To the editor:
While Malcolm Gladwell is a gifted writer, reporter, and analyst, his most recent article, "The Moral-Hazard Myth," cites several questionable studies and examples:
- First, he writes "The leading cause of personal bankruptcies in the United States is unpaid medical bills." This was the conclusion of a flawed analysis by Harvard researcher David Himmelstein and others that said medical debt "now accounts for as much as 40 to 50 percent of personal bankruptcies." The study has been widely criticized for its overly broad definition of medical bankruptcy (which included uncovered medical bills over $1,000, a two-week loss of work-related income due to illness, or simply citing illness or injury as one reason for bankruptcy) and for the subjective and skewed sample it used.
The Department of Justice's U.S. Trustees Program, which oversees bankruptcy cases in 21 regional offices nationwide, produced a major study of the causes of bankruptcy and found that medical bills were in fact not a significant cause of bankruptcies in the 1998-2000 period they studied: www.usdoj.gov/ust/press/articles/abi01octnumbers.html
"Overall, medical debt did not seem to be a major factor in the vast majority of cases. The average medical debt listed per debtor was $2,582, or about 5.6 percent of the total general unsecured debt. More than one half (53.6 percent) of the debtors reported no medical debt at all…Only 11.1 percent of debtors reported $5,000 or more in medical debts, and in only 4.4 percent of cases did medical debt comprise one-half or more of total unsecured debt."
- Second, Gladwell says access to dental care is the top priority of Americans responding to a recent poll. However, comprehensive dental care is seldom available either in public or private programs. Those who live under socialized health care systems are often the most disadavantaged, as reported in a New York Times article of August 12, 2003.
- Finally, Gladwell cites the famous RAND Corporation study, excerpting one finding regarding people with hypertension to argue that those in the high-deductible group had a higher incidence of death. Aside from the difficulty of treating hypertension in the 1970s when the study was conducted, the overall conclusion of the RAND study was that there were no overall measurable differences in health outcomes between those in the zero and ninety percent copayment groups.
This would therefore bring into question the veiled conclusion of the article — that the United States should join other industrialized democracies in creating socialized medicine.
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