Why Infant Mortality Rate and Life Expectancy are not good comparative indicators
Rabid Weasel Lawson
Unreliable Measures for Comparing the U.S. Health Care System to Others
by David Hogberg, Ph.D.
How does the United States health care system fare when compared to the
rest of the industrialized world? This is an important question.
Accurately measuring our health care system relative to those of other
nations can yield insight into the types of health care policies America
should pursue. New York Times columnist Paul Krugman has expressed the
view that the U.S. health care system is inferior: The United States
spends far more on health care than other advanced countries. Yet we
don't appear to receive more medical services. And we have lower life
expectancy and higher infant mortality rates than countries that spend
less than half as much per person. How do we do it?1 Life expectancy and
infant mortality are two measures that are widely cited, yet seldom
questioned. This is unfortunate, because life expectancy and infant
mortality tell us little about the efficacy of a health care system. This
paper examines the deficiencies of using life expectancy and infant
mortality to measure a health care system. It also examines the question:
How should we measure a health care system?
Why Life Expectancy and Infant Mortality are Popular Measures
Type in the terms "life expectancy," "infant mortality" and "health care"
into the popular search engine Google, and it will yield about 449,000
results. Clearly, linking these two measures to health care is very
popular. It is easy to understand why.
Life expectancy and infant mortality are powerful tools for those who
support some form of socialized medicine. On those measures the United
States fares worse than all other industrialized nations. Most other
industrialized nations have some form of government-run, universal health
insurance. Thus, the reasoning goes, America's inferior performance on
life expectancy and infant
mortality is due to its heavy reliance on a system of private sector care.
Paul Krugman is in good company. Liberal pundit Sebastian Mallaby
recently lamented that the American health care system
...achieves shorter life expectancy than the British, French, German,
Canadian or Japanese systems, but it eats up 16 percent of the resources
in the economy, compared with between eight and 11 percent in those other
countries. The difference - six percent or so of economic output -
suggests that the waste in the American system comes to $700 billion a
year.
He concludes that the "most plausible subsidizer of universal insurance is
government, and the only entity with a stake in lifelong wellness is the
government."2
A recent study that compared the U.S. to Canada and garnered some media
attention used life expectancy as a measure of the efficacy of each
nation's health care system. Noting that Canada spends about half as much
on health care as does the U.S., the scholars stated, "Canadians live two
to three years longer."3 The scholars concluded, "Universal health care
attenuates inequities in health care and should be implemented in the
United States."4
Physicians for a National Health Program, a vocal advocacy group, recently
examined the health care systems in 16 industrialized countries. The only
measures that the study used to compare the different nations were, not
surprisingly, life expectancy and infant mortality.5 The Center for
Economic and Policy Research, a Washington D.C. think tank that supports
government-run health care, produced the following table. Using
expenditure per capita on health care as a proxy for health care system,
it shows that America spent more on health care but got less return than
countries that had some form of universal health insurance. "The high
costs and poor outcomes seem to stem from inefficiencies that are unique
to the U.S. health care system," the Center for Economic and Policy
Research claimed.6
Table 1-Life Expectancy and Health ExpenditureLife expectancy and infant
mortality are widely used as measures of a health care system because
doing so serves an ideological agenda of greater government involvement in
health care. However, these measures are useless for trying to determine
the effectiveness of a health care system. Even some advocates of
government-run health care acknowledge this. For example, Jonathan Cohn
of The New Republic states "those statistics are pretty crude measures."7
The next three sections offer an explanation why.
Measuring Health Care Systems
Any statistic that accurately measures health-care systems across nations
must satisfy three criteria. First, the statistic must assume actual
interaction with the health care system. Second, it must measure a
phenomenon that the health care system can actually affect. Finally, the
statistic must be collected consistently across nations.
Under the first criterion, the phenomenon being measured must be one in
which the individual actually has contact with the health care system.
