That's a scarily illogical leap of paranoia...
Clever, I like that.
But even paranoids have enemies.
1) "most vulnerable", more likely, means those who are.... most vulnerable! The people who are most susceptible to disease and illness, such as the old, those living in squalid conditions, the disabled, or people with a high chance of inheriting degenerative conditions. People in such situations likely can't afford to pay for their healthcare, because of their condition - a vicious circle.
'Most vulnerable' was not defined in their mission statement. And that is fine. It is really not the place to define it. But something undefined can also be indefinable. Some one or some group will always be 'most vulnerable', no matter what.
2) Even if the people who commissioned the study are in favour of socialised health-care, it doesn't mean that the study itself is biased. Just because they believe in socialised healthcare does not change the fact that US healthcare is more inefficient (in terms of level service per dollar) than healthcare in other countries. This is largely due to the fact that US healthcare costs, for example, three times as much per person than healthcare in the UK (which is one of the most nationalised in the world).
This is from the Executive Summary of the report, which is
>>HERE<<.
Commonwealthfund (emphasis added) said:
The most notable way the U.S. differs from other countries is the absence of universal health insurance coverage. Other nations ensure the accessibility of care through universal health insurance systems and through better ties between patients and the physician practices that serve as their long-term "medical home." It is not surprising, therefore, that the U.S. substantially underperforms other countries on measures of access to care and equity in health care between populations with above-average and below average incomes.
In other words, the US system was compared to a different system and the US did badly. Apples and oranges were compared on how well they made orange juice and the apples did not do so well.
This report is all about an unequal comparison, which the authors acknowledge, and still the report focuses on this inequality.
This is bias and distortion.
The Report Itself
The Sample Data
In the
Methodology Appendix section of the report (page 35 of the .PDF) it states that the data was drawn from surveys done in 2004 and 2005 of patients. Both surveys were done by phone.
The 2004 survey was about 'primary care experiences'.
The final sample included 1,400 in Australia, 1,410 in Canada, 1,400 in New Zealand, 3,061 in the U.K., and 1,401 in the U.S. Data are weighted in each country to adjust for variations between the sample demographics and known population parameters.
Or to order this another way:
- UK: 3061
- Canada: 1410
- US: 1401
- Australia: 1400
- New Zealand: 1400
The 2005 survey numbers were similar.
The final sample included 702 in Australia, 751 in Canada, 704 in New Zealand, 1,503 in Germany, 1,770 in the U.K., and 1,527 in the U.S.
And these numbers in a different order:
- UK: 1770
- US: 1527
- Germany: 1503
- Canada: 751
- New Zealand: 704
- Australia: 702
The populations of these nations, according to
Mongabay, last updated May 5, 2003.
- US: 280,562,489
- Germany: 83,251,851
- UK: 59,778,002
- Canada: 31,902,268
- Australia: 19,546,792
- New Zealand: 3,908,037
In the 2004 survey, the US and New Zealand had roughly the same number in the final sample, yet the US population is over 90 times larger than New Zealand.
Which leads to this, how many people in each country are represented by one response in the 2004 sample.
- New Zealand: 1 for 2,791
- Australia: 1 for 13,961
- UK: 1 for 19,528
- Canada: 1 for 22,625
- US: 1 for 200,258
If the US had been sampled at New Zealand's rate, 1 for every 2,791 persons, it would have had over 100,000 in the sample. And the sampled base for the other nations would have been higher also.
I can see the physical task required to do 100,000 telephone surveys. It would be monumental. Yet it was not so difficult to do 3061 phone surveys in the UK. Given the population ratio of the UK to US (1 to 4, roughly), it would be reasonable to expect that the US sample size would have been four times larger than the UK's. In reality, it was less than half the size of the UK's sample (3061 vs. 1400).
Demographics
There are none.
Nada. Nothing. Zippo.
Nowhere in the report is there any breakdown of the age of the respondents for any survey in any country. We don't know anything about their age, race, sex, education level, income or family status. What is their living situation, do they have a chronic physical aliment or condition,
In the chartpak (a separate download, with charts of the data), only one chart, page 8, has any sort of demographics, as it refers to women, detailing Pap smears of women aged 25 to 64 and mammograms in women aged 50 to 64.
In a report that claims to be a serious study of the issue, I find the lack of demographics troubling and a serious omission. Are the demographics consistent country-to-country? Is one subgroup over sampled?
My Conclusions
The mission statement made me uneasy.
The blatant bias in the Executive Summary made me suspicious.
The unequal sampling of US data in relation to the sample sizes from other nations made me doubt the integrity of the data.
The lack of demographic data made me doubt the honesty of the data.
My bottom line: hogwash.
