The Fighting 29th

All about New York's 29th Congressional District

I've heard a lot of noise about numbers in the healthcare debate. People are uncomfortable with the claim that we spend far more than any other country, and with the claim that the quality of our healthcare trails other countries. So, this weekend I went looking for reliable sources for those two claims.

First, spending, which is the easy one. An organization called the Organization for Economic Cooperation and Development (OECD) has been compiling data on healthcare spending for years. Their latest report shows that the US spends significantly more than other developed countries, no matter how you slice it. The graph above uses 2006 OECD data, which is the latest full set available. As you can see, we spent about $7,000 per person on healthcare that year, far more than other developed countries.

One of the talking points I've heard is that per-capita numbers don't tell the whole story, because they don't count illegal immigrants. The graph above, based on the same OECD data, that shows spending as percentage of GDP. We still spend the most by a longshot using GDP as the benchmark. (Note that you can click on either graph to enlarge it.)

The second claim -- that the quality of our healthcare isn't as good as the rest of the world -- is harder to measure. The non-partisan Robert Wood Johnson foundation has sponsored a comprehensive analysis of the existing reports on healthcare quality. The full report is a dozen pages and cites a number of different studies. Here are some findings:

• The US is "one of several world leaders" in cancer care.
• US-Canada comparisons more often find that Canadian care is better overall.
• The US has more surgical and medical errors (known as "patient safety" issues) than other countries.

The report specifically debunks one talking point: that the higher US rate of homicide and violent death skews mortality statistics. The study authors looked at "amenable mortality", which adjusts for different accident rates, and found that the US still lags other countries.

Overall, the study found:

[W]hile evidence base is incomplete and suffers from other limitations, it does not provide support for the oft-repeated claim that the “U.S. health care is the best in the world.” In fact, there is no hard evidence that identifies particular areas in which U.S. health care quality is truly exceptional.

Tom Reed's campaign site has now posted its "issues" page, which contains a short run-down of Reed's positions on eight issues of the day.

Since healthcare is driving our current discussion, it's interesting to take a closer look at Reed's statement. He begins with this:

The current proposal, HR 3200, has been changed a number of times and likely will change many more times. At this point, the debate is not about the specifics of HR 3200. It’s about private care vs. socialized medicine.

He goes on to point out that Massa is in favor of single-payer healthcare, and Reed isn't. Fair enough, though even Massa agrees that single-payer is off the table. Reed wants the debate to be about socialized medicine, but it isn't -- it's about the way that the market for private insurance should be structured, and whether that market should include a public option to ensure competition.

Reed ends with :

We should subject health insurance to competition in the free market. Instead of being forced into a particular plan by their employer, people should be able to choose. Choose their own plan that allows them to work with their doctors, not a government board, to determine what treatments are necessary and when.

Allowing patients to choose health plans in an open market will force health insurance companies, healthcare providers and pharmaceutical companies to compete by offering plans, services and products based on market needs and demand. Free market competition will inevitably drive costs down.

Am I missing something here? Hasn't the free market led to rescission and denial of coverage for pre-existing conditions? How will Reed address that? Though HR 3200 contains no "government board" to determine treatment, why is it better to have an insurance company board making decisions, as they do today?

Also, even though employees can't choose their insurance, employers who purchase insurance can probably strike a better bargain, because they have the bargaining power of purchasing a good in volume. Xerox gets a better price from GM for fleet trucks than I do because they're buying thousands rather than one, and the same is true of insurance.

It's good that Reed is engaging on healthcare instead of just saying "No", but we need more meat on this topic.

Joe Spector has Massa's announcement that he's endorsing Kirsten Gillibrand for Senate. It looks like Gillibrand won't have any primary opposition, so her spot as the Democrat in the race is sealed.

Reader Elmer sent today's Corning Leader editorial [pdf] about Eric Massa's performance. The Leader's editorial writer isn't overly concerned with Massa's statement at Netroots Nation, and the Leader concludes that Massa was doing what he was elected to do. Leader columnist Bob Rolfe also has a positive column on Massa.

The Massa press office also sent Andy Thompson's column in the Hornell Evening Tribune [pdf]. Thompson lauds Massa's hard work, but wonders if the Netroots Nation remarks will come back to bite him.

Here's the Olean Times-Herald's take on Massa's Tuesday press conference.

The Buffalo News praises Massa for holding town hall meetings.