More specifically, he must have contact with a health care professional,
be it a doctor, nurse, lab technician, etc. A statistic measuring the
rate of cancer survival satisfies this criterion, since diagnosis and
treatment of cancer requires health care professionals. By contrast, a
statistic measuring the rate of car accidents would not satisfy such a
criteria since health care professionals are not essential to identifying
car accidents.
Some statistics may assume interaction with the health care system, but
the phenomena they measure are not ones on which the health care system
can have any meaningful impact. Take, for example, the rate of cancer
incidence. While this statistic assumes interaction with the health care
system (an incidence of cancer cannot be known without the diagnosis of a
health care professional), there is little a health care system can do
about the rate of cancer. Rather, cancer incidence is affected by factors
such as genetics, diet, lifestyle, etc., over which the health care system
has no control. Thus, to be an adequate measure of the effectiveness of a
health care system, a statistic must measure a phenomenon that health care
professionals can actually affect.
Finally, a statistic must be collected consistently across nations. While
this seems simple in theory, in practice it is quite complicated. Nations
use diverse definitions of health phenomena. This leads to some nations
excluding a segment of their populations from the collection of a
statistic while other nations include those segments. In such
circumstances, cross-national comparisons are largely meaningless. Thus,
for health care systems across countries to be meaningful, there should be
little to no variation in how statistics are collected.
As shown below, both life expectancy and infant mortality are poor
measures of a health care system because each fails to satisfy at least
one of the above criteria.
Life Expectancy
Life expectancy is a poor statistic for determining the efficacy of a
health care system because it fails the first criterion of assuming
interaction with the health care system. For example, open any newspaper
and, chances are, there are stories about people who die "in their sleep,"
in a car accident or of some medical ailment before an ambulance ever
arrives. If an individual dies with no interaction with the health care
system, then his death tells us little about the quality of a health care
system. Yet all such deaths are computed into the life expectancy
statistic.
Life expectancy also largely violates the second criterion - a health care
system has, at most, minimal impact on longevity. One way to see this is
to reexamine the table constructed by the Center for Economic and Policy
Research. The interpretation that the Center for Economic and Policy
Research wants readers to derive from Table 1 is that the United States
would be better off with a system of universal health care. However, a
careful examination of that table yields a more accurate interpretation:
There is no relationship between life expectancy and spending on health
care. Greece, the country that spends the least per capita on health
care, has higher life expectancy than seven other countries, including
Belgium, Denmark, Finland, Germany, Netherlands, the United Kingdom and
the United States. Spain, which spends the second least per capita on
health care, has higher life expectancy than ten other countries that
spend more.
More robust statistical analysis confirms that health care spending is not
related to life expectancy. Studies of multiple countries using
regression analysis found no significant relationship between life
expectancy and the number of physicians and hospital beds per 100,000
population or health care expenditures as a percentage of GDP. Rather,
life expectancy was associated with factors such as sanitation, clean
water, income, and literacy rate.8 A recent study examined cross-national
data from 1980 to 1998. Although the regression model used initially
found an association between health care expenditure and life expectancy,
that association was no longer significant when gross domestic product
(GDP) per capita was added to the model.9 Indeed, GDP per capita is one
of the more consistent predictors of life expectancy.
Yet the United States has the highest GDP per capita in the world, so why
does it have a life expectancy lower than most of the industrialized
world? The primary reason is that the U.S. is ethnically a far more
diverse nation than most other industrialized nations. Factors associated
with different ethnic backgrounds - culture, diet, etc. - can have a
substantial impact on life expectancy. Comparisons of distinct ethnic
populations in the U.S. with their country of origin find similar rates of
life expectancy. For example, Japanese-Americans have an average life
expectancy similar to that of Japanese.10
A good deal of the lower life expectancy rate in the U.S. is accounted for
by the difference in life expectancy of African-Americans versus other
populations in the United States. Life expectancy for African-Americans
is about 72.3 years, while for whites it is about 77.7 years.11 What
accounts for the difference? Numerous scholars have investigated this
question.12 The most prevalent explanations are differences in income and
personal risk factors. One study found that about one-third of the
difference between white and African-American life expectancies in the
United States was accounted for by income; another third was accounted for
by personal risk factors such as obesity, blood pressure, alcohol intake,
diabetes, cholesterol concentration, and smoking and the final third was
due to unexplained factors.13 Another study found that much of the
disparity was due to higher rates of HIV, diabetes and hypertension among
African Americans.14 Even studies that suggest the health care system may
have some effect on the disparity still emphasize the importance of
factors such as income, education, and social environment.15
A plethora of factors influence life expectancy, including genetics,
lifestyle, diet, income and educational levels. A health care system has,
at best, minimal impact. Thus, life expectancy is not a statistic that
should be used to inform the public policy debate on health care.
