Tuesday, June 10, 2008

Liars, Damned Liars, and the Heartland Institute, Part I of III

Just as The Heartland Institute purports to be a non-partisan think-tank, so, too, does the monthly rag it puts out every month purport to be news, specifically, Health Care News.

It ain't so.

Every first-year high school debate student learns about fallacious arguments. It's a requirement and something you had better learn well unless you want your argument to fail, your proposal to lose, and what little social standing there is to be had from membership on the debate team to be negated by having your ass publicly handed to you by an even bigger geek at a public (albeit most likely unattended) public event.

I speak from experience here.

As the saying goes, things change.

In our modern era of corporate media, where a powerful and wealthy few dictate what constitutes both entertainment and news, as well as their bastard offspring - infotainment, the validity and coherence of one's argument doesn't matter; volume does.

Volume can be measured in decibels (talk radio), eyeballs (Drudge Report), Nielsen Ratings (Fox News, Desperate Housewives), circulation (The National Enquirer), or some combination thereof. Health Care News apparently knows how to pump-up the volume: according to their masthead they reach 53% of all healthcare professionals.

I know that healthcare is a business, and that even the most selfless non-profit organization has to figure the bottom line into the equation somewhere, but it is my sincere hope that when most healthcare professionals and the organizations they work for need to get a feel for the pulse of the nation on important questions of the day, they'll keep in mind that Charmin is a better quality paper than The Heartland Institute's propaganda organ is.

Why am I being so hard on Health Care News? For starters, they have a widget on their site that is a consistent part of their navigational structure that declares Crichton is Right! This is a reference to science fiction author and 2006 American Association of Petroleum Geologists Journalism Award-winner Michael Crichton, whose novel State of Fear denies the science of the greenhouse effect and slanders The New Republic Senior Editor Michael Crowley.

With both John McCain and Barack Obama in favor of joining some version of the Kyoto Protocols and enacting some sort of carbon cap-and-trade system, this ranks The Heartland Institute right up there with holocaust deniers and The Flat Earth Society in my book.

Is this unfair of me? Am I painting with an overly broad brush? Am I resorting to unjustified Ad Hominem attacks and throwing the baby out with the bathwater just because I think Michael Crichton is a despicable human being and corporate drama whore who is trading on name recognition in lieu of long-since-gone talent?

I don't think so.

Here's a critique of their three-article, red-letter Single-Payer expose'.

Read it.

Better yet, read the original articles independently of my critiques, and decide for yourself.

Meanwhile, I will be tackling all three of Health Care News' extremely fallacious and biased articles one-at-a-time over three posts. First up:

Russia's Failed Universal Health Care Program Exposes the Perils of Single-Payer Systems

This article attempts to paint a picture of what universal healthcare in the United States will look like by describing in lurid detail what's going on at the bottom of the barrel in Russia's healthcare system.

For this article alone, the fallacies include:

If you look at the subheadings in this article, two of the three read like they're straight out of the tabloids:
  • Awful Facilities
  • Rampant Corruption
  • Proposed Solutions
Now sing along withe me:

One of these things is not like the others,
One of these things just doesn't belong,
Can you tell which thing is not like the others
By the time I finish my song?

Did you guess which thing was not like the others?
Did you guess which thing just doesn't belong?
If you guessed this one is not like the others,
Then you're absolutely...right!

The first section, Awful Facilities, is clearly an Appeal to Fear as it describes Russia's hospitals in the following manner:
Many state-run hospitals, particularly in remote areas, do not have hot water, and some do not have running water at all. Even the most basic medicines are often in limited supply.
This is an attempt to form a Post Hoc fallacious argument. It fails in this regard, however. Awful Facilities actually Confuses Causes and Effect - the Russian Federation is the successor to the collapsed Soviet Union and the product of more than a decade of economic decline before its recent economic stabilization. Consequently, it's healthcare infrastructure isn't a shambles because the country's national, single-payer healthcare model is a failure; the country's national, single-payer healthcare model is a failure because the country's healthcare infrastructure is a shambles!

