A right-wing argument on healthcare that I'm going to examine and debunk here is that, yes, the United States does pay more for healthcare, but that's because we receive healthcare of a higher quality. Contrary to what conservatives argue, United States healthcare quality—as measured by objective outcomes—can only be described as average.
Steven Crowder, in a so-called "rebuttal" to Vox on healthcare, argued the following:
". . . This entire video only discusses costs; it does not discuss quality of service. . . . If you're looking to argue your point, if you're looking to have this conversation with somebody—usually, not from a country that has socialized healthcare, mind you. Usually people who come from socialized healthcare, they go: 'We'll give ya that one. It's better here. . . .' It is nice here, compared to where I was raised, in Montreal.
You need to, when discussing this issue . . . pin them down on quality of care. And make sure that quality of care is measured by objective outcomes, and not subjective polls asking people 'how do you feel about your healthcare?' When you frame that in, and, ok, let's get outside of costs, let's get outside of what people think about crappy healthcare because they're not paying for it and they live in socialized hellholes, what are the actual objective outcomes of healthcare? It is a losing issue for them, it's a losing issue for them internationally, it's a losing issue for Vox. Domestically, if you actually compared Medicare, Medicaid, and the private sector, it sucks!"
Before we jump into the core question of healthcare quality and outcomes, Crowder gets so many things wrong here that I have to address some of the other points he makes.
First, he complains that that entire Vox video only discusses costs—not quality of care. That might have something to do with the fact that it was a video about healthcare costs. The title of the video that he's responding to is: "The real reason American health care is so expensive."
"Hey, that video you made that was about that thing wasn't about that other thing."
"Fuck, man; ya got me!"
He also describes countries which provide universal healthcare as "socialized hellholes." Crowder's stand-up comedy experience is on full display right here, because this is a fucking joke.
The 2018 World Happiness Report ranks the following countries as the world's top 10 happiest: Finland, Norway, Denmark, Iceland, Switzerland, the Netherlands, Canada, New Zealand, Sweden, and Australia. The United States, by comparison, ranks number 18.
Every single one of these countries in the top 10 has a more progressive healthcare system than the United States. In the case of Switzerland, they have a heavily-regulated private system. In the case of the Netherlands, New Zealand, and Australia, they have a public-private blend, and in the case of Finland, Norway, Denmark, Iceland, Canada, and Sweden, they have public healthcare systems. Obviously there's nuance to each country's system, but these are the general classifications.
There is a real disconnect here between the facts and the fiction that Crowder wants his low-information audience to believe. If these countries truly are socialized hellholes, why are they among the happiest countries in the world? If the World Happiness Report is any indication, they seem a lot more like socialized heaven-holes to me, and if this is what hell is going to be like, eternal damnation doesn't sound so bad after all.
In the context of dismissing subjective, satisfaction data, Crowder says: "let's get outside of what people think about crappy healthcare because they're not paying for it." They're not paying for it? Yes, they are paying for it, through their tax dollars.
Conservatives want it both ways on this question: When they talk about how terrible these countries are, they'll agonize about the high tax rates that go towards funding things like health care. Then when they get shown polling data which indicates that actually, people in these countries are very satisfied with their healthcare systems, suddenly this data becomes inadmissible and they're only under the illusion of satisfaction because they're not paying for their healthcare.
Which one is it? Is the tax burden to fund this healthcare system unbearable, or do the people who live under this healthcare system not pay for it? Clearly they do pay for it through their tax dollars, but the reason I make this point is to illustrate that Crowder will shapeshift and argue in favor of whichever one of these contradictory positions is convenient for him to make.
Or let's be generous and assume he meant that people in these countries aren't aware that they're paying for healthcare through their tax dollars. Beyond demonstrating that he has mind-reading capabilities, I don't know how he could possibly prove such a bold statement. Anybody living in these countries can look at what percentage of their income is going to taxes and can look at what percentage of these taxes are going to what functions of government, so no matter how you slice it, his position here just doesn't make sense.
