Many half-baked theories abound to explain changes in relative levels of health care use and health care spending ("Coming up short," Aug. 31). The reasons for slower growth in some types of U.S. health care spending within the last few years are rather complex, though partly related to declines in our economy. However, the recent National Bureau of Research study behind this story made a sloppy and flawed assertion that a key factor was Americans facing higher out-of-pocket costs than people in other comparable nations. It confuses absolute dollar totals (in a larger health care economy) with the more decisive "share" of health care spending that is paid out of pocket.

The most recent national health expenditure statistics show that our out-of-pocket share of health care spending continues to decline (11.5 percent estimated for 2009, 10.8 percent projected for 2014), which reflects a long-term trend. Moreover, the U.S. out-of-pocket share of health spending, as of the last comparative figures available in 2008 (12.1 percent), was below that of Germany, Canada and the weighted average of all reporting members, respectively.

In other words, Americans do not pay a higher portion of their own medical costs than citizens of any other developed nation. Moreover, not all "routine" health care turns out to be preventive, and most of it leads to more, not less, future health care spending. Much preventive care needs to be more targeted, rather than widespread, to be effective.

Thomas P. Miller is a resident fellow at AEI.