weekly response

A Fallacy of Comparison
By Jamal Jefferson

In President Barack Obama’s State of the Union address, health care was scarcely mentioned. Only in a segment of his speech in which he speaks about the oil spills off the Gulf of Mexico does he add, "I will not go back to the days when health insurance companies had unchecked power to cancel your policy, deny you coverage, or charge women differently from men."

Meanwhile on the Republican presidential trail, the candidates have not been shy on the matter. The remaining four candidates all vows to repeal the bill once elected as President. And if the front runner of the Republican Party, Mitt Romney, does in fact become the Republican Party nominee, this issue will be one of the hot topics of debate, as many claim the Massachusetts health care reform law ("Romneycare") is the framework of Patient Protection and Affordable Care Act ("Obamacare").

Outside of politics, some in academia are looking at the health care problems in a different light. Instead of focusing on the issues of clinical medicine, some are focusing of the issues of preventative medicine. But the problems are interdigitated between clinical and preventative health and solutions will not come from one branch of medicine or the other. Therefore, strong proponents of preventative health may also miss the mark when it comes to finding truly effective solutions to the US’s health issues.

On December 8th, 2011, Dr. Elizabeth H. Bradley, professor of public health at Yale and faculty director of its Global Health Leadership Institute, and Lauren Taylor, a program manager at Yale’s Global Health Leadership Institute, wrote an op-ed in the New York Times entitled "To Fix Health, Help the Poor." The authors point out that the US spends more on health care than any other country, yet still ranks low in life expectancy, infant mortality, and maternal mortality among developed nations. They claim that the US does not spend enough on social programs, which in turn relates to our sub-par health care statistics. According to Dr. Bradley’s research, in 2005, "Sweden, France, the Netherlands, Belgium and Denmark dedicated 33 percent to 38 percent" of their gross domestic product to health and social services combined, compared to the US, which only spent 29 percent. But is it so easy to look at these numbers and simply conclude that spending more on social services would improve US health statistics?

It is doubtful that the reallocation of funds from health care to social programming will have a significant effect on our world health rankings. The article did not present any "real" or applicable examples of reallocation and relied primarily on a macroeconomic approach which would naturally support their conclusion. In fact, the issues preventing the US from improving their world health rankings are far more complicated. When describing the factors particular to health inequity among women in Detroit, where white women experience 4.6 deaths per 1,000 live births while black women experience 16.6 deaths per 1,000 live births, Dr. Talat Danish of the Wayne County Health Department suggested six different issues: 1) unemployment, 2) a lack of education, 3) women being socially isolated, 4) poverty, 5) a lack of gender equity in pay, and 6) the social perception of women. These deeply rooted issues are the crux of many of our health disparities in America. The article did not provide enough evidence to support the rudimentary claim that more money in social programming will sufficiently tackle these complicated issues plaguing America.

The authors' macroeconomic stance bears fallacy because it compares the United States with other countries with dissimilar health care systems. They do not mention that developed countries like Sweden and France have some kind of basic health care systems funded by taxes and levies, allowing citizens access to health care free of charge (not including taxes, of course). For example, preventative health measures are more easily accessed in countries with universal health care systems because they do not pay out pocket for health services. The fundamental differences in how the health care systems work do not allow for accurate systematic comparisons, leading the authors to inaccurate conclusions.

I agree that social programming is needed to improve our health disparities in our country. However, the authors’ large scaled comparison is too simplified for such a complex issue.

Jamal Jefferson works as an aide to a radiologist in Cincinatti, Ohio. He graduated from Williams College in 2011 with a major in Biology. Jamal's post is the first in an ongoing "Guest Blogger" series. If you're interested in writing, do click the link and be in touch!