Wednesday, August 31, 2011

Premature Babies, Infant Mortality, and Socialized Medicine

A recent report by Dr. Linda Halderman begins with the question:
Q: If socialized medicine is so bad, why are infant mortality rates higher in the U.S. than in other developed nations with government or single-payer health care?

A: U.S. infant mortality rates (deaths of infants <1 year of age per 1,000 live births) are sometimes cited as evidence of the failings of the U.S. system of health care delivery. Universal health care, it’s argued, is why babies do better in countries with socialized medicine.

But in fact, the main factors affecting early infant survival are birth weight and prematurity. The way that these factors are reported — and how such babies are treated statistically — tells a different story than what the numbers reveal.

Dr. Halderman goes on to handily destroy this broadly accepted myth of the global left, and I certainly suggest looking over the insurmountable case she presents.

Americans may remember this argument being brought up in the healthcare debate.  Proponents of the ObamaCare model, which more closely resembles a Euro or Canadian-style system, would suggest that since American infant mortality rates are higher than these other nations with more socialized healthcare, they must have better healthcare systems than America, right?  The implication is that these other nations are able to save more infants' lives, which is presumably evidence of a more efficient healthcare construct. 

But I guess that all just depends on what your definition of "life" is.  Americans recognize a life if it, well... lives.  Born.  Breathing.  Heartbeat.  Reacting to stimuli.  Any of these things.  It's not rocket science.

These other nations with socialized medicine only recognize an infant's life if it meets their standards of what they think "life" is- or at least what it should be for reporting purposes.  According to Dr. Halderman's report:

-Low birth weight infants are not counted against the “live birth” statistics for many countries reporting low infant mortality rates.

-Some of the countries reporting infant mortality rates lower than the U.S. classify babies as “stillborn” if they survive less than 24 hours whether or not such babies breathe, move, or have a beating heart at birth. **

And if an infant doesn't meet these state requirements it takes to be considered alive, can that infant ever really die?

Not according to the comrade that's tallying the low "infant mortality rates" that are touted as a measure of the success of state-run healthcare.

So do you really want socialized medicine, America? Where the state must first declare that your prematurely born baby meets the requirements of being considered a life and therefore worthy of saving before efforts are made and resources are dedicated to the task?  This is not fear mongering- and it's certainly not far-fetched.  Consider how Dr. Halderman concludes her report::

Too short to count?

In Switzerland and other parts of Europe, a baby born who is less than 30 centimeters long is not counted as a live birth. Therefore, unlike in the U.S., such high-risk infants cannot affect Swiss infant mortality rates.

Efforts to salvage these tiny babies reflect this classification. Since 2000, 42 of the world’s 52 surviving babies weighing less than 400g (0.9 lbs.) were born in the United States.

The parents of these children may view socialized medicine somewhat differently than its proponents.
Indeed.  They are certainly lucky for their children to have been born in the American healthcare system, rather than a single-payer or universal healthcare system that would have declared their child to have never existed at all.  Let us hope that the future may hold such joy for some lucky parents in America.

-William Sullivan

Thanks to Rick Moran of American Thinker

** Perhaps pertinent to note, 40% of all infant deaths result in the first 24 hours after birth.


  1. I saw a link to this post through a mutual friend on fb and thought I'd note a few weaknesses.

    First, the absence of a US infant mortality rate in the Halderman article is glaring. Despite the premise of the post (that counting methods tell a different story), the argument is limited to claims that certain countries under-report their rates relative to others. Nobody disagrees with this fact. NGOs who count IMRs internationally do their best to minimize differences in methodology. But it's obviously problematic to compare among countries counts intended for use at the national level. Since the sources of the particular IMR values Dr. Halderman uses are not cited (she could be using Canada's internal IMR), it's unclear whether her argument is anything new. But what is clear is that the international counts show that the US has a higher IMR than other developed countries. For example, the CIA World Factbook estimates for 2009 for Canada and the US are 4.85 and 5.98, respectively. So even rate adjustments of the scale the Halderman article claims do not make up for the discrepancy. The insinuation that IMR counting methods reflect the standard of care taken by hc providers is certainly misguided.

    Second, I think you mischaracterize the efficiency arguments brought up in the US healthcare debate. As far as I know, they referred to health outcomes relative to costs, not outcomes alone. In this respect, the existing single payer plans are certainly more efficient than the US hc system. For example, we paid on average 70% more than Canadians on hc in 2009 without appreciably better health outcomes (the main difference between the systems' outcomes likely being the distribution relative to SES).

