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Misleading with statistics: The Fraser Institute on health care and 'value for money'

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No sooner noted than illuminated -- yesterday morning mainstream media was credulously reporting another "Fraser Factoid," this one a report by the far-right political lobby group purporting to show Albertans get poor value for the money they spend on public health care.

Actually, since in this case the market-fundamentalist "think tank" had little choice but to rely on publicly available and legitimate research to tease out its predictable conclusions, the news couldn't be made to seem as bad as the reports author doubtless would have preferred.

Indeed, from the perspective of those of us who live here in Alberta where the Progressive Conservative government of Premier Alison Redford has committed itself to keeping our system of primary health care in the public sector, the news hidden in the real numbers was actually pretty good.

So the Fraser Institute's propagandists had to grudgingly admit that, even according to their biased interpretation of facts from a single year, 2010, Alberta has "the highest quality of clinical performance" -- that is, the best "mortality rates, hospital re-admission rates, and patient safety."

What's more, according to the Fraserites (and notwithstanding the constant brouhaha in the media often stirred up by the same people), Alberta is not doing badly for wait times either, and ranks No. 3 for the number of procedures performed per capita.

In other words, despite their stream of negativity and propaganda, Alberta's public health system is delivering the goods and serving most citizens pretty well. Right?

Of course, that's not where the Fraser Institute wants us to go. So if they can't persuade us that a publicly financed and publicly operated primary health care system is getting lousy results, because the indisputable facts say otherwise, they'll try to get us to think instead that we’re not getting value for our money.

This is a point you may wish to dispute if you’ve actually had to use the Alberta health care system lately -- as my family has -- but it's the Fraser Institute's story, and in the absence of more helpful facts, they're stickin' to it.

To this end, the lobbyists employed as researchers by the Fraser Institute have concocted an arbitrary index, the Provincial Healthcare Index 2013, that purports to compare a highly subjective collection of equally weighted performance indicators with clinical data harvested from such sources as the respected Canadian Institute for Health Information.

The reliable stooges of the mainstream media were quick, naturally, to emphasize this negative point yesterday, racking up another score for the foreign and domestic billionaires who bankrolled the Vancouver-based propaganda mill to the tune of $9.9 million in 2011.

For example, the stenographer from the Edmonton Journal, my hometown daily website, dutifully noted in the lead sentence of his story that this means we Albertans get "less value for money compared with most other provinces." Needless to say, there was not a word of reaction from the government or any other stakeholder in the health care system.

So, based on the 2010 numbers he crunched, the Fraser Institute researcher reported that Alberta spent the most per capita among Canadian provinces on its health care system with the sole exception of Newfoundland. Quebec spent the least, the report said.

Not every researcher agrees that this is the right way to look at the data, of course -- although, from the Fraser Institute's premeditated perspective, it's the best way of coming to the conclusions they desire and to explain away Alberta's otherwise strong performance.

In 2012, former Alberta Liberal Leader and University of Alberta professor Kevin Taft published a book called Follow the Money, Where is Alberta's Wealth Going? In it, Taft concluded Alberta spends the least per capita of all Canadian provinces on health care when you adjust for the size of the provincial economy.

This has not changed. CIHI’s projected numbers for 2012 show Alberta will again have the lowest health care expenditure of any province as a percentage of Gross Domestic Product, at 8.67 per cent. That compares to Quebec, the Fraser Institute's supposed low-cost example, which is expected to spend the most per capita, 12.7 per cent!

By the way, health care spending in Alberta is not rising particularly quickly, according to Taft, who reported that over the long term -- smoothed out with five-year averages to account for Alberta's horrible record of wildly fluctuating health budgets -- total spending rose about 1.2 per cent a year, in line with the rest of the country. "Since 1994, public spending on health care in Alberta has ranged from around 4 per cent to around 5 per cent of GDP. … This is far below the spending rate of other provinces, which consistently averages about 7 per cent," Taft wrote.

Getting back to the Fraser Institute's key claim -- the conclusion to which their research is intended to lead us -- the news release about the report states that, "on a national basis, Canada's health care system provides very poor value for money in comparison with universal-access health care systems in other developed nations."

This is a highly dubious proposition, to say the least, but it is designed to set the stage for the Fraser Institute's true full-time objective, the aim of 100 per cent of its constant political activities -- influencing government policy in the direction of total privatization and, where that is not yet possible, partial privatization, of public services.

Accordingly, the Fraser Institute is a constant advocate of "choice" in health care, provided through private insurance for medical services that may not, they coyly suggest, meet everyone’s needs.

In addition to introducing the controls, co-payments, denial of coverage based on pre-existing conditions and high costs of private insurance, as most Canadians still understand despite the tireless efforts of the Fraserites for the past 39 years, "choice" in heath care is not choice at all -- it is more and better service for the wealthy and impoverishment, sickness and death for those of us who cannot pay.

Imagine the cost of insurance coverage -- let alone the full cost of treatment, which can range from $20,000 to $180,000 in the United States -- to pay for something as common and simple as an emergency appendectomy operation!

So if media coverage of the Fraser Institute's latest "report" about the supposed poor value for money delivered by Alberta's and Canada's health care systems left you with the feeling another shoe was about to drop, this is it: In every case, we will all find out soon, those wonderful European universal-care systems the Fraser Institute touts as delivering better value (without a shred of evidence for this dubious claim in the report that makes it) include a substantial component of services that must be privately insured.

As the report's author promises, "an assessment of the relationship between value for money and specific provincial health-care policies is left for future research." Don't expect to be surprised by what this research will conclude!

As noted in this space yesterday, in spite of claiming to be an educational and research group and despite enjoying charitable status granted by a strangely distracted Canada Revenue Agency, the Fraser Institute operates as a full-time political lobby that pushes for the adoption of market fundamentalist policies in open violation of the CRA's rules for charities.

Yesterday's Fraser Institute exercise -- credulously swallowed hook, line and sinker by the mainstream media -- is merely another example, and far from the most egregious one.

This post also appearson David Climenhaga's blog, Alberta Diary.

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