Ocean State Policy Research Institute

Dear Friends,

The healthcare "town hall" meeting hosted by State Representative John Loughlin was a well attended event. As reported by the Providence Journal, there was only one topic that stirred debate and that was when the representative from the insurance industry said that America's healthcare system isn't that good and he referenced statistics on Infant Mortality Rates (IMR) as his proof. The response from the crowd was, "you lie."

He didn't really lie, but there is more to the story.

Country rankings on IMR do indeed show that America isn't on the top of the list (CIA World Factbook ranks the United States at 180 out of 224, with #224 being the least number of deaths). But what is not told in those statistics is the difficulty when comparing apples and oranges.

In 2006, US News and World Report stated that "it's shaky ground to compare U.S. infant mortality with reports from other countries. The United States counts all births as live if they show any sign of life, regardless of prematurity or size. This includes what many other countries report as stillbirths. In Austria and Germany, fetal weight must be at least 500 grams (1 pound) to count as a live birth; in other parts of Europe, such as Switzerland, the fetus must be at least 30 centimeters (12 inches) long. In Belgium and France, births at less than 26 weeks of pregnancy are registered as lifeless. And some countries don't reliably register babies who die within the first 24 hours of birth. Thus, the United States is sure to report higher infant mortality rates."

There has been some change in reporting standards, especially in the former Soviet states, but there clearly remain discrepancies.

But our population and culture are also a factor. Like it or not, the rate of infant deaths for African Americans is drastically higher than for Caucasians and other races. And this difference remains regardless of socioeconomic conditions. According to the Center for Disease Control, there are 6.2 deaths per 1000 births for Whites with less than eight years of education and 13.4 deaths per 1000 for Blacks with the same education - a ratio of more than 2 to 1. Looking at those with more than 16 years of education we see 3.8 deaths for Whites and 10.6 for Blacks, an even larger discrepancy. The IMR for Latinos is actually better than for Whites.

So, when you compare our diverse nation to Asian or Scandinavian countries, which can have as high as a 94% homogeneous population, it should not surprise us that differences in outcomes occur.

The people at the forum instinctively got it - they knew something just wasn't right about those statistics. And this also speaks to the more important point and one that was on full display - Americans are generally happy with their healthcare system. And we also generally agree with some basic free market solutions that can be done right here at the state level - we don't need Washington to take care of us. In order to save money on healthcare, there was a consensus on these major topics:

Consumer Control - allow the consumer to control the money and receive the tax breaks. This will increase accountability at the spot it is most needed: the point of service.
Remove barriers to competitions - most easily done by allowing the purchase of insurance across state lines.
Transparency - consumers need to know how much things cost (before getting the bill) and what quality ratings there are for the various goods and services.
Health Information Technology - the day of paper records and the disconnect between service providers must end. Private ownership of healthcare records in digital form will improve outcomes and efficiencies.

As we move forward in this debate, I caution you to view statistics with an eye of scrutiny. Of course, scrutiny is always easier when done in your own back yard, which is another reason we don't need Washington taking control. I'm far more comfortable dealing with legislators here at home than trying to debate and influence those in DC.

Onward and upward,

Bill Felkner

President and Founder

PS. There was also a question why AARP was endorsing Obamacare. Michelle Malkin suggests they are getting a kickback.