And make no mistake: the only reason that Crowder is making this absurd argument is because the healthcare satisfaction data deeply contradicts his political worldview. According to 2016 Commonwealth Fund polling data, only 20% in the United States said that the healthcare system "works pretty well and only minor changes are necessary to make it work better." Compare this to the average of 42% and 48% who responded this way in countries with public or mixed healthcare systems, respectively. Crowder's ridiculous argument on this point is nothing more than a pathetic attempt to weasel his way out of the healthcare satisfaction data which makes absolutely clear that he is on the wrong side of this argument.
If the satisfaction data indicated that countries with more progressive healthcare systems were deeply unsatisfied, and if the data showed that countries with private healthcare systems were much more satisfied, do you think that Steven Crowder would be dismissing this self-reported data? "Yeah, it may look like this data supports my position, but here's why we can't trust it!..."
There is not a chance that this would happen. He would cite this data in every single video he makes on healthcare until the end of time. It would be the first point he brings up in those videos where he debates unprepared, uninformed college students on campus and declares triumphant victory.
Who does he think he is to so confidently and carelessly dismiss this data? "Oh, what do you know about your country's healthcare system? You only live there." It's like saying: "What do you know about sex with your girlfriend? You're only fucking her!"
To presumptuously discount this satisfaction data is basically to say: "Mmm, I'm a much better judge of whether you should be satisfied or not than you are." Sorry to break it to you Crowder, but this is not your decision to make, and I would actually argue that, when it comes to the question of which healthcare systems are superior, satisfaction data on the system as a whole is some of the most informative data that there is.
How does this guy manage to get so many things wrong in such a short span of time? Steven Crowder is like the Fountain Of Youth of shitty arguments. It's like you take a drink from the beer glass, and it just keeps getting magically refilled.
I will listen to an argument from Steven Crowder, find three things wrong with it, then I'll go back and listen again to the exact same thing, and somehow—like he's a fucking magician or a magic genie or something—more falsehoods and flaws in the argument mysteriously appear from nowhere as if we're living in The Twilight Zone. It's almost spooky how wrong this guy is.
This is why I love making this style of content, where I can take my time to carefully analyze and address every little thing that a person gets wrong, because if I was trying to do this in real time, it just wouldn't be possible to keep up. It's like you're jogging behind somebody and you need to retrieve everything they drop on the ground, but instead of dropping one thing at a time right behind them, they just throw a bunch of shit in five different directions.
Have you ever heard of Murphy's Law? It's basically the idea that anything that can go wrong eventually will. I think it's about time that we coin a new term: Crowder's Law, which says that anything he can get wrong, he will. It's almost like he learns what the facts are, and then he argues the exact opposite.
But ok, Crowder wants to focus on the quality of care and objective outcomes, so let's focus on those things. He says that when discussing healthcare, you need to "pin them down on quality of care." Pin us down? Nobody is running away from anything here. What kind of delusional healthcare conversations is this guy imagining?
Liberal: "Well hello, Republican: I'd like to talk about health care."
Republican: "Ok, liberal: What do you think about...*pauses suspensefully*...quality of care?"
Liberal, while sobbing: "No, please! Anything but that!", and then the liberal sprints away in the opposite direction across five lanes of traffic just to evade the conservative's brilliant arguments on this point.
Gimme a fucking break. I've got news for you, Crowder: Your fallacy-riddled arguments are not that intimidating, and the only thing you're likely to pin somebody down on is a wrestling mat.
So what do the objective outcomes indicate about United States healthcare? We pay almost twice the OECD average for healthcare, so assuming that quality would scale with spending, you would expect to see significantly better outcomes in the United States compared to these other countries. Is this, indeed, what the data shows us?
Let's first look at some very general indicators from the Peter G. Peterson Foundation. (By the way, who the fuck names their son Peter Peterson?) Average life expectancy in the United States, at 79 years, is slightly below the OECD average of 81 years. In terms of infant mortality, the United States, at 6 deaths per 1000 births, is above the OECD average of 4 per 1000.
