Tuesday, June 30, 2009

The Myth of Our Great Healthcare System

In response to my latest entry (and an additional remark in which I noted that we have been attempting without success to achieve some kind of health care reform for almost 100 years), a Facebook friend writes:

Of course--we have had the best health care system in the world for the last 100 years--so I can't believe we have not changed it. (Please don't tell me you believe Michael Moore and go to Cuba for your healthcare needs). And I'm sure we can agree that a public option is not the only one way to radically ... Read Morechange the system [sic]. Examples are: delink insurance from your job--it should be similar to car insurance--I have had the same car insurance for 15 years because they pay my claims, I trust them, they provide a plan I like, etc---ahhhh--liberty is great!!! Or we could go with health savings plans, or just up the level at which people can go on Medicaid--and don't tell me Medicaid is horrible---where ever I have worked Medicaid patients received the exact same treatment as everyone else.

A couple of points are worth making:

"We have had the best health care system in the world." This used to be a claim about which people could actually have spirited disagreement; now it's demonstrably false by any objective metric one chooses. Before we even discuss the cost of our "best healthcare system in the world" let's just focus on what we get for it: our actual health. Here the US is pretty shabby. Here is a quick summary of the average life expectancy, by country, according to the CIA World Factbook (well known for its commie leanings), where we learn that, leaving aside teeny non UN-member states, the United States ranks 30th at 78.06 years. That is well behind other industrialized nations of its caliber: Japan (2nd, 82.07); France (5th, 80.87); Australia (8th, 80.62); Canada (10th, 80.34); Germany (24th, 78.95); and even the only country with actual, bona-fide socialized medicine, the UK (26th, 78.70). If we want to make the rallying cry "we're better than Cyprus!" (31st on the list), then we're in good shape, I suppose, but I can't believe most politicians or policy wonks will find this fact comforting...which is why you (almost) never hear anybody, even people who ostensibly want a better system, like Obama, say this out loud. We don't have the best system in the world; we stink. (A nice pic showing life expectancy by country in a world map format can be found here.)

Now for the best part: we pay a lot for that 30th slot. Our per-capita expenditure for health care for 2007 is $6096. That is, we spend six thousand dollars per person on health care each year in the US--not just people who have health insurance, all people (UN statistics, the link here). Congrats, we are number one. More telling is how far off a cliff you fall in the next few spots: funny little Luxembourg comes in 2nd at $5,178 (too many MRIs out there? too much plastic surgery? hard to say), then Norway and Switzerland come in at just over $4000, and every country's per capita expenses are under four after that. France, which has been the butt of Republican party jokes for at least the last 20 years on any number of political issues amounting to a shorthand meaning "if it's dumb then France does it," has a per-capita expenditure of $3040, precisely half the amount of the US.

These are two simple and indisputable facts, the very two facts that should be driving the debate on healthcare reform in the US and barely ever mentioned: we spend more that twice as much as most countries on healthcare, and for that cash outlay, the health of our nation is toward the back of the pack of industrialized countries.

Which brings us to Cuba. Michael Moore's documentary Sicko floats out some stats about the state of healthcare in the US, and although he does this is his own inimitable agit-propstery way, he nails the basic gist of the above paragraphs. Recall, the gist is we stink in terms of what we get out of how much we spend; everything else is details. He noted that Cuba--little, backwards, poor and commie Cuba--gets a lot more bang for its buck in terms of life expectancy. According to UN stats, Cuba spends $229 per person per year on healthcare. That's a whole lot less than the gaudy six thousand figure for the US, and what does that get them? If you take the UN figures that average expenditures over a five-year period, it's exactly one rank higher than the US on the life expectancy list (on the list I cite above, it ranks lower at 53rd, 75.08 years).

Let's leave the commies of Cuba behind and look at this through a different lens: the bankruptcy of General Motors. Here in Warm & Wunnerful Capitalism USA there has been much that has been said and written about the downfall of GM, and one of the critiques from the laissez-faire crowd is that this is how the system should work: it rewards the ingenious and punishes the inept. Oddly, GM is the maker of the critically acclaimed Chevy Malibu and also won the 2007 Motortrend Car of the Year Award for its Cadillac GTS. These ain't K-cars, so why is the second-biggest (just surpassed by Toyota last year) car maker in the world in such dire straits? Well, if the health insurance drag on its bottom line ain't the single critical factor, it's certainly one of them. Nate Silver of fivethirtyeight.com has a brief piece about this here, and references a WaPo article here. Money quote (literally!): "most of the excess costs it requires to produce a Buick versus a Toyota come in the form of legacy costs, not what those employees are receiving in salary and benefits today." I don't think it's too much to suggest that that the piece that brought down one of American capitalism's greatest icons, General Motors, was the lack of government involvement in healthcare insurance. (And, incidentally, we were on the verge of having a form of nationalized health insurance just when GM was entering its juggernaut phase in the late 1940s. The reason why it couldn't pass then? Not because of any nonsense used in today's debates, but because southern Democratic party politicians refused to allow for racial integration of hospitals, which a nationalized insurance structure would create since hospitals wouldn't be reimbursed if they didn't integrate.)

This is what we have of our medical insurance system, the only one of industrialized nations whose policies are created by a philosophy that government involvement in the healthcare of its citizens is somehow an encroachment on personal liberties. So I ask: ain't "liberty" great?

A couple of final points: after a Google search I don't know what "Morechange the system" is but assume it was an error of quick typing. I do highly recommend Jonathan Cohn's book "Sick," which is not to be confused with the more popularly-known movie by Michael Moore, as it is a considerably more sober, though less funny, discussion. In it he includes a lengthy discussion of the possible rational solutions, a subject that I've not even ventured to touch upon here.

And my friend refers to Medicaid's popularity, which only makes my point for me as this is a government-run insurance program, although I suspect that she means Medicare rather than Medicaid, but I could be wrong. Medicare is the highly popular government-run health insurance program for seniors, while Medicaid is also a government-run health insurance for the very poor. Why the politicians in favor of reform haven't figured out that the simple phrase "Medicare For All" is a much more winning slogan than all of the jargony claptrap that they use is totally beyond me.

My guess is this: if the debate continues to revolve around what seems to me the overly facile distinction of "liberty" versus "the cold dark hand of government" then we ain't getting nowhere. If we could burst the myth that the system we've got is so good, even if viewed from the perspective of American capitalist interests (as I tried to explain with reference to GM, and the same could be said of even the smallest of companies these days that struggle with offering insurance as a benefit to employees), we might start on the road to fixing it.

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