JAMA Article Guilty of Political Spin

Published February 1, 2007

In its December 13, 2006 issue, the Journal of the American Medical Association (JAMA) published an article on “Changes in Financial Burdens for Health Care.”

Written by Jessica Banthin and Didem Bernard, two researchers at the federal Agency for Healthcare Research and Quality (AHRQ), the numbers in the article are fine. However, it is yet another example of how researchers are not content just to present research, but instead try to spin the meaning of that research to fit a policy agenda.

The authors find a growing number of American families are spending more than 10 percent of their household income on health care, including both premiums and direct services.

That’s undoubtedly true … as far as it goes. But the authors call this a “burden,” say families are “at risk” of greater burdens, and contend that anyone spending 10 percent or more is “underinsured.”

What’s a Burden?

The implication is that no one should have to spend 10 percent or more of their income on health care.

Hmmm. Why should that be? The latest numbers I could find from the Bureau of Labor Statistics say the average American family spends 35 percent of its income on housing, 26 percent on transportation, and 19 percent on food. Yet no one calls any of this a “burden.” No one suggests that 26 percent on transportation leaves people “at risk” for anything.

What is magical about 10 percent on health care, and why is it somehow better to spend money on transportation than on health?

Burden for Whom?

Interestingly, the nation as a whole spends 16 percent of its economy on health, so anyone spending only 10 percent is getting a bargain–a bargain that someone else is paying for.

But, of course, it is not “someone else.” It is employers or the government. And the government gets its money from taxpayers.

The more government spends, the higher your taxes are, but that is not considered a burden. Ditto for employers. The more your employer spends on health care, the less there is to pay your wages, but these authors don’t consider that a burden either.

When health care is paid for by the government or your employer, you are really paying for it, but you don’t get to control it. You have to accept whatever it is the government or your employer is willing to buy. If you spend the money directly, you have absolute control over how you spend it.

But that would increase your “burden,” according to these authors.

Who Spends Most?

Setting all that aside for a moment, and accepting the authors’ premise that spending 10 percent or more is bad and 10 percent or less is good, what should we do about it?

The answer is hidden in the paper. The authors report that 19.4 percent of the people on public health care programs (Medicaid and the State Children’s Health Insurance Program) spend more than 10 percent of their income on health care, while 18.2 percent of people who are privately insured do, and only 10.5 percent of the uninsured do.

That suggests that if our goal is to lower the number of people with a 10 percent health care “burden,” we should encourage more people to become uninsured. The very last thing we should do is encourage more people to be in public programs.

Finally, the authors concede they are looking at only one year’s worth of data. Therefore, it’s worth remembering that people spending 10 percent this year may have spent only 5 percent last year and may spend only 5 percent next year.

What a shock! When people are sick, they spend more on health care than when they are not sick. Can anyone say, “Duh!”?

Greg Scandlen ([email protected]) is president of Consumers for Health Care Choices in Hagerstown, Maryland.

For more information …

“Changes in Financial Burdens for Health Care: National Estimates for the Population Younger Than 65 Years, 1996 to 2003,” by Jessica S. Banthin, PhD, and Didem M. Bernard, PhD, Journal of the American Medical Association, 2006;296:2712-2719, http://jama.ama-assn.org/cgi/content/abstract/296/22/2712