Of course we’ve all heard the assertions: “we pay more for health care but we don’t get better outcomes”

Even President Obama decries this “fact” in his speech to the AMA.

Today, we are spending over $2 trillion a year on health care — almost 50 percent more per person than the next most costly nation. And yet, as I think many of you are aware, for all of this spending, more of our citizens are uninsured, the quality of our care is often lower, and we aren’t any healthier. In fact, citizens in some countries that spend substantially less than we do are actually living longer than we do.

In a several part response we will discuss how the data is being cooked and the assertions are misleading. Part one is a discussion about the often overlooked facts concerning Infant Mortality rates in the US and countries with National Health systems. For obvious reasons, these facts are distorted or never mentioned in order to advance an agenda. The goal here is to expose the “qualifications” behind the numbers allowing people to decide for themselves.

Interestingly the CIA has published infant mortality rates for countries around the world. The US ranks number 44 behind such paragons of virtue as Slovenia and Cuba. But wait just a minute. Things are often not what they seem.

The issue with such statistics is that as the WHO acknowledges, definitions are inconsistent and the data “incompletely reported”. The European Union Public Health Information System notes that the definition of a “live birth” varies between reporting countries and herein lies the rub. Canada, Germany and Austria consider infants born weighing less than 500 grams “unsalvageable” and therefore exclude them from reported data. In other countries infants that survive less than 24 hours are classified as stillborn and are also excluded. Japan and Hong Kong classify such infants as a “miscarriage”, again excluding them from the reported data. Finally, in Switzerland and other European countries a neonate is not counted if less than 30 centimeters in length. In contrast the US counts each and every neonate regardless of weight, length or gestational age so long as there is evidence of life at delivery.

Despite all the inconsistencies in data reporting, infant mortality is often cited as evidence that these health care systems deliver better care than provided here in the US. While infants born weighing less than 1500 grams (~3 pounds) have an overall mortality some 20 times that of heavier babies, it is American physician’s ability to keep them from immediate death that leads to classification as a “live birth”, and consequently higher US infant mortality statistics than in countries where such efforts are not even made. In reality I must acknowledge that the spread of infant mortality between developed countries is strikingly low, but it is ironic that our application of advance medical treatment, which gives these infants a chance at life, also leads to lower reported survival, an artifact of a classification system that is neither standardized nor comparable.