National Healthcare
My favorite econ blogger breaks down the many obstacles facing those who advocate for a national single payer healthcare system in the U.S. I think those who want to advocate for this type of a system in our country have a lot of work to do and I’m hoping they fail.
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Yes, implementing nationalized health care in the U.S. would require surmounting a number of immense social and cultural obstacles. But Jane Galt’s first premise is significantly flawed. Even if it were true that 75% of Americans are “happy as clams” about their health care (a claim I find questionable), their confidence is sadly misplaced. The Journal of the American Medical Association in May reported on a study demonstrating that Americans (the “beneficiaries” of a “for profit” health care system) are significantly less healthy than the English (those who rely on nationalized health care)–despite the fact that America spends more than twice as much per capita for health care.
No health care system on this planet is perfect, and the British system surely has its share of problems. But can we seriously entertain the idea that Americans have “much more lavish coverage than that available elsewhere”? The proof is in the pudding. Free-market advocates have long claimed that government intervention is both less effective and less efficient than market solutions. In this study, both claims have been refuted. For all its problems, I’ll take the system which guarantees all citizens access to fundamental health care and more efficiently promotes significantly better health among its citizens.
I addressed this report several months back on my own blog here.
Comment by Derek — November 16, 2006 @ 4:49 pm
Derek,
I’m the last one you should come to if you are looking for a defense of our current health care system. I agree that it is flawed. I also believe you and JAMA when you claim the Brits are healthier than Americans on average. That doesn’t change the fact that we have more high tech medical equipment per capita than any other nation on earth or that we are the source of the vast majority of major beneficial medical developments over the past 40-50 years. We spend a lot but we get a lot as well. We just need to find a way to make it so resources are managed more wisely.
Turning our medical system into a free for all “reward the biggest moocher” system is only going to exacerbate the problems we have now. I think we need a better “welfare” safety net for the poor but a socialist style one size fits all system like that in England/Canada means the end of the vast majority of incentive for those who make it their business to create new medical technology. More importantly it makes my neighbor’s vices even more my business than they are now. I don’t like the idea that I have direct financial responsibility through my taxes for the medical care of my smoking/sunbathing/drinking/meat eating/everything else that could possibly be bad for you participating neighbor. We’ll end up with an even bigger nanny state than we have now…and that worries me.
I don’t have all the answers and I do agree with you that the system is broken. I just don’t see that England/Canada are examples which provide much promise for America.
Comment by Jeremy Manning — November 16, 2006 @ 8:58 pm
I’m sure we could have a very interesting ideological discussion on “moochers” versus “money-grubbers”; laziness versus greed; “nanny” states” versus “jungle (as in “law-of”) states; the gun of the state versus the coercion of capital; free-market democracy or manufactured consent; personal responsibility versus communal responsibility; independence versus interdependence; the good of the one versus the good of the many; Friedman and Rand versus Galbraith, E.F. Schumacher, David Korten et al. I wouldn’t mind such a discussion, but for now I’d like to put all that aside. More important than all the ideology and dogma is pragmatism. If reality proves my ideology flawed, I’m perfectly willing to amend my ideology. For example, I’ve got serious ideological concerns with Huntsman’s flat tax ideas; but if concrete data shows that his flat tax is successful in improving the economic stability of all classes and provide for better funding of our educational system, then I’m willing to adjust my beliefs and support the flat tax. Practicality is the ultimate judge.
If we use practical observation as a guide, I don’t really see how you can make the claim that “we [Americans] get a lot as well.” The study indicates that we get much less return on our investment in this free-market based health-care system than do the British under a socialized system. And isn’t the primary ideological premise of free-market theory that it supposedly maximizes the efficiency of inputs?
Even if we do, as you suggest, have more “high-tech equipment per capita than any other nation on earth,” so what? What use is it to have that much equipment if our health is on average measurably worse in spite of that equipment? That benefit may be important for the wealthy few who can afford the use of that equipment, but is meaningless in the context of national health policy.