Now there are some important caveats about this data that are outlined in a Forbes article written by Gary Price and Tim Norbeck.
". . . one of the big 'knocks' on America’s healthcare system is our infant mortality rate, especially when compared to the other countries. Experts all agree that there is a lack of consistent and reliable data out there in which to make truly valid comparisons. . . . One of the reasons is that countries vary in their reporting of births.
. . . in infant mortality reporting, mechanisms vary greatly among the countries compared with the U.S. For example, in France, 'a baby has to be alive at the time of registration, which could be 24-48 hours after delivery. If the infant does not survive at that point, it is recorded as a false stillbirth.' On the other hand, if a newly born infant in the U.S. takes one breath and dies, it is recorded in the infant mortality stats.
Life expectancy has been another 'knock' on the U.S. healthcare system. Unfortunately, our suicide rate is higher than the other countries mentioned in the Papanicolas et al study, with the exceptions of only France, Switzerland and the world leader, Japan.
We have the worst rate of car crash deaths and the highest rate of gun homicides. Furthermore, we lead the world in another very dubious 'distinction' – that of obese or overweight adults."
These are very fair points about data collection and factors that account for the differences, although I think we do need to be careful not to fall into the trap of finding reasons to discount only the data that disagrees with our position. This is, of course, a psychological bias that everybody is guilty of to a certain degree, but it's something to watch for in yourself. Frank Luntz put it bluntly in his book What Americans Really Want:
"We use polls we agree with to validate our point of view, while polls that challenge our assumptions are dismissed for their methodology or their inaccuracy."
Source: p. xvi, What Americans Really Want . . . Really, by Frank I. Luntz. 2009.
If you try hard enough, you can find some reason to criticize virtually any data that contradicts your viewpoint, and I think Price and Norbeck's analysis does contain a hint of special pleading. I think they're spot on when it comes to infant mortality, but when it comes to life expectancy, I think they're a bit off track. They say: "Oh, what about our high suicide rate?" Couldn't it be argued that a high suicide rate is, in part, the product of inadequate mental health care in this country? The same could be said about many of the gun homicides in this country.
And yes, the United States has a high suicide rate, but so does Japan, with both countries having a rate of 21 suicides per 100,000 people. Despite this similarity, Japan has a life expectancy of 84 years compared to 79 in the United States. I think I know what might account for this disparity, however: In The United States, we have pseudo-intellectuals like Steven Crowder who make such memorably moronic arguments that you have to drink yourself into oblivion just to forget about them!
Another factor Price and Norbeck point to that drags down our life expectancy is obesity. As we can see here in 2015 OECD data, the United States has an obesity rate of 38%, compared to the OECD average of 20%.
Again, couldn't it be argued that high obesity rates are partly caused by the inadequacy of our healthcare system? I would argue that there's much more to healthcare than the physical act of entering an examination room or being under the knife and receiving surgery; aren't education and prevention crucial components of healthcare?
Ask any doctor—even the one Ben Shapiro constantly reminds us he's married to—and I'm sure they'll tell you that an enormous amount of needless disease and pain and suffering could be completely prevented if people simply exercised more, ate a healthy diet, stopped smoking and drinking, and maintained a healthy weight. If everybody accomplished all of those things, I genuinely believe that disease rates and hospital visits could be cut in half.
And many doctors are trying to move in the direction of not just applying Band-Aids by, for example, prescribing cholesterol-lowering medication, but are actually trying to get the person to improve their diet and address the root cause of their problem. It was none other than the ancient Greek physician Hippocrates who said "Let food be thy medicine and medicine be thy food."
