Thursday, October 8, 2009

Health care re-form XIII (bad math)

Last night this blogger idly turned on the television, and ran smack dab into a Keith Olberman rant on health care. It mainly appeared to be a soliloquy on the victimization of the hapless and helpless public by the evil depredations of the insurance companies that hold the Congress in their thrall, this apparently for the bagatelle of less than one and a half million dollars (one million, four hundred and ninety two thousand, to be precise). A kernel of (correct) health care issues/weaknesses in the country was spun into a phantasmagoric kaleidoscope of family health issues, Churchillian bombast, 'hospital as cash register drawing from your veins' imagery, more family medical travails, Dickensian "Tiny Tim" allegorical allusions, a bandying about of percentages to demonstrate that the country is on its way back to the Middle Ages, a reflection on the agony of Dr. Sabin, anecdotes from a doctor friend, even more family heartbreak, and on and on... Wow! Fortunately there were the commercial breaks, if only to allow him to catch his breath prior to launching full tilt into the next section of the diatribe.

Sprinkled here and there like small pieces of flotsam and jetsam thrown around by the raging current were some valid points... but unfortunately they were overwhelmed by the rhetorical torrent issuing forth. Where to start with a deconstruction of this... this.... words fail!

Let us consider one example of foolishness, what appears to either be some poorly thought through mathematics, or else a reliance on the poor math skills of the general population to bandy about numbers as if they "prove" his case. Per Olberman:

People, in short, are dying for the lack… of money. Dying as surely as they did when Charles Dickens wrote about the exact same problem. Of a boy who couldn't get sufficient medical care for his affliction. Of the underprivileged, suffering not just privation but death, as the comfortable, moved silently and unseeingly through the streets of London. The book was called "A Christmas Carol" and the boy Dickens imagined was called "Tiny Tim" and it was published on the 19th of December, 1843, and it is 166 years later and the problem is not only still with us, it is getting worse. The mortality rate among Americans under the age of 65 who are uninsured, is 40 percent higher than among those with insurance. In 1993 a similar study found the difference was only 25 percent.

We are moving backwards! We are letting people die because they do not have insurance. What's worse is that barring meaningful health care reform, this will only grow. The difference between the surveys from 1993 and now suggest this fatal insurance gap is growing by about one percent, per year. Your chances of dying because you don't have insurance are now 40 percent higher than those who have it. By extrapolation, three years from now your chances will be 43 percent higher. Your chances of dying because you used to smoke, compared to those who never smoked, only 42 percent higher. You heard that right. At the current rate, in 2012, you will be more fortunate, more secure, more long-lived, if you used to smoke, than if you don't have insurance. It is mind-boggling, and mind-less. This is the country you want? This is the country you will accept?

OK, so Olberman would have us believe that "you will be more fortunate, more secure, more long-lived, if you used to smoke than if you don't have insurance" because the difference in death rate between those who have and those who don't have health insurance is 43%, while the difference in death rate between those who smoke or used to smoke and those who never did is 42%. Unfortunately, he is comparing the differences between two dissimilar sets of underlying items, and simple logic tells us that these comparisons can not be extrapolated to compare the underlying situations. But, he then goes on to higher flights of fancy:

Do those other people in this country have meaning to you, or are they just extras in your movie, backgrounds in your painting, choruses in your solo? Without access to insurance for all of us and the only way we get it is with the government supplying the gaps, just like it does in flood insurance for God's sake that fatal gap will just keep growing. A 45 percent higher likelihood of death for the uninsured compared to the insured by 2014. By 2022, the figure will be 53 percent higher. Fifty-three percent! In the 1840s, as Dickens wrote a "Christmas Carol" - in a time at which we now look back with horror, the city of Manchester in England commissioned a crude study of mortality among its residents. A Doctor P.N. Holland categorized the sanitary conditions of the houses and streets of Manchester into three classes. And when he compared the death rate in the First Class Houses in the First Class Streets, to the death rate in the Second Class Houses in the Third Class Streets, he found mortality in those worst locations was 53 percent higher. If we do not reverse this trend, in fourteen years' time we will not be living in the America of 2022. The shadows of the things that may be, tell us, that we will instead be living in an insurance-driven version, of the Dickensian England of 1843! God Bless Us, everyone.

Wow, so we apparently we are headed back to 1843. Here again, he compares the differences between two dissimilar underlying items. Let's try a math exercise here... Suppose the mortality in the "First Class houses" was 15% and that of the worst locations 22.95% (i.e. 53% higher). And suppose the mortality of those with insurance today is 5% while that of those without insurance is 7.65% (i.e. 53% higher). While the difference in each case is the same at 53%, one would have to be insane to draw the conclusion that a person without insurance today is as badly off as were the poor in Dickensian times. In fact, in this example the uninsured person today is actually significantly better off than the "First Class" person of yesteryear. (Note: this blogger does not know the underlying figures. The numbers provided here are for the purposes of illustration only, to show that it is not possible to draw the parallels that Olberman does with the figures he has provided!)

Even if you give Olberman the credit of the doubt and allow that he was concentrating on the differences and thus was arguing that the disparity in 2012 will be as large as the disparity back in Dickensian times (though his language certainly seems to go far beyond focus on disparities to implying that the overall situations would be equivalent!), this would still be a poor comparison. After all, back in Dickensian times the "First Class" represented a small percent of the population, and the vast majority of the populace was in the worse position, while today it is the opposite i.e. the vast majority (80%+) have insurance, while a much smaller number is in the worse position...

Ahh... Keith, Keith, Keith.

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