An Inferior Argument for American Superiority

Aaron Carroll, in his health-care-focused blog “The Incidental Economist,” had a very good takedown of a recent Wall Street Journal op-ed article by Republican Senator Ron Johnson, who basically exploits his infant daughter’s medical experience to make an incoherent attack on the Affordable Care Act.

“Today is the first anniversary of the greatest single assault on our freedom in my lifetime: the signing of ObamaCare,” Senator Johnson wrote on March 23. “As we consider what this law may do to our country, I can’t help but reflect on a medical miracle made possible by the American health-care system.”

His goes on to explain that his daughter, Carey, received excellent treatment in the health-care system after she was born with a serious heart defect, and asserts that she wouldn’t have received that kind of treatment under universal health insurance, because … well, he doesn’t explain. Along the way Senator Johnson commits some of the classic howlers, like the one about how you can see how bad single-payer insurance is by the fact that Americans don’t have to wait as long as Canadians for hip replacements, which in Canada are paid for by the government, while in America they’re mainly paid for by … Medicare.

Mr. Carroll points that Senator Johnson “seems to be under the illusion that no government money or insurance is in the system now.”

“Did the hospital where Carey got her miraculous surgery accept Medicaid?” he wrote. “Did it have any federal funding? Was it an academic medical center? Were residents involved in her care?”

But what struck me about the whole piece was the assumption that modern medicine in general is something only we lucky free-market Americans have, while in Europe they’re still using leeches or something. In other words, it’s part of the superiority complex you often encounter in American politics; people just know that we’re the best, and won’t believe you when you tell them that actually they have the Internet, cell phones and antibiotics in Europe too.

Cancer Survival

What about those cancer survival rates that a lot of people, including Senator Johnson, cite when asserting American medical superiority?

There’s a well-known problem with survival-rate comparisons, acknowledged in a 2008 Lancet Oncology study: “Cancer survival is a valuable indicator for international comparison of progress in cancer control, despite the fact that part of the variation in cancer survival identified in this study could be attributable to differences in the intensity of diagnostic activity (case-finding) in participating populations.”

Here’s how I understand the overdiagnosis issue, in terms of an extreme example: suppose that there’s a form of cancer that kills people seven years after it starts, and that there is in fact nothing you can do about it. Suppose that country A screens for cancer very aggressively, and always catches this cancer in year 1, while country B chooses to invest its medical resources differently, and never catches the cancer until year 4. In that case, country A will have a 100 percent five-year survival rate, while country B will have a 0 percent five-year survival rate — because survival is measured from the time the cancer is diagnosed. Yet treatment in country B is no worse than in country A.

Real life isn’t that simple, but you get the point: a society that tests for cancer a lot may have higher survival rates simply because it tends to catch cancer early on, even if it doesn’t treat cancer any better.