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Friday, July 27, 2007

Junk Social Science Leaves Congress Feeling Sicko
Todd Zywicki & Gail Heriot

Here's the op-ed Todd & I published in the Washington Times yesterday:

No one has ever accused Congress of being overly meticulous about the scientific evidence it takes in. But the 110th Congress has been on a binge diet of junk social science. It’s no wonder it’s been looking sick lately.

Or should we say Sicko? An excellent example is last week’s hearing before the House Subcommittee on Commercial and Administrative Law. Preciously titled "Working Families in Medical Crisis: Medical Debt and Bankruptcy," the hearing purported to be a serious look at medical debt and bankruptcy. In reality, it was just another arm of the publicity leviathan behind Michael Moore’s new "documentary." The star witness was Donna Smith, whose story was featured in the movie--including her trip to Havana to seek the supposedly superior medical treatment available in Cuba. She was surrounded at the hearing by a bevy of nurses in brightly-colored "Sicko" t-shirts, who applauded her testimony enthusiastically. The hearing quickly developed into a cheerleading session for single-payer healthcare—an issue over which the Subcommittee has no jurisdiction.

But Ms. Smith’s testimony was the best–or the least bad-- part of the hearing. At least she had a story to tell, which she told forcefully and, as far as we could tell, forthrightly. Most policymakers can tell the difference between a serious inquiry into bankruptcy policy and a single-anecdote photo opportunity, so there is little danger that bankruptcy policy will be crafted in a way that is responsive only to Ms. Smith’s case.

The same cannot be said of the testimony from Harvard professors David Himmelstein and Elizabeth Warren. They purported to offer generally-applicable social science. In fact, it was junk. Blandly entitled "Illness and Injury as Contributors to Bankruptcy," their long-discredited 2005 study may be among the most misleading research ever placed before Congress–no small dishonor.

The study’s central findings were that 54.5% of all bankruptcies have a "medical cause" and that 46.2% of all bankruptcies have a "major medical cause." Even if this were true, bankruptcy law already provides adequate safeguards for the special problems posed by medical bankruptcies, as one of us (Zywicki) testified at the hearing. But it is not true. And the only way to make such a claim is to gerrymander the definition of medical bankruptcies to generate the desired results–true junk social science.

For example, the study classifies uncontrolled gambling, drug or alcohol addiction, and the birth or adoption of a child as "a medical cause." There are indeed situations in which a researcher may legitimately classify those conditions as "medical," but a study that is being used to prove that Americans are going bankrupt as a result of crushing medical debt is not one of them. A father who has gambled away his family's mortgage payment is not the victim of crushing medical bills. Similarly, new parents who find they can no longer afford their previous lifestyle now that one of them has to stay home with the baby will usually find the obstetrician's bill the least of their problems. Babies are a financial hardship even when hospitals give them away free.

But that’s just the tip of the iceberg. The authors also classified bankruptcies as having a "major medical cause" if the debtors had more than $1000 in accumulated, out-of-pocket medical expenses (uncovered by insurance) over the course of the two years prior to the bankruptcy, even if the debtors themselves did not cite illness or injury as among the reasons for their bankruptcy.

Nobody likes to have to pay $1000 in medical expenses, even if it is spread out over the course of two years. But for most Americans (particularly those with enough at stake to declare bankruptcy), it is not catastrophic. To put this figure in perspective, in 2001 (the year that provided the basis for the study’s sample) average per capita out-of-pocket medical expenses were $683—meaning that during that two-year period the average American spent about 30% more than their figure on uncovered medical expenses. To designate all cases involving expenses of more than $1000, regardless of circumstances, as bankruptcies with a "major medical cause" is both silly and deliberately misleading. A bankrupt with $1001 in uncovered medical expenses and $50,000 on a Bloomingdale’s card would constitute a "medical bankruptcy" in their study. Perhaps their expansive definition of "medical bankruptcy" should include self-proclaimed "shopaholics" as well.

We could go on. The point is simply that the study uses trick after trick to classify as many bankruptcies as possible as medical. It’s remarkable that they didn’t include them all.

