Yes, Michael, American Health Care Really Sucks.
Back in 2005, President Bush tried to reform Social Security. I don’t know if his partial privatization plan was the best, but at least he was acknowledging there was a problem with Social Security. Democrats, opposed to privatization, fought back against any reform by saying “there was no crisis.”
In the concern over health care reform this year, many Republicans and conservatives are basically saying the same thing about health care in the United States: there is no crisis.
Michael Barone, a writer for US News comes to such a conclusion in his latest column. He throws out several statements that makes it seem that Democrats are crying wolf about health care. Here is his statement about health care in general:
An April tracking poll conducted for the Kaiser Family Foundation shows that voters rank changing health care below strengthening the economy, stabilizing Medicare and Social Security, and reducing the federal budget deficit on a list of eight possible priorities. Democrats rank it higher, Republicans rank it at the bottom, and independents, on this issue like many others this year, look more like Republicans than Democrats.
The blunt fact is that most Americans are satisfied with their health insurance and don’t believe major legislation will improve things for them. This gives opponents of the Democrats’ rush to legislate a strong talking point.
Barone gives people the illusion that the Democrats are just pushing reform when there is no crisis. But as the blogger named “Henry Clay” notes:
While certainly decent compared to the alternatives, objectively speaking our health care system is a mess. The government subsidizes the care of the elderly by stiffing doctors, who then pass along those costs to the privately insured. In a post-industrial national economy, individual insurance decisions are subject to the regulations of 50 state insurance commissioners, undermining portability. The government provides massive and regressive subsidies to employer-provided coverage, while providing practically meaningless tax breaks to those who seek care in the individual marketplace.
In other words, the system is pretty lousy and needs work. Conservatives helped to make this case, first in the think tanks, then in President Bush’s proposal for health care reform, and finally during Senator McCain’s campaign.
It may be that the vast majority of Americans with private health insurance are satisfied with their coverage. But they certainly worry, particularly in this economy, about a health insurance system that largely ties your opportunity for coverage to your employment. And they understand that their share of coverage is consuming an ever larger portion of their income.
In other words, they might be satisfied with the system, but they aren’t ecstatic about it.
They might have real concerns about who will wind up holding the bag for the Democrats’ reform. But there is no special place in their heart for America’s insurers and pharmaceutical manufacturers.
Americans do worry about health care. Maybe they aren’t marching in the streets asking for a Canadian-style system, but they are worried what happens as health care costs rise and what happens if they lose their jobs.
But maybe the coup de grace of Barone’s comments is this one about young adults:
the segment of the electorate that did most to produce the Obama victory and give the Democrats large majorities in Congress is the least concerned and least informed about health care. That segment is the 18 percent of voters under 30. Young voters preferred Obama to John McCain by a 66 percent to 32 percent margin, according to the exit poll. Voters 30 and over preferred Obama by only a 50 percent to 49 percent margin. Some 63 percent of the young voted Democratic for the House of Representatives. Only 51 percent of the rest of Americans did so. Without the young, the votes would clearly not be there for what the Democrats are trying to force through.
But what do the young know or care about health insurance? They have the fewest medical problems of the whole population. Their image of health care, at least until they become pregnant and have babies, is university health services. You come in if you feel like it, someone else pays, you get some pills or some counseling, or whatever. As for the downside of government insurance, pollster Scott Rasmussen reports that the young favor capitalism over socialism by only a 37 percent to 33 percent margin. The rest of us prefer capitalism by a 57 percent to 17 percent margin.
But while young voters may be open to government health insurance, they surely don’t care very much about the issue.
So in Barone’s mind, twenty-somethings are basically carefree idiots.
Yeah, that’s a way the GOP can get a share of the youth vote.
I can tell you that young people under 30 do know a thing or two about health care insurance or lack thereof. Most people in their 20s are in jobs after college. Since you don’t normally end up in a corner office at 25, you might end up working in a very low-paying job that may or may not have health care. And if health care is available, you might not be able to pay for it.
I should know, since it happened to me.
In my 20s, I went through periods where I didn’t have health insurance. One of those experiences was 12 years ago, when I was 27. I had just moved to Minneapolis and was working at a coffeeshop. I was working full time and making $6 an hour. Health care was available, but when you make only $6/hour and have to pay for various things like food, health care becomes out of reach.
That fall, I got the flu, which then turned into pneumonia. I ended up in the hospital for two weeks. I didn’t have to face a big medical bill (or at least not so much) because a wise nurse practioner at the clinic I was going to, was able to get me on to General Assistance health care, which is Minnesota’s health care program for the poor.
