I was running out the door for work last week when I heard Diane Sawyer give a teaser about John Stossel's^ take on health care waiting times in the US.
I finally got around to looking at it. Sure enough, it's a hit piece. He's good about saying where he gets his facts, but he didn't think about what he was reading. I guess that's what happens when you have Pollyanna looking over your shoulder.
Way down deep in his report Stossel says that the average person in the US pays 12.5% as their share of the total health care expenditures which is on page 12; but he didn't factor in what healthy people, Medicaid, Worker's Compensation, SCHIP and Medicare Advantage does to that statistic. Then there's another issue with premium payments......and don't forget the unisured that pay 100% of their care and just don't get much care at all!
I think one of the more facinating parts of his statisitcal cherry picking is that he had to ignore page 8 where it says that 31% of the spending is contributed by households before he got to page 12 with a fact more to his liking.
see what I mean?
It's in the eye of the beholder.
First I'll start with the waiting times. The best place to refute that is the CommonWealth Fund's report: Mirror, Mirror where the US comes out dead last with Canada on waiting times and that a country with universal health care, Germany comes out first. I guess Stossel et al either didn't see that report or didn't want to include it (it messed up his bias).
Then as I read further he quotes the president of AHIP, Karen Ignagni as she
Polls show that while people dislike the insurance industry in general, 87 percent of people with health insurance are happy with their coverage. Only 3 percent of health insurance claims are denied, she says.
Apparently Stossel didn't get the memo on AHIP. The stat she quotes is accurate, but she fails to mention all the other stuff in that poll like 85% of the respondents worry about affording health care over the next few years or that 28% of the respondents had family members that had to delay or go without health care within the last year. What Ms. Ignagni doesn't say is that poll shows the unease most people have with our health care system and that it is impossible to accurately poll emotional feelings. That poll told me that people understand they are a catastrophe away from being unable to meet medical costs and becoming uninsurable.
Then Stossel goes on to quote a darling of the CATO Institute, P. J. O'Rourk as a health care expert.
This story needs parity.
Our current (2006) benchmark stats are:
The US spent $2.35 trillion on health care
That's about $7,835 per capita
That's about $31,340 per family of 4
12.5% of $7,835 = $979.17
12.5% of $31,340 = $3,917.50
Now compare this to Medicare premiums only:Medicare Part B Premium = $93.50/mth
Medicare Part D Premium = $57.53/mth
Medicare Part B + D Premium = $1,812.36 per year
Medicare Medigap premium average $160/mth
Medicare Part B + D + Medigap = $3732.36 per year per Medicare enrollee
These are costs before the patient even walks in the doctor's office door!
That's almost 2-4 times the $979.17 (12.5% of $7,835).
Now compare to a family of four with decent insurance & no corporate contribution:Monthly premium medical only = $1,100/mth or $13,200/year
Monthly premium medical w/junk dental & vision = $1,200/mth or $14,400/year
That's 3.67 times $3,917.50 (12.5% of $31,340)
Now compare to a family of four with decent insurance and 40% company contribution:Monthly premium medical only = $660/mth or $7,920/year
Monthly premium medical w/junk dental & vision = $720/mth or $8,640/year
That's about 2 times $3,917.50 (12.5% of $31,340)
This is the median income (per capita) level for 2006:
PER CAPITA INCOME5 (page 14 of the pdf)
------------------------ 2005 ------------------------------- 2006 ----------------------------------
----------------------- people ----- median $'s--------- people ---------- median $'s--------
Total2. . . . . . . . 293,834,000 $25,857 296,824,000 $26,352
50% of the population made $26,352 or less in 2006
12.5% of $26,352 = $3294
Mr. Stossel, sometimes the government's sites will publish what looks like conflicting data, so as a researcher, you have to dig deeper to get a clear picture. That 12.5% figure you used for your story doesn't paint an accurate picture. The first rule of statistics is to ask what the percentage represents. (i.e. That's 12.5% of what?...exactly?) You didn't do that. You needed to look around the sites a little more. For instance, theres a government report with this interesting factoid figured out in 2005 about the 2002 health care.:
Half of the population spends little or nothing on health care, while 5 percent of the population spends almost half of the total amount. In 2002, the 5 percent of the U.S. community (civilian noninstitutionalized) population that spent the most on health care accounted for 49 percent of overall U.S. health care spending (Chart 1, 40 KB). Among this group, annual medical expenses (exclusive of health insurance premiums) equaled or exceeded $11,487 per person.