You say that a nationalized health-care system would “end of the vast majority of incentive for those who make it their business to create new medical technology.” I don’t think history bears that out. Louis Pasteur didn’t develop the germ theory of disease and pasteurization because he thought he could make a killing on the process, but because he wanted to help stop the rampant diseases he saw infecting society around him. Marie Curie did not investigate pitchblend and make the discoveries in radiation that ultimately led to x-radiography and chemotherapy so she could retire to a lavish estate, but because she was driven to understand the nature of the universe. Alexander Fleming researched anti-bacterial agents and discovered penicillin not to pad his bank account, but because he was determined prevent the sort of excruciating deaths by infection that he saw during World War I. No, nationalized health care won’t dis-incentivize innovation. Countless examples like these show that many of our great innovators are motivated to innovate because they want to do good, not just mammon. Socialist health care may disincentivize the restriction of access to information and processes, (ie, disincentivize the tight control of “intellectual property” by corporate industry participants such as the pharmaceutical companies) encouraged in our market system, and which further minimizes the opportunity for the public to partake of those breakthroughs. But that would be bad how?
Back to the specific question of essentially free-market versus nationalized health care…
Given the study results (not to mention the fact that the U.S. has an infant mortality rate far worse than any other developed nation but Latvia), how can anyone confidently assert that a British-style nationalized health care would not work here when it is working much better than ours in a similar democratic, industrialized nation? How does that success not hold promise for our own? Why would anyone not at least be willing to try a system proven to work better than our current system until such time as evidence–not dogma–suggests something else works better still?
Comment by Derek — November 18, 2006 @ 4:20 pm
Derek,
The JAMA study you’ve cited twice now goes out of its way to point out that the differences in health between the American subjects and the British subjects can’t be attributed to the health systems of the different countries since Americans in the high income levels who have full access to health care are less healthy than the comparable English respondents in the study.
As you said…lets get dogma out of the way and talk about practicality. This study in now way supports adoption of an English/Canadian style health care system in America.
Americans are paying more for health care than their cousins in England but a good portion of this extra expenditure appears to be a result of the fact that for some as yet unknown reason Americans are generally less healthy than the English. This is not because they have less access to health care.
The story you cited on high infant mortality rates in the United States admits that much of the reason for our poor performance in this statistic is that in our country we are able to keep very premature infants alive a longer than most other nations and we try to do that more often.
For every instance of medical technological advancement achieved because of altruistic scientists there are hundreds that have taken place in this country which only took place because our system rewards innovators financially. If you take that away the whole world will suffer because they are benefiting from our technology just as we are even though they are bearing very little of the financial burden we bear for rewarding the innovators.
I don’t have a solution to this issue but I am very skeptical of anyone who claims the answer to any public policy problem is a technocratic government run program. There is always give and take and our country really needs to look at what we would lose by adopting a socialist style single payer system of health care if we are going to consider the few proven benefits. I think the fact that most Americans are skeptical of what you advocate even though our system is so admittedly abysmal supports my contention.
Comment by Jeremy Manning — November 19, 2006 @ 1:50 am
The promise of the HMOs was that more emphasis would be put on preventative care, something our nation desperately needs. The US has a rate of obesity about 2.5 times what the UK shows. Despite efforts all the time to emphasize “eat less, eat better, exercise more”, our national culture of instant gratification will have none of it. HMOs try desperately to get people onto healthier lifestyles to try and drop their costs to no avail. My plan goes so far as to offer coverage for seeing a dietitian and discounts on gym memberships.
Look at what the primary drugs advertisements are for: lowering cholesterol, solving sleeplessness, kicking depression, and lowering blood pressure. All of these are conditions caused by and worsened by obesity. I daresay that if we win the battle of the bulge, we’ll lower healthcare costs and increase longevity substantially.
No national system of healthcare is going to accomplish a reduction in our oversized rear ends. It’s going to take the kind of societal shift that only a crisis can bring about to accomplish it.
Comment by Jesse — November 19, 2006 @ 10:08 pm
Thanks for answering, Jeremy. I’ll add this one last response before moving on.
The fact that the upper classes in the U.S. have an average level of health equal to the lower classes in Britain shows just inferior our health-care system is to theirs, as it doesn’t even effectively serve those who have full access!
You are right, the study doesn’t encourage the adoption of a nationalized heath care system. It merely compares the results of both systems and leaves us to derive our own conclusions.