Infant Mortality
At first glance, infant mortality appears to be a good measure of a health
care system. First, it assumes interaction with a health care system
since most babies born in the industrialized world are born in a hospital
or other health care facility. It also satisfies the second criterion of
assuming that health care professionals can affect the outcome, since
doctors and nurses have a direct impact on the survival chances of a
newborn. If infant mortality were accepted as an adequate measure based
on those two criteria alone, then the U.S. health care system is one of
the least effective in the industrialized world. This can be seen by
constructing a table using the data on infant mortality utilized in the
report from the Physicians for a National Health Program. Table 2 shows
that on infant mortality, the U.S. ranks below all nations save New
Zealand.
Chart 2-Infant MortalityBut infant mortality tells us a lot less about a
health care system than one might think. The main problem is inconsistent
measurement across nations. The United Nations Statistics Division, which
collects data on infant mortality, stipulates that an infant, once it is
removed from its mother and then "breathes or shows any other evidence of
life such as beating of the heart, pulsation of the umbilical cord, or
definite movement of voluntary muscles... is considered live-born
regardless of gestational age."16 While the U.S. follows that
definition, many other nations do not. Demographer Nicholas Eberstadt
notes that in Switzerland "an infant must be at least 30 centimeters long
at birth to be counted as living."17 This excludes many of the most
vulnerable infants from Switzerland's infant mortality measure.
Switzerland is far from the only nation to have peculiarities in its
measure. Italy has at least three different definitions for infant deaths
in different regions of the nation.18 The United Nations Statistics
Division notes many other differences.19 Japan counts only births to
Japanese nationals living in Japan, not abroad. Finland, France and
Norway, by contrast, do count births to nationals living outside of the
country. Belgium includes births to its armed forces living outside
Belgium but not births to foreign armed forces living in Belgium.
Finally, Canada counts births to Canadians living in the U.S., but not
Americans living in Canada. In short, many nations count births that are
in no way an indication of the efficacy of their own health care systems.
The United Nations Statistics Division explains another factor hampering
consistent measurement across nations:
...some infant deaths are tabulated by date of registration and not by
date of occurrence... Whenever the lag between the date of occurrence and
date of registration is prolonged and therefore, a large proportion of the
infant-death registrations are delayed, infant-death statistics for any
given year may be seriously affected.20
The nations of Australia, Ireland and New Zealand fall into this category.
Registration problems hamper accurate collection of data on infant
mortality in another way. Looking at data from 1984-1985, Eberstadt
argued that, "Underregistration of infant deaths may also be indicated by
the proportion of infant deaths reported for the first twenty-four hours
after birth."21 Eberstadt found that in the U.S. and Canada more than a
third of all infant death occurred during the first day, but in Sweden and
France they accounted for less than one-fifth. Table 3 shows that the
pattern still holds today.
Chart 3-Infant DeathsInconsistent measurement explains only part of the
difference between the U.S. and the rest of the world. Were measurements
to be standardized, according to Eberstadt, "America might move from the
bottom third toward the middle, but it would be unlikely to advance into
the top half."22 Another factor affecting infant mortality Eberstadt
identifies is parental behavior.23 Pregnant women in other countries are
more likely to either be married or living with a partner. Pregnant women
in such households are more likely to receive prenatal care than pregnant
women living on their own. In the U.S., pregnant women are far more
likely to be living alone. Although the nature of the relationship is
still unclear (it is possible that mothers living on their own are less
likely to want to be pregnant), it likely leads to a higher rate of infant
mortality in the U.S.