The article then tries to draw a direct linkage between these sorts of conditions and not just healthcare reform in general in the United States, but healthcare reform originating with one particular political party:
Healthcare is far too important to leave to politicians - be the autocrats or Democrats [sic]," said John R. Graham, director of health care studies at the Pacific Research Institute.
Did you spot the Ad Hominem fallacy? It's tricky because it's also an example of Guilt by Association. In the above statement, the poor state of the Russian healthcare system is the fault of the autocrats, who are synonymous with Democrats! Since all Democrats are autocrats, and autocrats can't be trusted to administer healthcare, then obviously neither can the Democrats.

Finally, with the Democratic Party poised to increase its congressional majority in November and favored to win the White House as well, a Slippery Slope is hinted at: if Democrats are autocrats, and autocrats believe in large, ineffective healthcare bureaucracies, then putting Democrats into power will increase the likelihood and speed at which the U.S. healthcare system will come to resemble the failed healthcare systems in states run by autocrats (i.e.: the U.S. will be just like Russia if the Democrats get their way).

Though I can't imagine why, the author goes on to further develop the linkage between Russia's incredibly corrupt and byzantine bureaucracy and government healthcare by painting the faithfully terrifying picture of government bureaucrats picking the pocket of ordinary tax payers and giving them absolutely nothing in return - a Hasty Generalization if ever there was one:
"The Russian 'free healthcare for all' system is nothing of the sort," said Jeff Emanuel, research fellow for healthcare policy at The Heartland Institute and managing editor of health Care News. "Instead, it is simply another program built on governmental taking of taxpayer fund and mismanagement of the services it promises to provide."
You see, in the neoconservative fantasy land that Jeff Emanuel lives in, any single failed government program from any government anywhere is proof that all government programs from all governments everywhere will fail! And be sure to take a good look at just who Jeff Emanuel is: the editor of the very publication the article appears in! While this isn't a logical fallacy, it certainly makes him a less than objective - and therefore credible - subject matter expert for this particular piece.

The article fails the Biased Sample test because it holds up Russia's national, single-payer healthcare systems up as the only example of a national, single-payer healthcare system. Moreover, by sensationalizing this small sample, the article is guilty of Misleading Vividness, as the statistical evidence doesn't bear out the original premise.

Despite the fact that there is currently no legislation before Congress to institute a national, single-payer healthcare system, nor a presidential candidate from either party intending to introduce one (a Factual Error), even if universal coverage and a national, single-payer system were the same thing (which they are not), citing only Russia as a representative example of such a system is not only a Biased Sample fallacy, it also grossly distorts the success of the many other national, single-payer healthcare plans of every other industrialized country, all of whose citizens enjoy a comparable or superior degree of health and wellness than the average American does from healthcare systems that universally consume fewer resources and produce comparable or superior outcomes to our own.

(It is also insulting to the intelligence of anyone who has been paying attention since 1991 and knows that for all of our problems, the United States and the keystone republic of the former U.S.S.R. have about as much in common as William McGuire and Mother Theresa when it comes to infrastructure and other assets to bring to bear on their respective national healthcare concerns!)

In fact, according to the CIA World Factbook, as of 2007, per capita GDP in the Russian Federation was $14,600 - less than .33% (one-third) of per capital GDP in the United States of American ($46,000) during the same period!

Despite the enormous differences between the two counties, the average life expectancy at birth for all Russians is 84.5% that of their American counterparts, a difference of only 15.5%. Based on these numbers, if the United States were to adopt the horrific Russian healthcare system in its current form in its entirety tomorrow, but maintain current U.S. healthcare spending levels, median life expectancy at birth for all Americans would exceed 129 years!