In contrast, the 50 percent of the population with the lowest expenses accounted for only 3 percent of overall U.S. medical spending, with annual medical spending below $664 per person. Thus, those in the top 5 percent spent, on average, more than 17 times as much per person as those in the bottom 50 percent of spenders.+
Average someone with no insurance that ignores their chronic health problems and only gets care for acute, can't be ignored health problems pays:
100% of $664
with someone with catastophic problems with the total medical costs of "X" that pay "y" of their costs which would be:
Total Patient contribution = $11,487 = y
------ y -------- x% --------------- x $'s -------------------------------
if $11,487 = 1% then $1,148,700.00 are the total medical expenses
if $11,487 = 2% then $574,350.00 are the total medical expenses
if $11,487 = 2.5% then $459,480.00 are the total medical expenses (i.e. multi-drug resistant Tb/yr)
if $11,487 = 3% then $382,900.00 are the total medical expenses
if $11,487 = 4% then $287,175.00 are the total medical expenses
if $11,487 = 5% then $229,740.00 are the total medical expenses (i.e. transplant surgery only)
if $11,487 = 6% then $191,450.00 are the total medical expenses
if $11,487 = 7% then $164,100.00 are the total medical expenses
if $11,487 = 8% then $143,587.50 are the total medical expenses
if $11,487 = 9% then $127,633.33 are the total medical expenses
if $11,487 = 10% then $114,870.0 are the total medical expenses
if $11,487 = 11% then $104,427.27 are the total medical expenses
if $11,487 = 12% then $95,725.00 are the total medical expenses
if $11,487 = 12.5% then $91,896.000 are the total medical expenses
if $11,487 = 15% then $76,580.00 are the total medical expenses
if $11,487 = 20% then $57,435.00 are the total medical expenses
if $11,487 = 30% then $38,290.00 are the total medical expenses
if $11,487 = 40% then $28,717.50 are the total medical expenses
if $11,487 = 50% then $22,974.00 are the total medical expenses
if $11,487 = 60% then $19,145.00 are the total medical expenses
That's quite a slope going there. If you are uninsured and part of that 5% that utilizes 50% of all medical services rendered, you either get medically needy Medicaid or you're dead.
Ok, here's a list of questions I think you might have (if you're still with me) with snarky answers):
- Are premium dollars being factored into the per capita out of pocket spending stat? Probably not. The source tables are unclear.
- Why don't analyst's admit that insurance is paid for by their members? The math makes their head ache and destroys their propaganda.
- Why aren't the expenditure tables subsected by acuity, poverty or at least income? Too hard to extract the data.
- Why aren't insurance premiums considered a health care expense? The IRS does.
So, John Stossel you served your Disney masters well. ABC will retain advertising revenue from pharma, insurance companies and the like, but you let your viewers and readers down.
^ The story posted at ABCnews.com lists Andrew Sullivan as a co-author.
One of my sources referenced this as their source:
+ Conwell LJ, Cohen JW. Characteristics of people with high medical expenses in the U.S. civilian noninstitutionalized population, 2002. Statistical Brief #73. March 2005. Agency for Healthcare Research and Quality, Rockville, MD. Web site: http://www.meps.ahrq.gov/... Accessed April 7, 2006.
here's the web sites I reviewed for this diary:
Sometimes I think I lose mojo, because I research too much!