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POLICY/POLITICS: The swiftboating of single-payer?

Here’s my FierceHealthcare editorial today

Last year the most viewed article in Health Affairs was an article suggesting that 50% of bankruptcies in America were in some part related to medical costs. The article was written by a group led by two of the intellectual leaders of the single payer movement, Harvard professors David Himmelstein and Steffi Woolhandler. This week their findings were challenged by two Northwestern-affiliated researchers, David Dranove and Michael Millenson, who reviewed their data and claimed that the number was closer to 17%. They also suggested that the not as many of people declaring bankruptcy were as solidly middle class prior to their medical catastrophe as the Harvard group had suggested. Himmelstein et al shot back saying that the Dranove and Millenson had got their math wrong, and that they were lackeys for AHIP the health insurance industry group that sponsored their study — even though it was a peer reviewed article which AHIP funded but didn’t control. Some of their supporters accused Dranove and Millenson of "swift-boating".

Why is this obtuse academic dispute so important? Whatever the facts, and facts are very malleable in our political debates, the role of the middle class in health reform is vital. There is incontrovertible evidence that lower-income Americans have disproportionately higher health costs out of pocket than poorer people in other countries. But 100 years of history shows that politically this doesn’t matter too much. If it becomes accepted that middle-class, middle income Americans are equally vulnerable to financial catastrophe due simply to bad luck with their health, then the political discussion might shift. So this is one of those occasions where, as Keynes said, the scribblings of some (not-yet) defunct economist might actually matter in terms of politics and policy.

UPDATE:  If you haven’t had a chance yet, you can listen to this week’s podcast of my converstation with Millenson on this very topic. 

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Dr. Aaron GreenwaldNick LentoEric Novackelliottgspike Recent comment authors
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Dr. Aaron Greenwald
Guest

Sham peer review is mobbing, false accountability, or just plain destruction of a professional career, persona, and indirectly, low cost healthcare. It has gone beyond the education profession in the ivied towers of colleges and universities. It has, like a cancer, metastasized into dentistry. The dental profession has taken a back seat to the medical in more than earned incomes. It has rarely earned a second look by the federal government for false and misleading advertising, excessive and unnecessary procedures, over charging, Medicaid fraud, and destruction of careers through sham peer review. The dental profession has managed to fly unobtrusively… Read more »

Nick Lento
Guest
Nick Lento

I haven’t read either of these studies, but what’s going on here is clear enough anyway. 🙂 Let’s assume, for the sake of not having an “argument” that the number is “only” 17%. (More likely it’s all a matter of how you measure and associate health care costs to bankruptcy….I bet almost ALL bankruptcies are in part associated with medical bills or illness of some kind.) That alone is a POWERFUL reason to consider single payer. There are at least 50 other good reasons. Imagine the effect on our economy when people don’t feel trapped in a job they would… Read more »

John C.
Guest
John C.

David Himmelstein and Steffi Woolhandler used an undercurrent of angst to promote a study that was flawed. When it came out I thought the conclusions didn’t make sense. However, no one seriously questioned it in the open because they felt the “ends justified the means”. Now, two guys ( Dranove and Millenson) call BS on the study and everyone questions the motives? That’s BS. The original study was a propaganda tool. The Dranove and Millenson study debunks it. That it was funded by AHIP, so what? Good research can’t come out AHIP funded programs? The point is, if Dranove and… Read more »

The Medical Blog Network
Guest

Eric,
That is because FOX has not seized onto healthcare issues just yet. They are busy defending today’s agenda.
Once there is a credible threat of real change to single-payor happening they will be all over this. Imagine how would Bill O’Reilly frame the issue!
That would be a media circus to watch. Remember the campaign against Hillarycare?

Eric Novack
Guest

Where was the intellectual outrage when the initial study was published? That the authors of the initial study are avowed opponents of the current healthcare system and, not surprisingly, produced a study that maligned the current system should surprise nobody.
The problem is not that the intial study was very flawed or that AHIP funded the subsequent study; rather it is that the popular media did not publish this study but put Himmelstein’s article on the front page.

elliottg
Guest
elliottg

Look, if Dranove and Millenson were so concerned about the study then how come they didn’t rush to publish a letter criticizing the study before taking AHIP’s money. They didn’t care until AHIP waved dollars in their face. As he says in his podcast, “I’d be happy to beat up anyone.” He was even happier that he got paid for it.

elliottg
Guest
elliottg

To imagine that David Dranove and Michael Millenson did not know who their patrons were is just BS. What happened is that AHIP knew the result they wanted. They HAD ALREADY RUN THE NUMBERS. Dranove’s and Millenson’s article is not rocket science and the problems with the original study are not unknown. In fact, the original study was poorly done and did border on advocacy. How the original article got published without more changes (or at least caveats) is probably a story in itself. What Dranove and Millenson did was take money so that they could slap their reputation on… Read more »

The Medical Blog Network
Guest

No, not science and mathematics. But social sciences tend to get entwined with politics – BIG time. People who fund this type of research tend to have an agenda.
Spike is correct that flawed reasoning gets exposed, eventually. But neither flawed reasoning nor mechanisms to get it smoked out is the monopoly of academia.
My point was that “ideological warfare” spills out into academia too. We cannot presume something valid, just because there is a “study”.
What if Millenson, Dranove or anyone else did not bother to rebut? Would you take the original study at face value?

John C.
Guest
John C.

Academia is only BS when it disagrees with your point of view. Spike is right. academia does have a systematic way of constantly putting theories to the test. Or else you are suggesting that science and mathematics are simply “ideological warfare”?

spike
Guest
spike

I would deny that because adademia does have a systematic way of ensuring that poor studies are revealed for what they are. The fact that Millenson and Dranove could rebut the “50%” number so effectively shows that facts do still matter in academia. That’s my take on it, anyway.

The Medical Blog Network
Guest

Academia is merely another front in ideological warfare, facts be damned. Same goes for blogosphere.
Right, everybody? Would anyone deny this?

John C.
Guest
John C.

It’s amazing to me when academic research falls prey to political strategery. Is it really so uncommon in the academic world that researchers test the theories put forward by other researchers? I thought it was these empirical test that made academia sort of immune to quacks, crack pots, and voodoo reasoning. So a couple of liberal leaning, elitist Harvard professors get their panties in all in a bunch because someone (some punks from Northwestern even) questioned them?! It no longer becomes a question of the quality of research but an issue of motive and political gain. Its absurd!

Matthew Holt
Guest
Matthew Holt

Yeah, IMHO David/Steffi made a mistake by coming after their motives, rather than just attacking them on their “misuse” of the data (which even as a sympathiser I think they stretched to bending point in the original article, by including things like gambling debts as medically related). Millenson at least (I don’t know Dranove) is a solid Democrat moderate, albeit one who enjoys deflating sacred cows and pointing out the obivous — that single payer is not a political winner as yet — than one who’s dirven by the search for a political solution. Saying that just because it was… Read more »

Trapier K. Michael
Guest

Quoting Dranove and Millenson: “We admit to being unprepared for the political attack-dog tone that dominates [the Himmelstein et al.] response…Perhaps Himmelstein and colleagues are simply taking out on us their frustration that middle-class American voters have ignored their decades-old advocacy of a Canadian-style health system… We agree with Himmelstein and colleagues that too many vulnerable Americans are financially devastated by the cost of illness. They seem to regard with a sense of outrage our objective examination of the methods they use to establish just how many such individuals there are. We, in contrast, continue to believe that passion to… Read more »