Of course you are correct that the sad state of American health isn’t entirely due to our deplorable health care system. There are certainly many factors which contribute. I’m not certain we can say that those reasons are entirely unknown. Our (speaking generally) horrendous diet, sprawling settlement pattern, employment arrangements, entertainment focus, transportation methods, etc, are all driven by the commercialism and conspicuous consumption of our economic system. All of these are symptomatic of what Pope John-Paul II called the idolatry of the market (1, see also 2), which seems to play a significant role in the pathetic quality of our collective health in the U.S. In other words, this is just a cog in a seriously dysfunctional socio-economic system. But I digress…
I believe you misread the article to which I linked (and on which I foolishly forgot to close my tags–whoops!). It mentioned that industrialized nations tend to experience deaths because, as you say, “are able to keep very premature infants alive a longer than most other nations and we try to do that more often.” That is not exclusive to the U.S. The fact that we in the U.S. are able to attempt to keep premature infants alive in no way account for the fact that we are so far behind the Scandinavian nations, who do the same thing–and with seemingly much higher success in their nationalized health care systems. The report specifically notes that “some nations ranked high in part because they offer free health services for pregnant women and babies, while the United States suffers from disparities in access to health care.”
I doubt there is any way to quantify and measure the number of innovators who innovated for the good of man versus for lucre, so there is no real method by which to argue there. I can only say that there is plenty of evidence that there are plenty of innovators who do innovate to serve others rather than just serve themselves. If conceivably the world is deprived of some benefits are withheld from the world due to a theoretical lack of innovation, I’m very confident that the world will also be deprived of many of the social and physical burdens which has been externalized on much of the world–usually the disadvantaged people of the world–through the “innovations” foisted upon the world. Ideologically, I would certainly rather trust in altruists who are trying to solve problems over those who are merely trying to enrich themselves.
I applaud your willingness to admit that you don’t have any solution to this problem. And I certainly cannot claim that I know exactly how to import nationalized health-care and bolt it to our system. I recognize we couldn’t just clone the U.K. system. I merely think it shows a successful model upon which to base a better system for ourselves, one both more successful on the pragmatic side, and more indicative of a society willing to care for everyone within that society as we morally should do on the ideological side.
Given your candor and integrity in your admission, I must pose a few more questions. They may sound harsh, but I honestly do not mean them in any way to be snarky or condescending. I am asking in sincerity.
Why oppose a possible solution when you freely admit that our system is broken and can propose absolutely no alternative solution whatsoever?
Do you honestly believe there to be any solution to our health-care problems which will not entail more government involvement?
Do you believe that a libertarian, truly free-market health-care system, unregulated and unmonitored by the government, would be an improvement to what we have now?
Lastly, I’ve studied too much history to put much stock in the skepticism of “most” Americans. I’ve come to firmly believe in the wisdom of Mark Twain.
Comment by Derek — November 21, 2006 @ 5:49 pm
Derek,
When possible I like to read the primary sources of studies/polls/arguments cited by those leaving comments on this site in an effort to understand where my correspondents are coming from. Those conducting the study you cited attempted to eliminate as many of the behavioral risk factor variables as possible to the point that even those bona fide experts conducting the study weren’t sure of the cause of the disparity in level of health between the two populations. They certainly weren’t prepared to chalk it up to deficiencies in the American health care system. Your confidence that you know the answers to questions they weren’t sure of is emboldening…but I still have my doubts.
Americans have innovated more medical advances over the past 50 years than all other nations in the world combined. Our system isn’t perfect and more needs to be done to take care of the poor who get left out but your choice of solutions seems more suicidal than beneficial. Eliminating the capitalistic drive to innovate would end the steady flow of new technologies that both Americans and the collectivist nations around the world (even England) are using to benefit their patients. It would hurt everyone.
Your response indicates that you want to have it both ways. When I responded to your comment with ideas supporting my philosophies of government and commerce you wanted to keep dogma out of the conversation. When I pointed out that your facts don’t logically support your conclusions you contended that I’m wrong because your dogma (commercialism/consumption are evil) says so.