    Third (I'll stop here), the comparison of the Affordable Care Act to the Canadian or European hc systems is misinformed. Far from being a single-payer system, the ACA provides access to health insurance by establishing a set of state-level exchanges for citizens to buy private insurance plans. The government has nothing to do with the operation of these private plans other than requiring that they meet a minimum standard of coverage.

    While I recognize that the post is imbued with a discourse of "life" and not necessarily intended to be an accurate representation of policy, I think the article cited is (at best) weak, the post itself mischaracterizes the counterarguments, and the language used is either disingenuous or misinformed. For a more accurate reference on the ACA, may I suggest Jonathan Gruber's work, such as his recent graphic novel, "Health Care Reform: What it is, why it's necessary, and how it works." He's an health economist at MIT who worked on the ACA and advised Mitt Romney on MA's Commonwealth Choice.

  2. Thank you for the response.

    First, I see your point, insofar as the IMR may not account for the entire discrepancy. There is a discrepancy, however, and that discrepancy exists because governmental administrators, seemingly for reporting purposes to pad statistical success, have redefined what "life" is to fit their preferred description. I see this as an affront to liberty. But again, your first point is taken.

    In response to your second and third points, as to the cost/service argument. If it is indeed as you say, and increasing the cost effectiveness of quality healthcare was truly the purpose of the 2009 debate and the goal of the 2010 bill, "failure" can be the only way to describe it. The CBO has just declared the actual cost of the legislation as twice the cost originally pitched, now with 10 year estimated cost at $1.7+ trillion. You do not have to know finance beyond a child's grasp to call this failure, in a budgetary planning sense at the very least. But as I remember it, the rhetoric pressing for healthcare reform consisted more of emotional triggers than hard figures about cost reduction. The "cost reduction" aspects of the healthcare debate were a red herring. The true discussion, as you and I both know, was about the identification of healthcare services as one of two things: 1) a self-rationed SERVICE that varies depending upon an individual’s financial circumstances and preferences, or 2) a fundamental RIGHT, where a centralized government will see to it that a "minimum standard" of healthcare is applied, as you put it.

    The problem with the latter, as I see it, is exactly as I described in the article. That "minimum standard" is malleable and dependent upon what that centralized government dictates the "minimum" is. Now, you can offer the same fallacy that has been offered, that everyone can keep their private policy w/ all or as few of the bells and whistles, and you can argue that this suggested path is a "third way" between single payer and privatized healthcare. But this is untrue, if only at the most basic level. To give but one simple example, mini-med plans have been eliminated in the bill, meaning that private policies must now offer increasing (unlimited in 2014) benefit rather than having capped benefits (100K, eg), a feature that had, until now, made many policies affordable for employers and employees, particularly at lower income levels. Since these cheaper policies can no longer be allowed (unless you're one of the thousands of co.s and unions that got a waiver) the policies will cease to be offered in the future. The only way for an insurance company to take on the exponentially increased risk is to raise premiums beyond what lower income policyholders can pay, and beyond what wealthier policyholders will pay without some sort of increased benefit. What this does, effectively, is use regulation to pigeon-hole insurance companies, making them unable to market to lower income Americans. The federal government will have then monopolized that lower income market in 2014, when “the better options” are available, as Robert Gibbs once put it. But the problem, of course, is: the “minimum standard” means that the government will be handing out policies w/ unlimited risk caps while still only collecting meager amounts from the low-income citizens that it insures. Financial realities dictate that the government will bleed money unless it does one or both of two things: increase taxes to subsidize the bad business model, or ration care to make use of allowable revenue. And again, we find ourselves at the point of allowing when and where care might be applied based upon its bureaucratic standards. Again, an affront to individual liberty.

  3. I will look into your suggested reading, but allow me to say this in closing. It is not fear-mongering to say that rationing of care takes place in socialized health systems, and quite honestly, I’ve spoken with some friends from the UK with some shocking stories about waiting for care. But the truth is, healthcare must always be rationed, whether individually or by a government administration. But at its core, it is a SERVICE that must be offered within its availability. And oddly enough, in regard to Canada, I have read of many instances of rationing and, in fact, that the country is looking to find free-market solutions to the problems it does experience. The irony, of course, being that we clamber toward a more socialized system as they are doing so.

    Thank you for discussion, and all the best,

  4. it's a very helpful article, In my opinion, every mom wanna-be should understand that being pregnant is a miracle, so they will take care their body with a great love and understanding.