What do the real data show? Numerous studies have found the number of bankruptcies caused by medical debt to be dramatically lower than Himmelstein and Warren report–down in the single digits. Among the most recent is a study of 5,203 bankruptcy filers (about three times the number examined by Himmelstein and Warren) by the Executive Office of the United States Trustee. It found that 54% of filers listed no medical debt at all and that medical debt accounted for about 5.5% of the total general unsecured debt. About 90.1% of filers reported no medical debt or medical debt of less than $5000. Of the 46% who reported medical debt, 78% reported medical debt of below $5000, with an average of only $1,212 within that group—hardly enough to send the average family into bankruptcy. Overall, 1% of the cases accounted for a total of 36.5% of medical debt, and less than 10% of all cases represent 80% of all medical debt.

In short, in a tiny number of cases, substantial medical debt does force bankruptcy. In a few others, medical debt combines with otherwise high levels of mortgage, automobile, or credit card debt to tip someone into bankruptcy. But the notion that half of bankruptcies are driven by medical debt is unsupported and insupportable.

Why did a Congressional subcommittee turn to such a thoroughly discreditable study when it needed information on medical debt and bankruptcies? We can only speculate. But the idea that Congress would consider revamping the bankruptcy law–or worse yet, the entire health care system--on the basis of junk social science is enough to make us feel sick.

Todd J. Zywicki and Gail Heriot are professors of law at George Mason University and the University of San Diego respectively.

http://rightcoast.typepad.com/rightcoast/2007/07/junk-social-sci.html

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Todd Zywicki & Gail Heriot
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Comments

As I pointed out in response to the previous post on this topic, the merits or demerits of the Harvard study are somewhat beside the point. The opponents of bankruptcy reform, howevermuch their public arguments may have been relying on "junk science", were obviously then, and even more obviously now, on the right side of the issue. And Zywicki was obviously, then, and even more obviously now, laughably wrong.

If you're going to argue against the political misuse of junk science, it would be better to choose an example where its use derailed the passage of a sensible law, rather than failing to derail the passage of a foolish one.

Posted by: Dan Simon | Jul 27, 2007 7:27:51 PM

Insofar as intellectuals may be said to have a duty, it is to reveal false or dishonest arguments, irrespective of which side of a political tussle is deploying them. Well done.

Posted by: dearieme | Jul 28, 2007 7:45:06 AM

Gee, Dan, I think that's a frightening argument. If you just smile and ignore it whenever a bad argument is made in support of a cause you favor, you're going to find that the argument turns around and bites you sometimes. Take this study. It may help you argue against a particular bankruptcy reform, but it is also being used to support single-payer health care. Maybe you support that too, but you can be sure that this study can somehow be used to support a cause that you oppose. And when it is put to that purpose, you won't be in a position to object. It will be too late.

Posted by: Gail | Jul 28, 2007 6:32:31 PM

Gail, I certainly would never use the study in question in support of my position on bankruptcy "reform". (I actually consider the question of why people declare bankruptcy quite irrelevant to the issue of how strict bankruptcy rules should be.)

But the study in question was just one argument used against the bill, and others--such as that lenders at that moment needed *fewer* incentives to lend to poor credit risks, not more--were not only far more compelling, but eventually borne out by events. Your co-author argued specifically against this point, and he was wrong. (To quote his blog: "[T]he growth in subprime lending is not creating overwhelming debt burdens for low-income households.")

Now, when a past vocal proponent of one side of an argument that has been proven wrong, responds by harping on a specific flaw in one of his opponents' specific arguments, *without ever conceding the point that he was wrong overall*....well, one can't help suspecting he's engaging in a dishonest backdoor defense of his original (wrong) position, insinuating that the flaw in the opposition's argument proves his own argument correct, when in fact the opponents' other arguments have already carried the day.

Think, for example, of the longtime defenders of Alger Hiss or Julius Rosenberg, still griping about various obscure nits in the government's case against them. Is it "frightening" to dismiss such cranks as focusing on some unimportant detail--on which they might well be correct--in order to distract from their overall incorrectness?

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