Now by this, he doesn't mean pour a bunch of pills into a bowl and eat them like cereal; even they do look suspiciously like candy, I wouldn't recommend this. (Rush Limbaugh's listening and—as he scoops another spoonful of Viagra and Oxycontin into his mouth—he's like: "Hey, speak for yourself, asshole.") What Hippocrates meant by this quote is that your diet is a huge factor in your overall health, and if improving the diet isn't already a big part of our healthcare system, it should be. As the saying goes, an ounce of prevention is worth a pound of cure—and in the case of fat people, we're talking about a hell of a lot more than just a single pound.
The Kaiser Family Foundation also reports that the United States has one of the highest rates of disease among comparable countries, at 23,000 per 100,000 compared to the average of 19,000 per 100,000. I don’t know why they didn’t just report this as 23 out of 100, but hey, you’re the fuckin’ experts here—not me. Now to be fair, the reason this number is so high in the United States is probably because so many Republicans are mentally retarded. (I am only joking, my Republican friends, so there's no need to get your George Washington–themed panties in a bunch!)
But ok, you could—and probably should—argue that life expectancy and disease are influenced by so many different variables that they can't be used as informative barometers of our healthcare quality. Factors like dietary choices, exercise rates, use of tobacco and alcohol—these, and many other factors, could also play a role. This is a fair point, so let's look more narrowly at measurements that can be used to assess the quality of care received.
HealthSystemTracker.org provides data on medical, medication, or lab errors over the past two years, and as we can see, the United States has a mistake rate of 22% compared to the average of 16%.
30 day mortality for heart attacks is slightly lower in the United States than the average, whereas mortality for ischemic strokes is significantly lower than the average. By contrast, mortality for hemorrhagic strokes is slightly higher in the United States.
Rates of post-operative clots in the United States are below average, whereas rates of post-op sepsis are about average and rates of suture ruptures are above average in the United States.
The rates of surgical items or foreign bodies left inside of people after a procedure is similar in the United States to rates we see in other countries. There's a very important question that needs to be asked here: What if the surgical instruments or whatever it is are left inside of an illegal immigrant? Then do we have a case of foreign bodies being left inside of foreign bodies? What if the foreign body itself is a tiny Hispanic bobblehead or something? Then is a foreign body foreign body being left inside of a foreign body?
How does the United States fare in terms of cancer treatment? According to Ben Shapiro during his Politicon debate against Cenk Uygur, this is one area where we excel:
"The idea that all of these socialized medicine countries have it so much better than we do, particularly in terms of cancer care, is a joke. We are still number one in terms of 5-year cancer survival rate here in the United States."
Here he's clearly just cherrypicking one specific area where the United States does well. Anybody in any country, if they tried hard enough, could find some region where their healthcare system does the best.
But the thing is, if you actually look at the data on this point, you'll find that it doesn't even support his case! As we see on HealthSystemTracker.org, five-year survival rates for cervical cancer in the United States are slightly lower than the average, and for colorectal and breast cancer, they're slightly higher than the average. Really, dude? This is the data that's supposed to drop our jaws? The only reason a person would drop their jaw after looking at this data is because it makes them yawn with boredom.
Statistically speaking, United States performance in this area is the same as the average of other countries. There's certainly not the sort of breathtaking difference that Shapiro led us to believe there would be. Yet not surprisingly, when he made this point in the debate, the Shapiro fans in the audience applauded so vigorously that they almost passed out from exhaustion.
And even if he was correct and the United States excelled dramatically in this one particular area, cancer care is only the most narrow fraction of our entire healthcare system, so shining a spotlight on this one area doesn't give us anything close to a big-picture idea of what our healthcare quality is like, overall.
So after looking at the data, what conclusions can we reach about the quality of healthcare received in the United States? Steven Crowder implores us to look at the objective outcomes, and if you actually take his advice, what you see is that, overall, the United States does not stand out from the other countries. In some areas, we underperform, in other areas, we're about average, and in other areas, we outperform other countries. Considering all of this data collectively, the best we can say is that the quality of care received in the United States is average.
