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Farenheit 98.6 By: Michael P. Tremoglie
FrontPageMagazine.com | Wednesday, February 23, 2005

“Medical costs lead more people to bankruptcy,” proclaimed one headline. “Half of personal bankruptcies caused by medical bills,” announced another.

These headlines referred to a report about medical bills and bankruptcies. It was featured – with a great sense of urgency – in TV, radio, magazine, and newspaper stories across the nation. The idea that medical costs incurred by people who have little or no insurance caused half the bankruptcies in the United States was alarming to those who heard the news, just as it was meant to be.

The source of this shocking announcement was an article published in the journal Health Affairs. The study was conducted by: Harvard professor David Himmelstein, an associate professor of medicine at Harvard Medical School and a primary care physician at Cambridge Hospital in Cambridge, Massachusetts; Elizabeth Warren, at Harvard Law School professor and chief adviser to the National Bankruptcy Review Commission; Deborah Thorne assistant professor of Sociology and Anthropology at Ohio University; Steffie Woolhandler, an associate professor of medicine at Harvard, where she co-directs the General Medicine Faculty Development Fellowship Program.


An abstract of the study states:


In 2001, 1.458 million American families filed for bankruptcy. To investigate medical contributors to bankruptcy, we surveyed 1,771 personal bankruptcy filers in five federal courts and subsequently completed in-depth interviews with 931 of them. About half cited medical causes, which indicates that 1.9-2.2 million Americans (filers plus dependents) experienced medical bankruptcy. Among those whose illnesses led to bankruptcy, out-of-pocket costs average $11,854 since the start of illness; 75.7 percent had insurance at the onset of illness. Medical debtors were 42 percent more likely than other debtors to experience lapses in coverage. Even middle-class insured families often fall prey to financial catastrophe when sick.


Health Affairs is a seemingly credible journal. The study’s authors apparently have sterling credentials. Given the authoritative nature of this study one can only concur with the statement, quoted by the Tribune-Review that, “National health insurance is the only solution to the problem in America of having the world's costliest health care.”


Of course, this was exactly what the distinguished professors wanted people to conclude. The actual purpose of the study was to influence public opinion to favor socialized medicine. The study’s authors are fervid advocates of Canadian-style, single-payer healthcare systems.


A cursory examination of the backgrounds of the authors leaves no doubt about the purpose of this study: it was an attempt by liberal academicians to rationalize government control of the healthcare system, one-seventh of the nation’s economy.


If one were to actually read the study and the section about methodology, he would notice a caveat. The study noted, “Even when data are reliable, making causal inferences from a cross-sectional study such as ours is perilous. Many debtors described a complex web of problems involving illness, work, and family. Dissecting medical from other causes of bankruptcy is difficult. We cannot presume that eliminating the medical antecedents of bankruptcy would have prevented all of the filings we classified as ‘medical bankruptcies.’” It also stated, “more-stigmatized causes of bankruptcy (such as addiction, mental illness, or profligate spending) may be underreported.”


That’s certainly not so black-and-white. If the report is not one-sided, its compilers are, consistently manipulating data to support their most recent political agenda.


One of its authors, Harvard Law Professor Elizabeth Warren, is recognized as an expert in the causes of bankruptcy. She lends authority to the claim that medical expenses comprise almost half of all bankruptcies. However, in April 1998, Warren testified before Congress that single parents are the people most affected by bankruptcy. Then again, in July 2004, the Christian Science Monitor quoted Warren as saying, “more than 90 percent of bankruptcies arise from job loss, onerous medical bills not covered by health insurance, and divorce.” Yet, in a 2002 New York Times article she wrote, “Women are more likely than men to seek bankruptcy in the aftermath of a divorce or a medical problem, though both men and women cite job problems as the biggest difficulty.” (Emphasis added.) To further muddy the waters, an October 2003 Salon article noted:


Elizabeth Warren, a professor at Harvard Law School, and her daughter, Amelia Warren Tyagi, a former McKinsey consultant, studied nearly 2,000 families that had gone bankrupt in the U.S. They analyzed myriad federal data detailing what Americans are actually spending their money on today compared to the legendarily more austere 1970s. What they discovered shocked even themselves: the effort to keep the kids in a good school district when one parent is laid-off is the main factor driving Americans into bankruptcy court…. (Emphasis added.)


