N. Gregory Mankiw fired the opening salvo on misinterpreted health care statistics when the New York Times published his op-ed entitled Beyond Those Health Care Numbers. Paul Krugman, also writing for the Times fired back with Health Care Excuses. Although he doesn't explicitly address Mankiw's piece, it seems clear that he intended to correct the record.
explains that the
Accordingly he offers his take on their misguided statements (which he calls excuses):
Excuse No. 1
He cites the standard 47 million uninsured in this country as exhibit one. People have argued (Mankiw, for example) that this number is misleadingly high because it includes illegal aliens (10-20 million) and that many of the Medicaid-eligible simply don't apply until they get sick. These are both excellent points; but Krugman diminishes the latter (and pointedly ignores the former) by suggesting that "showing up in an emergency room isn't at all the same thing as receiving regular medical care".
This may be true, but to some extent it really represents a matter of choice. Most of these patients are generally healthy and don't attach much value to seeing a doctor when they are well. Well-insured patients often make the same decision. It's hardly the health care system's fault that patients don't take advantage of resources made available to them. Certainly as a nation, we can do a better job of educating citizens about their benefits; yet to do so hardly requires the drastic overhaul Krugman would like to see.
Moreover, Krugman doesn't seem to know that much of preventive medicine falls into the category of dogma and has yet to be validated by well-executed studies. Many of the components of the highly vaunted "annual physical exam" fall into this category.
This is not to say that pap smears, mammograms, cholesterol screening, etc. are not useful (quite the contrary), but that much of "well-patient care" hasn't been shown to lower morbidity or mortality.
Excuse No. 2
argued that the reason our life expectancy is lower than
makes the legitimate point that the connection between obesity and
mortality is probably overstated.
However, to some extent, this is a straw man argument. Few people really believe that obesity is the
cause of our reduced life expectancy.
What Krugman fails to mention is that trauma, homicide, and teen
pregnancy (with its concomitantly higher infant mortality) have a much greater
Life expectancy is calculated by dividing the total number of person-years lived by an imaginary cohort by the size of that cohort. A teenager killed in a gang shooting or a premature infant who dies in her first year of life costs society far more person-years than the septuagenarian who passes quietly away in his sleep. When the young die, a country's life expectancy takes a much bigger hit.
it is an indictment of our society that violent death and the high infant
mortality associated with teen pregnancy are more common in the
Excuse No. 3
Krugman reports that people assert that health care is better in 2007 than in 1950. He points out the irrelevancy of that position in supporting current policy practices. If some people do make this argument then like Krugman, I don't find it very compelling. However, I don't ever recall anyone seriously raising this straw man point as an entire justification for our system.
Excuse No. 4
that those advocating change short of a government single payer are fear-mongers
when they point out inadequacies of other countries in their delivery of health
care. He describes Rudy Giuliani's
reference to higher prostate cancer mortality in
Unfortunately, he offers no other such examples nor does he offer a scintilla of proof that Dr. David Gratzer, who supplied Giuliani with this information was actually wrong.
In a previous column, Krugman's idea of "proof" takes on this form:
"The details are technical, but the
bottom line is that a man's chance of dying from prostate cancer is about the
Contrast this with Gratzer's reasoned response to mainstream media criticism of his methods. Gratzer, like Krugman is a scientist and deserves a cogent, logical argument. Failure to offer that serves no purpose but to obfuscate reality and cheapen the discussion.
In the end,
Krugman builds his op-ed to this conclusion: "So now you know how to answer the
false claims you'll hear about health care.
And believe me, you're going to hear them again, and again, and
Perhaps, but only to the extent that people continue to make the original claims without appropriate context.
Ford, MD, MPH is Assistant Professor of Medicine,