You’re distrust of free enterprise and market solutions to problems implies that your dogma consists of the desire to control Americans’ behavior to a point where the evils brought on by the market are eliminated. Where is the line that divides that ideology from totalitarianism? When will you have solved enough of the world’s problems that I get my freedom back to live as I chose? I’m glad dogma is up for discussion again.
The idea of my subsidizing my neighbor’s health care isn’t an idea I can’t accept…our current voluntary insurance arrangement is based on this idea. Your idea that I should have to pay the government for my neighbor’s health care is a different idea entirely because then the arrangement isn’t voluntary. This very real difference leads very quickly to a lot of trouble. I’m forced to subsidize the medical care of those elements of my society who are willing to take stupid risks with their health and there is nothing I can do about it but lobby my government to force those people to stop taking stupid risks. When the force (and I mean literal force…as in guns) of government enters the equation everything changes and many other freedoms we enjoy are on the chopping block because it is in the best interest of everyone else that our individual choices be highly regulated.
There probably aren’t any solutions to our present situation that don’t require more government involvement in the health care system…I’m not an expert on health policy and am not willing to invest a lot of my time researching this field for purposes of this discussion. I’m sure there are better ideas available than an Americanized Canada/England socialist system. If you really want to look at some alternatives I’d suggest Cato, or CEI or one of the other classically liberal think tanks which devote a lot of time to this field.
I don’t know that a truly free-market health-care system, unregulated and unmonitored by the government would be an improvement to what we have now. I can say that I haven’t heard of many discussions of this type before extensive government regulation of and involvement in medicine was taking place. Development of many of the modern medical methods and procedures we enjoy today were taking place under a system of much less government involvement than we have in any nation now.
Finally…please pardon a little “slippery slopism” as we go back to discussing dogma
Skepticism of the beliefs and opinions of most Americans is typical of those who think they can make the world a better place if they can just exert a little more control over the stupid/misguided/uneducated masses and force them to do what the more intelligent among them think is in the best interest of everyone. As time passes things never work out as well as planned and are nearly always even worse than they were before. Then the smart ones demand even more control over our lives than they wanted before so they can fix the mess we, their dumb subjects, made of their marvelous plans. When does it stop Derek? When will government technocrats have enough power and control over us to force us into the Utopia you smart guys think we so desperately need? Sorry for the rant but from what I’ve read of your writings there doesn’t seem to be a single part of American life involving free enterprise that you aren’t unhappy with. After you force collective health care on us what do you propose we be forced to do to fix the environment/bring world peace/eliminate poverty? Where does it end?
Life with a government that only forces us to do the minimum to maintain a semblance of order isn’t perfect but it sure beats the alternatives.
Comment by Jeremy Manning — November 21, 2006 @ 10:07 pm
Oh yeah…I\’ll concede the point on infant mortality. I did misread the piece you cited. I don\’t know of a logical explanation for the poor American performance in this statistic. Much of the article you cited contains very subjective argumentation and editorial content which disparages America\’s system without providing any evidence indicating why American babies are dying at a higher rate than those in many other developed nations. It is a leap to assume this is all because we don\’t have a single payer health care system. To improve this statistic America needs to ensure that care is given to all pregnant woman as early in their pregnancies as possible. Thats a far cry from throwing our current system in the garbage and socializing everything.
Comment by Jeremy Manning — November 21, 2006 @ 10:21 pm
I agree, reading primary sources is important. That’s why I linked to the JAMA article. You’re right, the experts who performed the study didn’t come to any absolute conclusions. And despite my passionate language, I don’t honestly believe my suggestions are absolutely right. But that doesn’t mean we shouldn’t critically examine some of the problems to which the evidence points, even if it challenges the conventional wisdom that “the market” is the end-all and be-all sacred answer to everything.
Voluntary subsidization of the health care of others may have been the original intent of our system of insurance. However, the focus on profit in the marketplace has led to an increasing exclusion of those likely to need subsidization as the industry continues to weed people out (this population or individual are/is more likely to need health care service x, and so they will not qualify for our insurance). Shared responsibility and subsidization are sacrificed for profitability.