In summary, infant mortality is measured far too inconsistently to make
cross-national comparisons useful. Thus, just like life expectancy,
infant mortality is not a reliable measure of the relative merits of
health care systems.
Conclusion
Life expectancy and infant mortality are wholly inadequate comparative
measures for health care systems. Life expectancy is influenced by a host
of factors other than a health care system, while infant mortality is
measured inconsistently across nations. Neither of these measures
provides the United States with conclusive guidance on health care policy,
let alone serve as reliable evidence that a system of universal health
care "should be implemented in the United States."24
Do measures that would permit accurate cross-national comparisons of
health care systems exist? The most exhaustive source of cross-national
data is the Organization for Economic Co-operation and Development (OECD).
Yet the OECD notes that in most cases its data is not "internationally
comparable" because "there is a lack of international agreement on the
most promising indicators and many definitions of each indicator that
could be adopted."25
To rectify this problem, the OECD and the Commonwealth Fund have embarked
on a collaborative effort to develop comparable measures across nations.
Called the "OECD Health Care Quality Indicators Project," it is taking the
"first steps towards a comprehensive reporting system for quality of care
in OECD member countries."26 A recent report updating the progress of
this project looks promising. For example, one standard that an indicator
must meet is its "susceptibility to being influenced by the health care
system."27 The researchers pose important questions on this regard,
including, "Can the health care system meaningfully address this aspect or
problem?" and "Does the health care system impact on the indicator
independent of confounders like patient risk?"28 In other words, these
statistics will assume interaction with a health care system and measure
phenomena that a health care system actually affects. Furthermore, the
aim of this project is to assure that data is collected consistently
across nations, so that national policymakers have "the opportunity to
compare the performance of their health care delivery systems against a
peer group"29
While the project researchers have chosen many indicators that measure
phenomena that are actually affected by a health care system,
comparability issues across nations remain. For example, one indicator
measures the fatality rate within 30 days of those diagnosed with acute
myocardial infarction (heart attack). However, the report notes that some
"countries are able to track patients after hospital discharge, [while]
some are not."30
Hopefully such difficulties can be resolved as the project progresses. In
the meantime, policymakers, pundits and reporters should stop referring to
life expectancy and infant mortality as meaningful comparative measures of
health care systems.
# # #
David Hogberg, Ph.D. is a senior policy analyst for The National Center
for Public Policy Research. Comments may be sent to
dhog...@nationalcenter.org.
Footnotes:
1 Paul Krugman, "Passing the Buck," New York Times, April 22, 2005, p. A23.
2 Sebastian Mallaby, "Bush's Turn To Health Care. President Ready to Expand the Public Role?" Washington Post, January 16, 2006, available at http://www.washingtonpost.com/wp-dyn/content/article/2006/01/15/AR2006011500929.html as of June 27, 2006.
3 Karen E. Lasser, David U. Himmelstein and Steffie Wollhandleer, "Access to Care, Health Status, and Health Disparities in the United States and Canada: Results of a Cross-National Population-Based Survey," American
Journal of Public Health, July 2006, Vol. 96, No. 7, p. 1300.
4 Ibid, p. 1306
5 Physicians For A National Health Program, "International Health Systems," December 12, 2005, available at http://www.pnhp.org/facts/international_health_systems.php as of June 27, 2006.
6 Dean Baker and David Rosnick, "The Burden of Social Security Taxes and the Burden of Excessive Health Care Costs," Issue Brief, Center for Economic and Policy Research, p.4, available at http://cepr.net/publications/social_security_2005_03_24.pdf as of June 27, 2006.
7 "Healthy Competition: What's Holding Back Health Care and How to Free It," Book Forum, Cato Institute, Washington, D.C., November 29, 2005, viewable at http://www.cato.org/event.php?eventid=2420 as of June 27, 2006.