The fact is, young people do face various illnesses. Twentysomethings are not fragile compared to the elderly, but they are not invincible. Right now, I know of a young woman who has health issues related to liver disease and her health care situation is perilous.
Republicans in my view are correct in opposing a public option for health care reform. But that doesn’t mean that we should pretend there is no crisis, as Henry Clay says, that’s the best way to ensure President Obama’s public option is a reality.
Crossposted at Neomugwump
62 Responses to “Yes, Michael, American Health Care Really Sucks.”
Bogeyman, Dr_J?
And your counterargument is that starving people have access to grocery stores?
Have you ever heard of WIC, Dr_J? Do you think government programs like WIC have had anything to do with reducing hunger her in the USA? Anything at all?
How long do you think it will take to fix the problem of lack of price transparency? What do you think we should do in the meantime about the 46 million people who currently don't have health insurance? Maybe we should just let that number keep growing until we can get things just right?
What do you think we should do about the comparatively low cancer survival rates in Europe, if not improve early detection? Do you think we ought to tell the Europeans who get cancer to just keep dying younger until we've flippin' cured it?
And when you say, “statistical comparisons are a dismal exercise”–you remember that you're the one who brought up European cancer survival rates, right?
And your comment, “Canadians are probably required to live two years longer so they can wait in the queues.”–?
Seriously, Dr_J?
That's what you've got?
George, calm down. You'll remember I came out in support of government subsidies to make sure everyone could afford health care. And I'm certainly not against earlier cancer detection, since that's all we've got, but no matter when you catch it, cancer treatments are still awful. So let's not be satisfied with earlier detection.
I'm concerned you're setting the bar too low, aiming for a system that will better deliver the same half-loaves we're getting today. I think that's a mistake, we should think more about what full loaves would look like. Health care doesn't have to be outrageously expensive. We could be making much faster progress against cancer and a million other problems we don't treat well. Look at wheelchairs and prosthetic limbs: people have been living with the same centuries-old designs, until someone like Dean Kamen comes along and suddenly reinvents them. And he's just one guy; imagine what we might do if the system encouraged millions of people to innovate.
Dr_J–
I'm not sure where you got the idea that I'm opposed to innovation.
Because you're not calling for a system that will deliver it. You're saying “let's do what those guys are doing,” rather than “let's get a system that does a lot better than anything out there.” Canadians may live to 80, but what will get us to 100? How do we deliver health care cheaply enough so it doesn't consume 20% of GDP and 90% of the population isn't desperate for someone else to pay their bills? What's going to deliver the cure for cancer?
And if your imagination is having trouble stretching that far, here's a limbering-up exercise: how are we going to settle once and for all what a healthy diet looks like? Lord knows the current system hasn't even answered this one, despite spending trillions treating obesity, diabetes, heart disease, et cetera.
Good discussion. Some more comments:
Maybe so, but I think the single-payer system is better. If people need care, whether cancer treatment or just a checkup, they can just go and get it, without worrying if they can afford it this month. Both the costs and the outcomes are better than we've been able to achieve. In fact our health statistics have more in common with a Third World country than with the first world countries who pay far less than us. It seems to me that in this discussion we are prioritizing lower cost above better health, and I think that's a mistake. Any solution we come up with, I believe has to improve both, and for right now the benchmark has to be those countries that currently pay less for better health care.
This seems to be at odds with the warnings voiced here that doctors will flee the scene if reimbursement levels fall to that currently paid by Medicare. It cannot be both ways; it cannot be legitimately argued that doctors and hospitals are not paid enough under Medicare, and that they would accept less from their patients directly.
The alternative to a specific vehicle is what Dr. J. seems to suggest, that patients themselves be responsible for all care except catastrophic care. As I said, this would probably result in less preventive and routine care, poorer physician income, and worse health care outcomes.
I assume you're joking here. Full analysis of single-payer systems suggests that, for example, waiting for treatment could be eliminated in the UK by their government paying 60% of what we do, instead of 50%. In other words, if they paid a little more, but still far less than us, this criticism would evaporate. I hasten to add that we have waiting lines too, as well as outright denial of treatment.
I think it's a disingenuous argument to say that the best health-care statistics we have are “dismal”. These studies are done by the best healthcare institutions we have, and if the companies with a stake in this, the insurance industry and the AMA for example, believe the research is faulty, they could certainly fund studies of their own. I suspect they have, but the absence of studies by our best institutions disproving the UN numbers indicates to me that we cannot get better numbers by doing the research at better institutions. In particular, life expectancy and infant mortality figures are based on extremely finite endpoints, namely death. I can't believe that deaths are under-reported in Japan, France or Germany. These countries are certainly as capable of accurately reporting that endpoint as we are.
