Part of a series designed to pave the way for nationalizing huge swaths of medical care, a new paper from The Access Project, the 2007 Survey of Farm and Ranch Operators, is a classic example of the advocacy research genre—it has all of the mechanical trappings of an academic paper without the evenhanded review of generally accepted facts and the literature supporting them that characterizes most scholarly papers. In this case, the idea is to marshal data to show that private health insurance provides little protection from the financial risk of high health care costs.

In case you were wondering, The Access Project was a 1997-to-2003 initiative of the Robert Wood Johnson Foundation. The Foundation gave $9.75 million to Brandeis University’s Heller Graduate Schools for Advanced Study. The Foundation says that this money was used to train 1,600 people in topics such as "gathering and using data."

The data used by The Access Project report that even though 90 percent of its survey respondents and their family members were insured, 29 percent, rounded up to "nearly a third" in the summary, had "medical debt." This, the reported, was true even though the "nearly a third" were healthier than the general population and had a higher net worth. Since farm and ranch operators are more likely to purchase high cost private insurance, the paper implies that high cost private insurance is a contributor to this sad state of affairs.

In the course of the paper, medical debt rapidly morphs into "unaffordable medical bills and medical debt" which were said to "significantly affect families’ overall financial stability" because "Healthcare expenses can lead to housing problems, increased credit card debt, ruined credit records, and in the worst cases bankruptcy." Medical debt is also used to refer to a composite category "medical debt or medical bills paid over time."

Though a future analysis is promised, income and age data are limited. They are not related to claims about financial stress. Though only 10 percent of the sample was uninsured, 25 percent of the uninsured said they did not see the value of health insurance. The report does not bother to relate claims about medical debt to insurance status. It has no information on the size of the medical debts people said they incurred, nor does it discuss why medical debt is more deserving of national reform than debts for automobiles, homes, or vacations.

Omitting the size of the medical debt is important. Data from the Medical Expenditure Panel Survey (MEPS) suggest that in 2004, the 10% of people with the highest out-of-pocket health care costs had expenses above $1,516. The median out-of-pocket expense among insured middle income individuals who had health care expenses was $219. Out-of-pocket costs were higher for those aged 55-64, at $653. Amounts like this might make a serious dent in one’s savings, but they are hardly the stuff of bankruptcy.

The paper plays the usual advocacy research games with references. It refers to reputable government sources for basic population statistics. Its other sources lack breadth. In addition to sources from the Commonwealth Fund, the paper cites the notorious paper by Himmelstein et al. "Illness and Injury as Contributors to Bankruptcy." It does not bother to tell the reader that Dranove and Millenson, in "Medical Bankruptcy: Myth versus Fact," found that Himmelstein et al. had overstated the number of cases in which medical bills contributed to bankruptcy and substantially misrepresented them as primarily affecting the middle class. In fact, the families affected had incomes closer to the poverty level.