8 M. Furukawa, "Factor Analysis of Attributive Determinant for Life Expectancy and Infant Mortality Rate With Recipient Country Data in Consideration of Socioeconomic Environment," Nippon Eiseigaku Zasshi, 2005, Vol. 60, pp. 335-344; Gabriel Gulis, "Life Expectancy as an Indicator of Environmental Health," European Journal of Epidemiology, 2000, Vol. 16, pp. 161-165 and
Erica Hertz, James R. Herbert and Joan Landon, "Social and Environmental Factors and Life Expectancy, Infant Mortality, and Maternal Mortality Rates: Results of a Cross-National Comparison," Social Science and Medicine, 1994, Vol. 39, pp. 105-114.
9 Cynthia Ramsay, "Beyond the Public-Private Debate: An Examination of Quality, Access and Cost in the Health Care Systems of Eight Countries," Marigold Foundation, Alberta, Canada, July 2001, available at http://www.davidgratzer.com/report1/MarigoldStudyPDF.pdf as of June 27, 2006. Especially see page 33.
10 "How Not To Judge Our Health Care System," Brief Analysis, National Center for Policy Analysis, Dallas, Texas, November 15, 1994, available at http://www.ncpa.org/ba/ba141.html as of June 27, 2006. Also see Chapter 4 of John C. Goodman, Gerald L. Musgrave and Devon M. Herrick, Lives At Risk: Single-Payer National Health Insurance around the World, (Lanham, Maryland: Rowman and Littlefield Publishers, 2004).
11 "United States Life Tables, 2002," National Vital Statistics Reports, November 10, 2004, Vol. 53, No. 6, Centers for Disease Control, Atlanta, Georgia, available at http://www.cdc.gov/nchs/data/nvsr/nvsr53/nvsr53_6.pdf as of June 27, 2006.
12 For a summary of the research on race and life expectancy, see Robert H. Hummer, "Black-White Differences In Health And Mortality: A Review And Conceptual Model," The Sociological Quarterly, 1996, Vol. 37, No. 1, pp. 105-125.
13 M. W. Otten Jr, S. M. Teutsch, D. F. Williamson and J. S. Marks, "The Effect of Known Risk Factors on the Excess Mortality of Black Adults in the United States," Journal of the American Medical Association, 1990, Vol. 263, No. 6, pp. 845-50.
14 Mitchell D. Wong, Martin F. Shapiro, W. John Boscardin and Susan L. Ettner, "Contribution of Major Diseases to Disparities in Mortality," The New England Journal of Medicine, 2002, Vol. 347, pp. 1585-1592.
15 Paul Sorlie, Eugene Rogot, Roger Anderson, Norman J. Johnson, and Erick Backlund, "Black-White Mortality Difference by Family Income," The Lancet, 1992, Vol. 340, No. 8815, p. 350.
16 "Table 4 - Notes," Demographic Yearbook 2002, United Nations Statistics Division, p. 1, available at http://unstats.un.org/unsd/demographic/products/dyb/dyb2002/NotesTab04.pdf as of June 27, 2006.
17 Nicholas Eberstadt, The Tyranny of Numbers: Measurement and Misrule, (Washington: The AEI Press, 1995), p. 50.
18 Ibid, p. 50. Also see Miranda Mugford, "A Comparison of Reported Differences in Definitions of Vital Events and Statistics," World Health Statistics, vol. 36, 1987.
19 "Infant Deaths and Infant Mortality Rates by Age and Sex: Latest Available Year, 1993-2002," Demographic Yearbook 2002, United Nations Statistics Division, p. 17, available at http://unstats.un.org/unsd/demographic/products/dyb/dyb2002/Table16.pdf as of June 27, 2006.
20 "Table 16," Demographic Yearbook 2002, United Nations Statistics Division, p. 1, available at http://unstats.un.org/unsd/demographic/products/dyb/dyb2002/NotesTab16.pdf as of June 27, 2006.