Dr_J–
I really hate it when someone out here quotes me as saying something that I never said. Mainly I hate it because the words they put into my mouth are usually a pretty crummy argument.
So, when you quote me as saying, “let's do what those guys are doing, ” rather than “let's get a system that does a lot better than anything out there,” I think you're being unfair to me. Also, since this is a public thread and everyone can see you putting a crummy argument into my mouth, I don't think you're really doing yourself any favors, either.
I do think the current Canadian system is better than the current American system. I can't tell if you disagree with me about that.
Still, for the record, I am in favor of innovation.
For the record, I am in favor of delivering health care cheaply enough that it doesn't consume 20% of GDP. (I think, though, that you're exaggerating when say 90% of the population is desperate to have the other 10% pay for their health care.)
Since you've raised that, maybe you can tell me how we get there.
Maybe you can tell me how long it will take to get there.
Maybe you can also tell me what we should do in the meantime about the 46 million Americans who currently don't have health insurance.
George, sorry if I'm misrepresenting what you said. What shall I take “it seems to me that 'half as disastrous' is a good place to start” to mean?
How do we get a system that's long on innovation and value for money? Through decentralizing control and setting up rules where people can make a few bucks by improving their corner of the industry, along the lines I described before. Courage, GreenDreams, but the P-word is our best friend as long as people are making profits for the right things. The best way to encourage millions of brains to improve the system is through their wallets.
What the private sector will not deliver is progressive subsidies, so this is the right role for the government. But it should do it as cleanly as possible, not by micromanaging prices and procedures and policies the way it does today. The solution to the 46 million people who can't afford insurance: write them a check.
write them a check
Disagree. The current system is too expensive for poor outcomes. A government subsidy to pay more into a broken system doesn't seem like a good place to start. I'm with GS. If there's a system that's only HALF as expensive as ours with better outcomes, that is indeed a good place to start. Anyone who can come up with a system less than half as expensive and/or with better outcomes, great. But profit motive has not always been our friend.
My starting position in this debate is that insurance companies will never care as much about our health as their profit. That does not match our national goal of better health care for all at the best cost. The starting point has to be how do we improve health care and lower cost. Profit does not equal innovation (European drug makers, with government negotiated prices, have overtaken ours in both size and innovation, for instance. Many of our best medical procedures were developed by doctors, hospitals and researchers elsewhere at costs far less than here). Despite my rep here as a liberal, shoveling government money into the same broken system, versus shoveling employer money into it, is not a solution. It's rearranging deck chairs on the Titanic.
It means I think the current Canadian system is better than the current American system. And it means that I think moving to that kind of system would be an improvement over what we now have.
It doesn't mean I'm opposed to innovation. You had to make up a quote for that one, right?
Also, how long will it take?
Giving more power to the government would indeed improve some aspects of the current system. I'm sure we'd get more complete minimum coverage than we have. But it would come at the expense of two ingredients we're sorely missing today: innovation and accountability, because the government does badly with both of these. Taking a step toward the Canadian model would set us back in the long run.
How long will it take to reform the system? It depends how you do it. You could attempt reform by freeing the private sector from the smothering mismanagement the government heaps on it today. Or you could expand demonstrably incompetent programs like Medicare. The first way will be a lot faster.
Dr_J–
You keep talking about innovation. Do you have any way of measuring innovation or it's absence? Some actual metric or methodology? Some source? Or is that just your opinion?
For example, Medicare was passed in 1965. It seems to me that there's been a fair amount of innovation in health care since then. Maybe–probably?–you would say that without Medicare there would have been more innovation. But do you have any evidence of that? What is the source of your evidence?
And would you day other government agencies, like the Centers for Disease Control, or the National Institutes for Health, have also stymied innovation?
You've also referred to Medicare as “demonstrably incompetent”. Can you demonstrate its incompetence? Again, I'm looking for some sources. Something beside your own opinion.
I work daily with Canadians. I have heard some horror stories. A client's dad had heart trouble and was on a waiting list for a very long time (6 weeks or so) to get scheduled for surgury. The family was very worried during this waiting period. There is a shortage of Doctors and no sense of urgency. That is just one story….i've heard several and they all involve long waits. They also involve that attitutude that I have experienced at say…the post office. The attitude that the patients/cusomers needs are bothersome. I'm sorry, but that attitude tends to be much more common among government workers…which is what the Canadian system is made up of.