• Choosing the evidence
    July 17,2014
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    To reply very briefly to Ellen Oxfeld’s defense of government health care (July 2): Any report from any source that purports to “rank” national health systems necessarily reflects the kind of “evidence” selected by the authors. The Commonwealth Fund report she cites has charts and tables down-ranking U.S. health care — but based on what?

    Says the Commonwealth report, conscientiously: “These rankings summarize evidence on measures of high performance based on national mortality data and the perceptions and experiences of patients and physicians. They do not capture important dimensions of effectiveness or efficiency that might be obtained from medical records or administrative data. Patients’ and physicians’ assessments might be affected by their experiences and expectations, which could differ by country and culture.” Well, yes.

    The Commonwealth authors are promoting their “summary” conclusions based on this shaky phone survey “evidence” (aside from the hard data on mortality and spending). I don’t buy it.

    I don’t have evidence that Country A provides “worse care” than Country B. There is however plenty of evidence — my own files go back 22 years — that the Canadian-style single payer on which Green Mountain Care is modeled produces “rationing, waiting lines, maddening bureaucracies, inefficient work rules, demoralized doctors and nurses and declining quality of care — and much higher taxation.”

    The best description of Canada’s health care problem is that of Kevin C. Fleming, M.D., a physician at the Mayo Clinic. His 2006 paper “High Priced Pain: What to Expect from a Single Payer Health Care System” (28 pp., 198 footnotes) can be accessed online at http://www.heritage.org/research/reports/2006/09/high-priced-pain-what-to-expect-from-a-single-payer-health-care-system.

    If educated people such as Ms. Oxfeld yearn for a foreign model, they could reasonably turn to Singapore, Switzerland or even the Netherlands. But they never do. Why? Because those systems do not centralize all health care decisions and finances in the government, and send the bill to the taxpayers, as single payer does. That ought to be a tipoff.


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