WHO Study Used to Justify ObamaCare a Scientific Fraud

An article in the current issue of Commentary (subscription only) suggests that the WHO study, which provided the “moral” basis and primary justification for ObamaCare, is deeply flawed. The study, which ranked the United States 37th of 191 countries in overall performance, relied on incomplete data, flawed comparisons, and estimates by “experts” to fill in the many data gaps.  But mostly, it evaluated health care systems not on outcome, but on inputs -- who pays for it, how much do they pay, and who is covered. This would be similar to evaluating the performance of a school system on the dollars of tax money spent per student, and on the student teacher ratio, but not on educational outcomes (for the record, teacher unions oppose any such outcomes measurement).

For the WHO study, higher scores were awarded for health care systems which came closest to the goal of providing the same insurance coverage for all, paid for by governments, and with minimal individual out-of-pocket contributions (other than for higher taxes, where the rich would pay more). Where individuals paid for their coverage, the ideal was a system where the rich paid more for the same insurance coverage provided to all residents.

The WHO might well have called their analysis “a comparative analysis of the level of redistribution of income used to pay for universal government-run health care coverage." The WHO study designers clearly oppose the idea of individuals having more control of their health care expenditures, rather than having them directed through third-party payers. In total, 62.5% of a nation’s overall performance score came from consideration of measures of fairness and distribution. The U.S ranked 54th in fairness in the WHO study.

Critics of the U.S health care system also pounced on the U.S performance in measures of quality in the WHO study. Since we spend a far higher percentage of GDP on health care than other nations, we should get better results . It turns out that the results are better here than anywhere else in the world in many areas, including cancer survival rates. But the WHO study relied on life expectancy as the key surrogate for quality. Here, it appeared the U.S underperformed, with life expectancy a few years below that of other developed countries, and infant mortality a few points higher than in these same countries.

Not surprisingly, the comparisons are flawed here as well. As Scott Atlas, the author of the Commentary article, explains:

At its most egregious, the report abandoned the very pretense of assessing health care. WHO ranked the U.S. 42nd in life expectancy. In their book, The Business of Health, Robert L. Ohsfeldt and John E. Schneider of the University of Iowa demonstrated that this finding was a gross misrepresentation. WHO actually included immediate deaths from murder or fatal high-speed motor-vehicle accidents in their assessment, as if an ideal health-care system could turn back time to undo car crashes and prevent homicides. Ohsfeldt and Schneider did their own life-expectancy calculations using nations of the Organisation for Economic Co-operation and Development (OECD). With fatal car crashes and murders included, the U.S. ranked 19 out of 29 in life expectancy; with both removed, the U.S. had the world’s best life-expectancy numbers.

The infant mortality comparisons were  even more defective. The U.S included all births in the denominator of total births, including low birth weight babies and infants who do not survive very long. Many of the European nations excluded these babies from both the numerator (infants who died) and the denominator of total births, as pointed out in an article by Dr. Linda Halderman.

The higher American infant mortality rate was preordained by this comparison of apples versus oranges.

Increasingly, the “science” in the "social sciences” has moved away from disinterested scholarship, and turned into advocacy. Journalism has taken a similar route. The social justice achievements that can be won are just too important to be left to people who are not on the team, and who have not reached their conclusions  before they begin their studies.  It is the result that matters, not the methodology that gets you there, or even the truth that might be found in an honest examination of an issue.