Health Care Nonsense [Bryan]

I’ll be the first to admit that, like most other things, the health care debate is too complex for me to get my mind around. But there are some things that are clearly true, some things that are unknown, and some things that are just nonsense. Here is my attempt to sort of facts from nonsense.

Claim: We have the best health care system in the world.

Truth: This is wrong by pretty much any broad-based measure. We pay much more for health care than any other nation, yet many health outcomes (like life expectancy, infant mortality, and so forth) are worse here than in many other OECD countries. The World Health Organization ranks the USA health care system 37th, below such countries as Dominica and Costa Rica. True, we do some things well, like treat cancer. Overall, though, we are less healthy and we are paying much more money. Polls show that Americans are more dissatisfied with their health care than they are in many other developing countries.

Health Care Spending as Percent of GDP

Claim: But in other countries you can’t choose your own doctor.

Truth: The reality is, in fact, that in American you can’t choose your own doctor. I, for example, have a very limited choice of primary care doctors under my plan, which is a very generous plan.

Claim: But in other countries, you have to wait a long time for procedures.

Truth: Actually, polls show that our wait times are often longer than in other countries. In my family, for example, we have waited weeks to get a procedure for our baby Stephen (and, again, we have good insurance).

Claim: In other countries, they ration care.

Truth: We ration care in the this country. You may have noticed that your insurance company decides what you can and cannot have.

Claim: I don’t want a government bureaucrat making medical decisions.

Truth: Well, right now you have a corporate bureaucrat making your medical decisions. The trouble is, the corporate bureaucrat has a vested interest in denying you medical care. When insurance companies deny claims, they make more money; indeed, they have no interest is providing you care if they can legally get out of it. (And they do try to get out of it: check out the highly questionable practice of “rescission” sometimes exercised by insurance companies. If you made any sort of mistake at all in providing your medical history, no matter how trivial, they can void any claim you make thereafter at any time. Hence, we have people being denied treatment for breast cancer because they failed to list past acne treatments. Check out this report, about 30 minutes in.)

Claim: I don't want socialized medicine.

Truth: We already have "socialized" medicine, just a very inefficient form of it. We are socialized in that everyone can receive health care if they just go to the emergency room. Unfortunately, this is probably the most expensive way to take care of sick people, and guess who pays for it. You do. You are, in effect, already paying for an very inefficient type of socialized medicine. The question is not about socialized medicine, it is about being smart about socialized medicine.

Claim: But those darn liberals are going to take away my choices in medical care.

Truth: You don't have choices now. In most states, for example, you don’t have much choice in health insurance providers. Most states have a near monopoly of insurance providers. And, if you are employed, you have to take what your employer gives you.

Claim: Well, Obama is out to take away the few choices that remain.

Truth: No, actually, what he and Democrats have proposed is intended to give you more choices. You can keep what you have, if you want it, or enroll in a not-for-profit public insurance plan if that might better meet your needs. The public plan, if it is included in the bill, will give you a choice you don’t have now.

Claim: Markets are the best way to allocate resources. Government should not be involved.

Truth: I'm a big fan of markets. Markets are cool, nifty things. But markets are not a good way to allocate health care, morally speaking. For markets to work, we have to admit that it would be okay if certain people did not have a certain good. If some people can't afford a plasma TV, we must be prepared to accept that some people will go without. That is how demand is reduced. But, are you going to refuse breast cancer treatment to that single mom because she didn't have adequate insurance? True, if things are too expensive the market may adjust to make things cheaper. But let's be clear: things would adjust in such a way to maximize profit, not to take care of all the sick people.