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Friday, June 25, 2010

U.S. Health Care: Twice as Costly, Less Effective

I'm on the Education subcommittee along with my neighbor (and chairman!) Gerry Lange at the Democratic convention this weekend, so I really ought to be reading up on education issues (like our state's willingness to federalize education with silly national standardized tests that take away local control and professional autonomy).

But then an eager reader sends me The Commonwealth Fund's latest update on the pathetic performance of the American health care system, and I'm all riled up on health insurance again:

In 2007, health spending was $7,290 per person in the United States, more than double that of any other country in the survey.

Australians spent $3,357, Canadians $3,895, Germans $3,588, the Netherlands $3,837 and Britons spent $2,992 per capita on health in 2007. New Zealand spent the least at $2,454.

This is a big rise from the Fund's last similar survey, in 2007, which found Americans spent $6,697 per capita on healthcare in 2005, or 16 percent of gross domestic product.

"We rank last on safety and do poorly on several dimensions of quality," [Commonwealth Fund's Cathy] Schoen told reporters. "We do particularly poorly on going without care because of cost. And we also do surprisingly poorly on access to primary care and after-hours care" [Maggie Fox, "U.S. Scores Dead Last Again in Healthcare Study," Reuters, 2010.06.23].

This year's health insurance reform law be damned—we need real reform. We need a robust public option, if not a full-tilt single-payer system. We need government-run health coverage, like the systems in all the countries that kick our cans in cost control and health care performance. We need universal public insurance like the Medicare program that treats Grandma and Grandpa (and George McGovern!) so well.

We need to acknowledge that the American health coverage system is broken. We need to acknowledge that the status quo is inequitable and unaffordable. We need to acknowledge that this year's reform is a step in the right direction, but not enough to fix a system where medical debt plays a role in more than 60% of personal bankruptcies.

Medicare for everyone. It works in other countries. It'll work here.


  1. I was going to argue with you on the issue yet again over the quality and cost of U.S. health care and decided not to. When it comes down to it it wouldn't even matter if you were right about a single-payer system being more efficient or effective. It would still be an immoral abuse of government power and you will have to drag everybody who believes in individual freedom kicking and screaming into your mindless utopia...or would you support somehow removing the obstacles represented by people standing in the way of progress

    If you truly want a single payer system start a commune.

  2. Commune's too small; we need a bigger risk pool... a 300-million-plus risk pool!

    Where's the liberty in going bankrupt to pay for cancer treatment? Or clinging to a bad job because you can't afford individual-market health insurance? Or not being able to get insurance because of a pre-existing condition? Switch to single-payer, and you'll have more individual liberty.

    Single-payer, or even robust public option, wins on practical grounds and moral grounds. More efficiency, better care, and more liberty.

  3. what does liberty have to do with resources? There is no freedom in having other people forced to pay for your needs for no other reason than you have those needs.
    What you label individual liberty is nothing more than individual security and well being. I may suffer and still make whatever choices life presents me with. Life may give me no other choice than to die of cancer or go bankrupt trying to pay for treatment. The fact that I don't have the resources for other options does not make me less free any more than my lack of singing ability makes me less free because I don't have the same opportunities Michael Buble has. Freedom only means I have the right to try.
    I may as an individual have moral obligations towards my fellowman, and society may have moral obligation as well. No amount of moral obligation is relieved for me simply by passing off the benefits my fellowman receive from government as my own 'charitable' actions due to my political support. Single-Payer fails to be a moral choice because it isn't anybody's choice at all, it is the abdication of making the choice on a personal level to give, but giving the illusion of morality to those that would steal more from individuals for the public good.

  4. Roger, you continue to live/argue in abstraction. Liberty has everything to do with resources. You flip over taxation specifically because it takes resources out of your pocket. I contend the private health insurance system takes more resources out of our pockets than would Medicare for Everyone. Plus, Medicare for Everyone would give us more liberty to choose our workplaces and to seek medical assistance if we so choose when we feel sick. On this score, Americans currently have significantly less liberty than people in most other industrialized countries.

