Ranking Health Care in the States: Promises and Pitfalls

As the scribbler of the U.S. Index of Health Ownership, the only piece of health policy research that ranks states’ laws and regulations according to the principles of free markets and individual choice, I always look forward to the Agency for Healthcare Research & Quality’s State Snapshots, which derive from its National Healthcare Quality Report.

State Snapshots is a very high quality publication, and does its best to focus on “hard” measurements of health system performance (such as the percentage of heart attack victims administered a beta-blocker within 24 hours of admission), as opposed to measures of social interference (such as the fraction of children in a government health plan). As such, it is superior to other rankings that I have discussed.

The State Snapshots should make us health policy prognosticators humble, noting that: “…no state does well or poorly in all areas,” (just like in the Index of Health Ownership). However, the AHRQ, which is an office within the U.S. Department of Health & Human Services Centers for Medicare & Medicaid Services, sees it as a call to action in ways that might actually be harmful to our health – through more government intervention.

For example, it “estimates how much money each state might save by lowering average blood sugar levels” for diabetes, or “how each state is doing on disease-prevention strategies, such as…..checking cholesterol levels, or advising smokers to quit”.

Wait a minute! How did any of these become states’ responsibilities, instead of individuals’? Since when does a state suffer from diabetes, or high cholesterol, or smoking-related diseases?

A previous boss of mine said: “If it matters, measure it!” But a friend, more ominously, warned me that: “What gets measured, gets done.”

A key man responsible for the success of Hong Kong was the colony’s long serving Financial Secretary, Sir John Cowperthwaite. Milton Friedman noted that while “Britain was embarking on an extreme socialist policy in its homeland, one of its last remaining colonies, Hong Kong, was embarking on an extreme free-market policy,” under Cowperthwaite’s leadership. What did Cowperthwaite recommend? Abolish the Office of National Statistics!

According to an obituary: “In Hong Kong, he refused to collect all but the most superficial statistics, believing that statistics were dangerous: they would lead the state to fiddle about, remedying perceived ills, simultaneously hindering the ability of the market economy to work”.

So, while it’s always beneficial to have good information, beware the bureaucrat bearing statistics. Your health depends on it.

Nothing contained in this blog is to be construed as necessarily reflecting the views of the Pacific Research Institute or as an attempt to thwart or aid the passage of any legislation.

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