Life Expectancy at Birth Russian Federation United States of America
Total population 65.94 78.14
Males 59.19 75.29
Females 73.1 81.13
Life expectancy: Russian Federation and United States of America as of 2007
Source: CIA World Factbook

Now, I know that this is a Misleadingly Vivid example, but then again so is Health Care News' representation of the Russian healthcare system as a legitimate cautionary tale for healthcare reformers in the United States looking to implement some form of universal coverage or otherwise assure care is made available to nearly 50 million of their fellow uninsured citizens.

As I pointed-out above, Rina Shah bases her entire article on a Factual Error when she presents the situation in Russia as an example of a failed universal healthcare system. However , Russia's implementation of universal healthcare is a national, single-payer universal healthcare system; there are no proposals for implementing such a system in the United States from either political party or presidential candidate.

I would argue that the entire article is nothing but a Strawman, but the second section, Rampant Corruption, is particularly egregious. In two paragraphs, the article's author serves up all of the quantified data in the entire piece, but they have nothing to do with single-payer or universal healthcare plans; on the contrary they have everything to the country's overall poor standard of living and lack of effective regulation and oversight of the Russian healthcare market. According to the article:
Research conducted by Moscow's INDEM think tank in 2004 showed Russians spent some $600 million each year on under-the-counter payments to health care providers. The Russian Academy of Sciences' Open Health Institute more recently estimated rampant corruption siphons off as much as 35 percent of the money spent on health care nationwide annually.

Low wages are another problem. Yearly salaries of physicians average $5,160 to $6,120, while nurses average $2,760 to $3,780. This often results in underpaid physicians accepting bribes for higher-quality care.
Do you see the Strawman here? The figures presented above only proves that Russia's healthcare market is inadequately policed; it doesn't prove that universal or single-payer healthcare systems are inherently corrupt or result in substandard wages for healthcare professionals. The average pay of Russian healthcare professionals is also something a Red Herring: compensation of individual healthcare practitioners is not an indicator of the likelihood of an overall healthcare market's ability to function efficiently, as the performance of healthcare markets from Canada to Cuba clearly show.

The article's concluding section, Proposed Reforms, is nothing of the sort. Instead, it merely serves to Poison the Well:
Reforms drafted this spring by the Russian Federal Assembly include placing higher emphasis on primary care, shutting down numerous substandard hospitals, scaling down the scope of free medical assistance guaranteed by the state, and increasing physician salaries by reimbursing doctors according to the number of individual treatments given instead of by the number of hours worked.

"Instead of forcing people to pay into this failed program, Russia's government should allow the market to influence the health care system, which it can begin to do by allowing its citizens to choose how their own health care money is spent," Emanuel said.

So-called "universal" health care does not actually exist, says Graham.
Do you see what's going on here? The reforms proposed by the Russian government are never addressed. Instead, they are summarily dismissed.

That's the the set-up; here's the pitch:
"At best, in a functioning democracy like Canada or Britain, it results in unequal access to health care by government rationing, lack of investment in innovation, and shortage of medical professionals," Graham pointed out. "At worst, in a country with little democratic bona fides, it results in the situation we are seeing in Russia."
The author has taken great pains to paint an unfavorable, ugly, and frankly prurient (from a healthcare policy perspective) picture of Russia's national, single-payer healthcare system. Having savaged the concept generally (i.e.: Poisoned the Well), Rina Shah sees no reason to bother backing up the claims made in the concluding paragraph about the failings of universal healthcare systems in functional democracies, which are better and more realistic models for potential universal healthcare solutions in the United States. Which was clearly her intention all along.

Next up: My adverse reaction to Universal Health Care is the Wrong Prescription

1 comment:

JaaJoe said...

Did you see the Bunk study stating 2/3 of doctors in America want National Health Care. The doctors who did this study also conducted one in 2002 and found that the majority of doctors did not want national health care, the problem with this is that the 2 question surveys drastically differ in there 2nd question. I found this article, 60% of Physicians Surveyed Oppose Switching to a National Health Care Plan, It's worth a read.