The U.S. Health System: The Rest Of The Story
By John Goodman
Health Affairs Blog
March 19, 2009
Here is a paper (link below) with as many as 100 references that you almost never see cited in Health Affairs, or in the Journal of the American Medical Association (JAMA), or in the New England Journal of Medicine (at least not in their public policy articles). In fact, if you are a regular reader of these publications, I think you are going to be very surprised.
My colleagues Linda Gorman, Devon Herrick, Robert Sade and I discovered that public policy articles in the leading health journals (especially the health policy journals) tend to cite poorly done studies over and over again in support of two propositions: (1) Our health care system needs radical reform and (2) the reform needs to be modeled along the lines of the systems of other developed countries. At the same time, these articles tend to ignore contravening studies that are often published in economics journals and subject to much more rigorous peer review.
In our rest-of-the-story literature review, we focus on eight questions:
1. Does the United States spend too much on health care?
2. Are U.S. outcomes no better and in some respects worse than those of other nations?
3. Is the large number of uninsured in the U.S. a crisis?
4. Does lack of health insurance cause premature death?
5. Are medical bills causing bankruptcy?
6. Are administrative costs higher for private insurance than public insurance?
7. Are low-income families more disadvantaged in the U.S. system?
8. Can the free market work in health care?
John Goodman says that he wants us to hear the rest of the story, but then he doesn’t tell it to us.
He and his colleagues have pieced together a document using classic Goodman rhetorical deceptions. They pull out of the literature isolated items that support their position without identifying them as exceptions to the great body of information available in the health policy literature. They repeat the use of many studies that have been discredited as manipulations or distortions based on libertarian ideology, even though they are aware of the highly credible challenges to those reports. They use silly diversions to attack some of the most solid and important studies in the health policy literature. Patching these deceptions together creates magical conclusions that would seem to refute the most fundamental principles that can be gleaned from a couple of decades of solid health policy science research.
Using health policy reports retrieved from the refuse bin, they then end with the conclusion that we should adopt their favored proposal for reform, health savings accounts, a non sequitur to the specious arguments they have presented. Even though the policy community has dismissed HSAs as a serious response to the tragic dysfunction of our health care system and its financing mechanisms, the authors persist in abandoning their academic purity in pushing their cause.
“The Rest of the Story” might appeal to ideologues, but it is repulsive to those of us who are outraged by the the physical suffering and financial hardship faced by the millions of U.S. residents who are victims of a flawed financing system, unable to afford or receive the care that they need in a $2.5 trillion health care industry.
http://healthaffairs.org/blog/2009/03/19/the-us-health-system-the-rest-of-the-story/comment-page-1/#comment-24954
Paper on health care reform by John Goodman et al:
http://www.ncpa.org/pdfs/sp_Do_Other_Countries_Have_the_Answers.pdf