If we were paying average amounts, perhaps this would be acceptable; but the thing is, we're paying almost twice the OECD average to receive healthcare of only an average quality. Listen to Crowder falsely argue in his video that we pay more to receive higher-quality care:
"Ezra Klein of Vox: We don't go to the doctor more than the Germans or the Japanese; in fact, we go to the doctor less. The difference between us and them is that we pay more everytime we go to the doctor for everything from an angioplasty to a hip replacement, from a C-section to a pain reliever—in America, the price for the same procedure at the same hospital, it varies enormously depending on who is footing the bill.
Crowder: . . . He just keeps talking about how we pay more. This is important. I want you to see the whole picture. If you pay more, that's only a portion of any transaction. If you go and purchase anything at a store, right, let's say I go and I pay ten dollars, what's your next question?
Producer: For what?
Crowder: For what! . . . There ya go! It's that simple! 'Look, we're paying X amount of money and it's too many X's!' What for? 'But, just look at the the bill!' . . . Are our results better than, say, South Africa, Spain, included in the charts?"
I think he overlooked the basic point that Vox was making here, because after playing that Vox clip, he responds by saying: Yeah, we pay more, but for what? For what? They show you for what on the fucking screen: for the exact same procedures.
"Are our results better?", he asks? No, not really, actually. What he's implying here is that, yes, we pay more, but we pay more to receive better-quality care! A look at the very data that he asks us to look at, however, shows that we pay significantly more to receive average care.
He does go on to cite some data to support his position, but the case he makes is pathetically weak. He points out that hospital death rates in the UK are 45% higher than the United States. Ok, so the United States does better than one country in one area. Wow, dude, I am thoroughly convinced! Case closed!
Actually, to be fair, the data shows that the United States does better than all the countries in this particular area—that is, all of the 7 countries that were examined in this study. Something that needs to be considered, however, is that these differences could partly be explained by hospital discharge rates. As Randeep Ramesh writes in an article for The Guardian:
"There is an additional issue that could affect the UK-US comparisons. In America people with insurance are often discharged to die at home or in a hospice as it is less expensive for the insurer. US hospital mortality data would not capture these cases."
So rather than this reflecting the superiority of United States healthcare, the differences could (at least partly) be the simple result of patients being moved around to different locations on different timelines in these countries.
But let's set that aside and say, ok, clearly this is one area where the United States does well. The thing is, in his entire video, this is the one, lonely piece of data he cites which is informative on the specific question of quality of care received. The other data he cites focuses on unrelated questions like the number of pharmaceuticals produced, the number of medical publications, wait times, and so forth.
If you want to hear the pinnacle of hypocrisy and irony, just listen to what Crowder says about Vox in this same video:
"We're not doing the thing that they try and do when they're trying to obfuscate all of their information, their facts, because they dion't want you to do the research. I'm not saying this is an issue that's way more nuanced; no, listen: they're not showing the complete picture."
Really, dude? Vox isn't showing the complete picture? Says the guy who cherrypicks one data point to make his case! Apparently Crowder has standards that he applies to his political opponents, but not himself.
Why does Crowder not cite any examples where the US underperforms in terms of quality? Isn't this an essential part of the complete picture? And didn't he portray liberals as the ones who run away from uncomfortable facts? Aren't we the ones who apparently need to be pinned down on these facts by the brave and truth-seeking conservative? When has Steven Crowder ever been intellectually honest enough to say: Here is some data which actually contradicts my position?
All Crowder does in this video is show us one singular example where the United States does better than other countries. This is not good enough. This is not enough data to reach an honest, big-picture conclusion about our country's quality of care. And anybody could play this game to make their case: I could just as easily cherrypick one or two areas where the United States underperforms and say: "See! Look at how shitty our healthcare quality is!"
But I'm not gonna play that game because I'm not a dishonest, partisan hack. I don't mean to suck my own dick here, but I'm genuinely interested in discovering what the facts truly are so that I can give you, as well as myself, an accurate understanding of whatever the question may be. And in this particular case, the facts demonstrate that the United States pays substantially more for average quality healthcare.