21 Eberstadt, p.50.
22 Ibid, p. 51.
23 Ibid, pp. 57-60.
24 Karen E. Lasser, David U. Himmelstein and Steffie Wollhandleer, "Access to Care, Health Status, and Health Disparities in the United States and Canada: Results of a Cross-National Population-Based Survey," Health Affairs, July 2006, Vol. 96, No. 7, p. 1306.
25 "OECD Health Care Quality Indicators Project," Organization for Economic Co-operation and Development, Paris, France, available at http://www.oecd.org/document/31/0,2340,en_2649_34629_2484127_1_1_1_1,00.html as of June 27, 2006.
26 Ibid.
27 Edward Kelley and Jeremy Hurst, "Health Care Quality Indicators Project Initial Indicators Report," OECD Health Working Papers, March 9, 2006, p. 13, available at http://www.oecd.org/dataoecd/1/34/36262514.pdf as of June 27, 2006.
28 Ibid.
29 "OECD Health Care Quality Indicators Project."
30 Kelley and Hurst.
Ref: http://www.nationalcenter.org/NPA547ComparativeHealth.html
Peace favor your sword (IH),
Kirk
hal
<lawson@NO19489SPAM+dayton.net> wrote:
> Don't Fall Prey to Propaganda: Life Expectancy and Infant Mortality are
>Unreliable Measures for Comparing the U.S. Health Care System to Others
This is all complete crap. Basically the bottom line says that we
don't like the fact that more infants and old people die in US
hospitals than in socialized medicine countries so we don't want to
use that as a measure. It doesn't really matter, anyway, because we
are making billions and we will say or do anything to protect that.
http://www.usatoday.com/news/health/2009-07-09-hospital-deaths_N.htm
'Double failure' at USA's hospitals
By Steve Sternberg and Jack Gillum, USA TODAY
Too many people die needlessly at U.S. hospitals, according to a
sweeping new Medicare analysis showing wide variation in death rates
between the best hospitals and the worst.
The analysis examined death rates for heart attacks, heart failure and
pneumonia at more than 4,600 hospitals across the USA. At 5.9% of
hospitals, patients with pneumonia died at rates significantly higher
than the national average. With heart failure, 3.4% of hospitals had
death rates higher than the average, and 1.2% of hospitals were higher
when it came to heart attack.
FIND YOUR HOSPITAL: See pneumonia, heart attack, failure death rates
near you
BEST: Baylor leads the way to lower heart failure readmission rates
Researchers also found that the majority of U.S. hospitals operate the
equivalent of revolving doors for their patients. One of every four
heart failure patients and slightly less than one in five heart attack
and pneumonia patients land back in the hospital within 30 days, data
show.
"We have double failure in our health system," says John Rumsfeld of
the Denver VA Medical Center and chief science officer for the
American College of Cardiology's National Data Registry.
FIND MORE STORIES IN: Donald Rumsfeld
The analysis by U.S. Centers for Medicare and Medicaid Services (CMS)
comes as the White House and Congress debate ways to cut costs and
improve quality in the nation's health system. One idea on the table
is to reward doctors and hospitals not just for how many procedures
they perform but how well their patients fare. More than 200 hospitals
have death rates better than the national average, and hundreds fare
better on readmission rates.
The findings are based on more than 1 million deaths and readmissions
among Medicare patients from 2005 to 2008. A separate USA TODAY
analysis of the data found that patients have higher death rates at
hospitals in the nation's poorest and smallest counties, compared with
those in larger, more affluent areas. Death rates in hospitals in
counties with fewer than 50,000 people rank 1 to 2 percentage points
higher than their most-populated counterparts, a significant
difference. A similar pattern emerges at hospitals in counties where
the median household income falls below $35,000 a year.
Barry Straube, director of CMS' office of standards and quality, says
the agency aims to intensify competition between hospitals by giving
patients the information they need to seek out higher-quality care and
by giving hospitals a way to measure their performance against their
competitors. It also provides a tool that government and private
health plans can use to determine which hospitals merit higher pay for
better performance.