I think we should be careful when throwing around phrases like “elements of my society who are willing to take stupid risks with their health.” What is a “stupid risk?” How much meat, cholesterol, sodium, saturated fats, et al are in our diets? How much exercise do we get each day? How careful are we to minimize RSI risks at our computers, on which we probably spend far too much time? I may not smoke, drink, or have sex with multiple partners, but know I take more of those types of “stupid health risks” than I should, and I’m willing to bet that everyone who reads this do as well. Whether or not we can morally judge and exclude others for their stupid health risks is the topic of another discussion entirely.
I’m not sure I’m as confident of the methods and procedures developed before the modern system of regulation. The era of snake-oil salesmen is not one I’d like to revisit. This reminds me of the times I’ve heard people complain about the FDA. When they do, I like to point out that at the turn of the previous century, irradiated water was sold by at least one creative entrepreneur as an erectile enhancer. I think government involvement is perhaps prudent.
I understand and respect the concerns you shared in your slippery slope excursion. But I think its pointless, nor do we have the time here (though I’m sure we’ll both explore our respective sides of the issue in other posts on our blogs) to hash out the age-old discussion of totalitarianism versus free-market jungle ethics. Both sides, unchecked, produce tyranny and evil.
I think that your interpretation of my distrust of purportedly free enterprise and market solutions and my supposed desire to control the behavior of consumers neglects the fact that those with power in the market exert a great deal of control over the behavior of consumers. That should be addressed when we talk about control. Should control solely rest in the hand of unaccountable economic elites, or should it be balanced with control in the hands of publicly accountable government? Similarly, I think your very valid point about your freedom to live as you choose needs to be balanced by your responsibility to the community. The free-market advocate tends to forget those balances. I want those balances restored to the discussion. But, of course, that is a much larger discussion, again to be pursued in bits and pieces over many other blog entries.
I would contend that I am skeptical of Friedmanian market idolatry (I say that because Friedman saw no problem when market theory led to child labor, sweatshops, increasing gaps between rich and poor, strengthening of the cycles of poverty, etc) not because my dogma says commercialism is wrong; but rather because the evidence I’ve studied indicates that commercialism and other aspects of “the market” can cause more problems than they solve. In other words, I believe my ideology is an outgrowth of the evidence. But I will admit that in these conversations, factual analysis and ideology are difficult to separate.
My primary purpose in trying to exclude ideology was to challenge your absolute opposition to nationalized health care. You state categorically that single-payer health-care is unacceptable, but I posit that there is no quantifiable evidence with which you can (nor did you even try to) support such a position. You used only ideological argument–arguments which are logical and raise valid concerns, but nonetheless only ideological (or dogmatic). On the other hand, I freely admit that I cannot give any absolute proof that single-payer health care is guaranteed to work. But I did present factual, quantitative evidence which suggests (though only suggests) that it does work. Would it not be reasonable to therefore at least admit the possibility and keep it open for discussion? If you or anyone else would give any sort of market-based alternative to what we have now–let alone quantitative evidence that it would work–I would certainly be willing to discuss the idea. Since nobody of which I’m aware has done so, shouldn’t we consider the possibility that this may be an area in which the deficiencies of the market outweight its benefits, and a non-market solution is more effective?
Fun conversation.
Comment by Derek — November 28, 2006 @ 4:16 am
I was thinking about it, and I thought I should amend my comments about the origin of my ideology. My dogma that commercialism/consumption/materialism are evil is derived from the doctrines of our faith (“The love of money is the root of all evil,” “For where your treasure is, there will your heart be also,” “It is easier for a camel to go through the eye of a needle, than for a rich man to enter into the kingdom of God,” “Ye cannot serve God and mammon,” etc). Observation of the results of the sort of commercialism/consumption/materialism encouraged by modern capital theory confirms how destructive they are when not checked.
Mind you, I said “checked,” not “eliminated.” I’m not a proponent of the elimination of any market principles. I understand and appreciate that the market can be a valuable tool that many aspects of its principles can be beneficial to society. However, it is only a tool, and just as a hammer is not a solution to all problems and its use can be harmful, so the market is not the solution to all problems, and over reliance on it can be harmful. I therefore oppose the veneration of market as some gospel principle or ultimate solution to every problem.
Comment by Derek — November 28, 2006 @ 12:28 pm