  5. Roger you also seem to forget that the freedom and morality that you argue for do not exist in the present system. Hospital corporations consistently take from the rich and give to the poor, and since it is a corporation doing it, you as an individual citizen has no say whatsoever, the hospitals could give a rip about your views on morality, they are beholding to their shareholders. So when my neighbor shows up a the hospital with cancer that has gone undetected and the hospital treats him costing $100,000 that he does not have, when early detection could have stopped the cancer with a shot, you and I and your neighbor will foot the bill on the virtue that we can afford to pay our bills , so the hospital tacks his costs onto ours. The hospital does not ask your opinion on this or give you a vote on whether you think it is correct , they just do it. The morality that you argue for just doesn't exist. You could maybe try to change the laws, to make it illegal for hospitals to treat people who can not afford to pay, you know based upon morality. Now that would be an interesting argument!!

    The $100,000 vs the shot is the main reason that the nations with health care for all kicks our butts on cost.

  6. Cory: What is the problem with my reasoning in abstraction? Your criticism is like you having a problem with me using numbers and equations to point out the bad engineering in an architectural design instead of just building a crappy building because it will benefit the homeless.
    You fail to recognize the sharp distinction between what you call liberty through provided resources and what I individual liberty. The difference is between equating liberty with the possession of resources that enable opportunities and meet needs, and equating liberty with the ability to own and use resources as I see fit, regardless of my poverty or great wealth. One is the security of the Dolist Slave that may lose little or none of their resources to taxation, the other is the freedom of the American that can give 78% of their resources to charity and not lose an ounce of freedom. Choose.

    Barry: "illegal for hospitals to treat people who can not afford to pay" That sounds odd, I'm not sure how you interpret the current laws. Your comment reads like a law forcing hospitals NOT to treat people, which would be immoral and tyrannical. On the other hand, I would happily change the laws that hinge on the Hippocratic Oath, mandating emergency services to anybody that shows up in an ER. Either was it is irrelevant as It doesn't matter how the prices are determined as I still have the choice to agree to pay them or not. The hospital takes zero money from me I choose not to agree to pay (at least implicitly by accepting the service even if I don't have the up-front pricing I should) It doesn't matter if I just blew off half my leg lighting a box of fireworks with gasoline, it is still my choice to seek medical services or not. The real reason for rising health care cost has very little to do with unpaid for care. It also has little to do with the cost of R&D innovations in the US as I once thought (we do finance most of the world's developments but it is still a tiny fraction of our overall spending) About half of the rising cost has to do with a rise in the proportion of the U.S. population being treated for chronic illness. We spend more than other countries because we are fatter, smoke more, and exercise less, than other countries. The Distribution shows this and socialism won't help change that.

  7. Liberty requires choice. Many choices require resources. Fewer and fewer people have the resources to access affordable health coverage and thus find their choices increasingly narrowed. They thus find their liberty to participate in the marketplace and pursue happiness diminished.

    Roger's liberty is the liberty of the naked guru on the mountaintop. I too like venturing inot the wilderness to contemplate existence. I then return from the wilderness to make society work. Roger does not.

  8. Cory does indeed return from the mountaintop to make it all work, in fact to make society work as he believes it should work. I stay on the mountaintop because I do not presume to have that right.

  9. That's a fundamental difference, Roger. I used to take the same selfish position, that I could remain at a distance from participating in actual society while still enjoying the fruits of its protections. Liberty does not exist in the wilderness. It exists only in the context of society, and it requires practical benefit. If the Constitution says I have liberty, but if the economic system makes it impossible for me to choose my workplace, practice trumps theory.

    And yes, I do have very clear views of how society ought to work, and if I can persuade enough people that I'm right, I will impose certain rules on society, just as you will impose certain rules (or the absence thereof). That's how democracy works. Stop trying to portray it as some kind of tyranny. The Founding Fathers and voting majorities in the States imposed our blessed Constitution on all Americans, over the strenuous opposition of numerous citizens.


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