"This kind of information is absolutely the backbone of many of our
efforts to reform the health system," Janet Corrigan, head of the
National Quality Forum, a consortium of government agencies, insurers,
hospitals and doctors' groups that approved the methods used in the
analysis.
"Based on what we see here, we have our work cut out for us."
TravIsGod
+dayton.net> wrote:
> Don't Fall Prey to Propaganda: Life Expectancy and Infant Mortality are
> Unreliable Measures for Comparing the U.S. Health Care System to Others
>
This is an easy one...blacks and hispanics. We have 'em; they don't.
Trav
Stanley Moore
"TravIsGod" <trav...@aol.com> wrote in message
news:06feb0cb-8bc3-4ce3...@m11g2000yqh.googlegroups.com...
Trav
******************************************
What about in Spain? <G> Take care
--
Stanley L. Moore
"The belief in a supernatural
source of evil is not necessary;
men alone are quite capable
of every wickedness."
Joseph Conrad
TravIsGod
> "TravIsGod" <travis...@aol.com> wrote in message
>
> news:06feb0cb-8bc3-4ce3...@m11g2000yqh.googlegroups.com...
> On Jul 9, 12:45 am, Rabid Weasel Lawson <law...@NO19489SPAM
>
> +dayton.net> wrote:
> > Don't Fall Prey to Propaganda: Life Expectancy and Infant Mortality are
> > Unreliable Measures for Comparing the U.S. Health Care System to Others
>
> This is an easy one...blacks and hispanics. We have 'em; they don't.
>
> Trav
>
> ******************************************
> What about in Spain? <G> Take care
My point was that if you compare peer populations, our crime rate,
infant mortality rate, etc., all look better. In fact, we are some of
the healthiest and least-violent on earth.
Trav
Rabid Weasel Lawson
> This is all complete crap. Basically the bottom line says that we
> don't like the fact that more infants and old people die in US
> hospitals than in socialized medicine countries so we don't want to
> use that as a measure. It doesn't really matter, anyway, because we
> are making billions and we will say or do anything to protect that.
So what you're saying is that you didn't actually read his paper and don't
have any rebuttal to his assertions such as "other countries use different
definitions of 'infant mortality'," "homogeneous vs. heterogeneous
populations," or "the medical system has no way to affect cultural norms
such as poor diet and lack of exercise as a deliberate choice."
Typical hal. Ignore the assertions and make up some crap.
(IH)
Rabid Weasel Lawson
That's one of the points that the author makes. When you normalize for
ethnicity things change.
Herbert Cannon
"Stanley Moore" <smoo...@comcast.net> wrote in message
news:39ydndlIAq0hvsvX...@giganews.com...
>
> "TravIsGod" <trav...@aol.com> wrote in message
> news:06feb0cb-8bc3-4ce3...@m11g2000yqh.googlegroups.com...
> On Jul 9, 12:45 am, Rabid Weasel Lawson <law...@NO19489SPAM
> +dayton.net> wrote:
>> Don't Fall Prey to Propaganda: Life Expectancy and Infant Mortality are
>> Unreliable Measures for Comparing the U.S. Health Care System to Others
>>
>
> This is an easy one...blacks and hispanics. We have 'em; they don't.
>
> Trav
>
> ******************************************
> What about in Spain? <G> Take care
They are European not Latino.
Stanley Moore
"Herbert Cannon" <hcan...@cox.net> wrote in message
news:WFv5m.33931$ob.1...@newsfe13.iad...
"Hispanic" as a term is derived from the Latin "Hispania", the name of one
of Rome's provinces. Nowadays of course people take it to mean Latin
American (those pesky Romans cropping up again with their Latin). I was
making a humorous remark. But strictly speaking natives of Spain while
indeed Europeans are also Hispanic since they are born and live in a nation
that used to be called Hispania. Take care
TravIsGod
> of Rome's provinces. Nowadays of course people take it to mean Latin
> American (those pesky Romans cropping up again with their Latin). I was
> making a humorous remark.
Hah. hah. hah.
hah.
Trav