• Was the Commonwealth Study ‘Rigged’?

    The Commonwealth Fund has a new study out that evaluates the health systems of 11 developed countries and it finds that the US system comes in last.

    Philip A. Klein criticizes that study.

    the report is deeply flawed… The problem with the Commonwealth Fund study is that it’s rigged to produce a result that favors socialized health care systems. The study determines that the U.S. system is worse because it lacks universal health insurance coverage and the report emphasizes “equity” as one of the key factors in evaluating a health care system. But it’s an ideological decision to view equity as one of the most important factors in judging a health care system, just as it is for the study to leave out a factor such medical innovation, which would work to the advantage of the U.S., or choice, which would work against the centralized NHS [in the UK].

    Calling the Commonwealth study “flawed” suggests that there are problems in the study that distort the ranking of countries relative to an objective study. Calling it “ideological” suggests that there is a scientifically neutral way to rank countries health systems. Calling it “rigged” suggests that the authors are deliberately distorting the ranking.

    These criticisms are misplaced. An evaluation of a health care systems must begin from a framework of values, because health care systems exist to fulfill normative human goals. We have health care because we value health, so we want to see whether the system delivers that. Most of us also want the system to treat people fairly, because we value fairness. And so on.

    Klein has different values from the authors of the Commonwealth study. He doesn’t value equity and the Commonwealth authors (and I) do. This is a key difference between conservatives and liberals on health care and it motivates much of the conflict about the ACA. Nevertheless, in the light of Klein’s values, he will reasonably reach different conclusions about the relative performance of US and other systems starting from the same data.

    It’s also possible that the Commonwealth authors have gotten some facts wrong. Thinking of the problems in care at uncovered at the Staffordshire NHS Trust, I too wondered whether the Commonwealth data on the NHS were accurate.

    My point is that health policy disputes involve disagreements about facts and values. We have to argue about both to come to policy decisions. Getting clear about the values that drive our policy is why philosophy matters.

    There is, however, an important technical problem in Klein’s post. He really really needs to get straight on what you can and can’t infer from cancer survival statistics.


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