Precisely this sort of tendentious scholarship is the hallmark of Drs. Himmelstein and Woolhandler, the study’s two other principle authors. Although Health Affairs did not identify them as such, this husband and wife team of Harvard Medical School physicians are the founders of an organization dedicated to the implementation of socialized medicine in the United States: Physicians for a National Health Plan (PNHP). They have been as disingenuous as a Michael Moore movie regarding their positive portrayal of the Canadian healthcare system.


Himmelstein published a proposal for a national health plan in the New England Journal of Medicine (NEJM) in 1989. The monograph extolled the merits of the monopsonistic/monopolistic Canadian healthcare system. However, Himmelstein’s tome did not mention the disadvantages of the Canadian system. It never mentioned that it is a prospective budgeting system. This means that each year the government allocates a certain amount of money for hospital and physician services. If the funds are depleted before the fiscal year then the providers will either render free care or close. It is not unusual for Canadian hospitals to temporarily cease operations or for Canadian doctors to go on strike.


Another feature about the Canadian system are the waiting lists for medical care. These problems are well documented, yet Himmelstein and Woolhandler deny their existence. During a 1993 edition of The MacNeil-Lehrer Report, Dr. Himmelstein said that waiting lists at Canadian hospitals were a myth, largely the invention of insurance companies in the United States. He modified this declaration somewhat in a 1995 essay in which he wrote, “While there are waits for a handful of expensive procedures, there is little or no wait for most kinds of care in Canada…There are virtually no waits for emergent coronary artery surgery in Canada….”


Nine years later, Steffi Woolhandler, appearing on the September 8, 2004, edition of “The O’Reilly Factor,” stated (in response to a claim that people in Canada would have to wait six weeks to have the same type of by-pass surgery that former President Clinton did), “waits for urgent care in Canada is only one day” [sic.]


Waiting lists have been a persistent problem for the Canadian system. In 1989, the government of British Columbia contracted with hospitals in Washington state because of the waiting times for bypass surgery.


Drs. Himmelstein and Woolhandler’s claims for the past 15 years that Canada is not plagued with waiting lists for surgeries definitely do not comport with the newspaper reports I read during my recent visit to Canada. According to the August 18, 2004, editorial page of the Toronto Globe and Mail, Prime Minister Paul Martin wants to reduce waiting time in five key areas, cardiac care being one of them.


An article by Murray Campbell, in the August 19, 2004, Globe and Mail mentions the Saskatchewan Surgical Care Network, a think tank which Campbell says is, “a leader in wait-time assessments.” The article states that the network “has needed nearly two years to develop a framework that allows patients and doctors to know the length of queues…a common language had to be created so that…everybody understood what constituted an urgent operation.” If Woolhandler’s claims were true, such an institute would be unnecessary: the waits are largely mythological and last at the longest one day.


Other data also refutes Woolhandler’s claim. According to a study done by the Canadian government in 2001-2002, the average wait for urgent in-patient coronary artery bypass graft (CABG) surgery for the province of Alberta was 7–13 days. For urgent outpatient CABG’s, it was 93–153 days.


According to Peter Singer, Director of the University of Toronto’s Joint Centre for Bioethics, writing for the Globe and Mail, “The Western Canada Waiting List Project…is developing tools to manage waiting lists.”


The September 8 edition of the Toronto Star features an article about how one Canadian citizen had to wait six months for initial consultation with a cardiologist.


Indeed, so much anxiety surrounds the viability of the Canadian system that there was a major conference on September 13, 2004, to address the problems – chief among them the waiting periods for care.


As is usually the case with those who advocate any variant of socialism, Himmelstein and Woolhandler do not provide the American public with the facts.


The single-payer faction is a well-organized, well-financed, well-educated group, with great access to the media. They are featured much more than those who advocate a more market-oriented approach to the healthcare conundrum.


Himmelstein and Woolhandler are at the vanguard of the left-wing academics proposing a socialized healthcare system that will not work. Like so many in the academy, these two use their status as professors to foster their political ideology.  One can only imagine what they teach their students.

A former police officer, Michael P. Tremoglie recently published his first novel, A Sense of Duty. His work has appeared in the Philadelphia Inquirer, Philadelphia Daily News, Human Events, and the Pittsburgh Tribune-Review. He has a Master of Science degree from Saint Joseph's University, Philadelphia.

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