2008October 23, 2008

The Myth of Non-Biased The Myth of Non-Biased SourcesSources

BiasBias

Ideological BiasIdeological Bias

Institutional BiasInstitutional Bias

Personal-Actualization BiasPersonal-Actualization Bias

How You Present Data How You Present Data MattersMatters

2 million Americans are behind on 2 million Americans are behind on their mortgages!their mortgages!

More than 94% of mortgages are More than 94% of mortgages are current.current.

A Few Common ClaimsA Few Common Claims

47 million Americans without health 47 million Americans without health insuranceinsurance

Rudy’s ProstateRudy’s Prostate

Life expectancy = Quality of health Life expectancy = Quality of health care care systemsystem

47 million Americans without 47 million Americans without health insurancehealth insurance

Actually 45.7 millionActually 45.7 million– U.S. Census Bureau, Current Population Report, U.S. Census Bureau, Current Population Report, Income, Poverty, and Health Insurance Income, Poverty, and Health Insurance

Coverage in the United States: 2007Coverage in the United States: 2007

12.1 million eligible for current programs12.1 million eligible for current programs– National Institutes of HealthNational Institutes of Health

20 million are not US Citizens20 million are not US Citizens– U.S. Census Bureau, Current Population Report, U.S. Census Bureau, Current Population Report, Income, Poverty, and Health Income, Poverty, and Health

Insurance Coverage in the United States: 2007Insurance Coverage in the United States: 2007

3.5 million have incomes over $75,0003.5 million have incomes over $75,000 – U.S. Census Bureau, Current Population Report, U.S. Census Bureau, Current Population Report, Income, Poverty, and Health Income, Poverty, and Health

Insurance Coverage in the United States: 2007Insurance Coverage in the United States: 2007

10.1 million have incomes over $50,00010.1 million have incomes over $50,000– U.S. Census Bureau, Current Population Report, U.S. Census Bureau, Current Population Report, Income, Poverty, and Health Income, Poverty, and Health

Insurance Coverage in the United States: 2007Insurance Coverage in the United States: 2007

47 million Americans without 47 million Americans without health insurancehealth insurance

45 % Uninsured for less than 4 45 % Uninsured for less than 4 monthsmonths

16 % uninsured for more than 2 16 % uninsured for more than 2 yearsyears– CBO, CBO, How Many People Lack Health Insurance and For How Long?How Many People Lack Health Insurance and For How Long?

Rudy’s ProstateRudy’s Prostate

5 year survival rates: 5 year survival rates: – US 98%US 98%– UK 74.4%UK 74.4%

BUTBUT death rate from prostate cancer death rate from prostate cancer– US 26.7 per 100,000 menUS 26.7 per 100,000 men– UK 27.0 per 100,000 menUK 27.0 per 100,000 men

Rudy’s ProstateRudy’s Prostate

Early Screening?Early Screening?

Mislabeling?Mislabeling?

Higher incidence in US?Higher incidence in US?

Life Expectancy Life Expectancy

US has lower life expectancy than other US has lower life expectancy than other industrialized nations:industrialized nations:

– JapanJapan 82.0 years 82.0 years– Canada 80.4 yearsCanada 80.4 years– FranceFrance 80.2 years 80.2 years– Germany 79.4 yearsGermany 79.4 years– UK UK 79.1 years 79.1 years– USUS 77.8 years 77.8 years

OECD Health Data, 2008OECD Health Data, 2008

Life ExpectancyLife Expectancy

Exogenous factorsExogenous factors– Murders, suicides, accidentsMurders, suicides, accidents– Lifestyle (obesity, smoking)Lifestyle (obesity, smoking)

Utah 78.7 yearsUtah 78.7 years NevadaNevada 75.9 years 75.9 years

– U.S. Census Bureau, Population Division, U.S. Census Bureau, Population Division, Interim State Population ProjectionsInterim State Population Projections, ,

2005.2005.

Projections are even worseProjections are even worse

Assumptions MatterAssumptions Matter

oror

Garbage In, Garbage OutGarbage In, Garbage Out

How much does Obama health How much does Obama health plan cost?plan cost?

$65 billion per year$65 billion per year– Obama CampaignObama Campaign

$110 billion per year$110 billion per year– Lewin GroupLewin Group

$160 billion per year$160 billion per year– Urban Institute/Brookings InstitutionUrban Institute/Brookings Institution

$600 billion per year$600 billion per year– Health Systems InnovationsHealth Systems Innovations

Insurance Coverage Under Insurance Coverage Under McCain PlanMcCain Plan

27.5 Million more insured27.5 Million more insured– Steve Parente, University of MinnesotaSteve Parente, University of Minnesota

5 million fewer insured5 million fewer insured– Health AffairsHealth Affairs

““Every econometric study is an Every econometric study is an effort in persuasion. I have to effort in persuasion. I have to

persuade the other guy that my persuade the other guy that my assumptions are responsible. assumptions are responsible.

Depending on what I feed into the Depending on what I feed into the model, I get totally different model, I get totally different

answers.” answers.”

-- Uwe Reinhardt-- Uwe Reinhardt Princeton University Princeton University

WebsitesWebsites American Health Quality American Health Quality

Association (Association (www.ahqa.orgwww.ahqa.org) ) Council for Affordable Health Council for Affordable Health

Insurance (Insurance (www.CAHI.orgwww.CAHI.org) ) Duke University Center for Duke University Center for

Health Policy Health Policy (www.hpolicy.duke.edu) (www.hpolicy.duke.edu)

The Commonwealth Fund The Commonwealth Fund (www.commonwealthfund.org) (www.commonwealthfund.org)

Agency for Healthcare Agency for Healthcare Research and Quality Research and Quality (www.ahrq.gov) (www.ahrq.gov)

The Galen Institute The Galen Institute (www.galen.org) (www.galen.org)

Henry J. Kaiser Family Henry J. Kaiser Family Foundation (www.kff.org) Foundation (www.kff.org)

CBO – Health CBO – Health (www.cbo.gov/publications/coll(www.cbo.gov/publications/collections/health.cfm) ections/health.cfm)

American College of American College of Physicians Physicians (www.acponline.org) (www.acponline.org)

Journal of American Medicine Journal of American Medicine (http://jama.ama-assn.org) (http://jama.ama-assn.org)

New England Journal of New England Journal of Medicine (www.NEJM.org)Medicine (www.NEJM.org)

Robert Wood Johnson Robert Wood Johnson Foundation (www.rwjf.org) Foundation (www.rwjf.org)

Centers for Medicare and Centers for Medicare and Medicaid Services Medicaid Services (www.cms.hhs.gov) (www.cms.hhs.gov)

U.S. Census Bureau, Health U.S. Census Bureau, Health Insurance Insurance (www.census.gov/hhes/www/h(www.census.gov/hhes/www/hlthins/hlthins.html) lthins/hlthins.html)

WWW.CATO.ORGWWW.CATO.ORG