health care

This is such a broken record, but as the health care pseudo debate rages I feel it incumbent on me to pass along useful information. I would like to think we were discussing health care but we aren’t. the reason I call the debate ‘pseudo’ is because there has been remarkably little focus on factual debate and an awful lot of yelling, screaming, and outright lying. The right wing see this as an opportunity to nip Obama’s reformist tendencies in the bud. They may well defeat him on this issue. Were that to happen the only definitive outcome is that America will be poorer. Literally poorer. Our system is the world’s least efficient. lack of efficiency implies wastage. Therefore reform is our chance to inject efficiency and save some money for other things – like rebuilding our education system so we don’t have to import engineers.

One of the mis-directional lies being tossed about – apart from the ugly obscenity about ‘death squads’ – is that government intervention brings rationing along with it.

I have tried to deal with that here before. Perhaps I have persuaded you. But perhaps you think that my left of center predilections push me that way. I try to be even handed in economics, which to the shame of academic economists is very hard since they have developed an avowedly right of center theory [aka free market theory] rather than a scientific one that withstands empirical scrutiny. Be that as it may – one factor that all economists, of all political persuasions, agree upon is that all economic systems, both public and private ration things.

In fact rationing is the very reason an economy exists. A market is a method of allocating scarce resources. Any allocation of scarce things implies selecting who gets what and when. That’s rationing. Simple. That the Republicans pretend that markets don’t ration is a massive lie and undercuts the public’s ability to participate in the debate – which is, of course the objective. Don’t let that facts get in the way of a political goal.

Anyway, to my great satisfaction, today’s Financial Times wades in on exactly this point: prices ration. Get over it. Since the FT is hardly a bastion of leftist thinking I thought I would pass the link along and simply let you read their article. It explains itself. It chastises the Republicans for lying. And it sets out the problem well: America wastes money on health care. Money is scarce. We would be better served as a society if we didn’t waste that money. Objecting to Obama’s ideas for saving money is one thing, but at least present an alternative that is not simply status quo ex ante. The one thing we all should know is that what we have is rotten. If the right wingers want to help society then give us a lower cost alternative to the Obama reform. Don’t just turn up with your guns and disrupt the discussion. That’s childish.

And one more thing: the FT article gives us a crucial statistic: America spends as much on Medicare – a government health care system – as many other countries spend on their entire systems. Adding in all the private money we waste spend means we end up allocating twice, on average, what others do. To no effect. Our health outcomes – what we get for our money – are no better, and in many cases are a lot worse. That is a good definition of waste. Spending money and getting nothing back is hardly a sensible long term course of action. Societies that head down that road eventually implode. None of us want that.

So debate. Don’t disrupt.

And leave those childish guns at home: who the heck do you think you’re impressing?

A quick update on the Stephen Hawking farce carried over from yesterday: when an opponent of health care reform wants to weigh in the discussion by using a reference to one of the world’s brightest people I think it wise that they check basic facts. Like where he was born and where he lives.

As you no doubt know by now the Investors Business Daily ran an editorial arguing against government run health care. It repeated and amplified the, by now common, right wing meme that government health care systems ‘ration’ money by, inter alia, refusing to treat difficult or long term illnesses. As an example it used the case of Stephen Hawking who suffers from crippling disease, is confined to a wheel chair, and who is now unable to talk without the aid of sophisticated machinery. The IBD said in its editorial that had poor Hawking been exposed to the British government run health care system [the ‘NHS’] he would have been refused treatment and thus the world would have been robbed of his enormous intellectual contribution.

Except of course Hawking is British and lives in Britain and uses the NHS.

Talking Points Memo caught up with him and asked his opinion. Which turns out to be quite supportive:

“I wouldn’t be alive today if it weren’t for the NHS. I have received a large amount of high quality treatment without which I would not have survived.” —Stephen Hawking, August 11, 2009

Not that this means the NHS is perfect. No system is. But it doesn’t deserve to be demonized either.

On a personal note: my father suffered from chronic kidney disease. He died very young – in his early 50’s – and his last years were made incomparably more comfortable by the NHS. The government installed, at no cost to our family, a dialysis machine in my parent’s home. They paid for all the plumbing and renovation necessary. I recall little or no bureaucratic hassle or resistance. The doctor controlled the entire decision. This was when dialysis was a new and very expensive technology – indeed it could be described as experimental at the time. Unfortunately the technology arrived too late to prolong my father’s life much – the damage was too pervasive.

This experience has made me a fervent supporter of government health care. Only those who have confronted the cost and bureaucracy of the American system in similar circumstances can understand the difference.

The issue is not about the quality of treatment or the professionalism of the doctors providing it. No. The issue is the cost and emotional burden at the heart of the American system. It is about removing the stress placed upon patients who have to understand and pay for complex and often lengthy processes that they are hopelessly equipped to comprehend; upon which they might depend for life; and for which they might have to bankrupt themselves and their families, right when they are most vulnerable.

No one would surely set out to construct a human system that places the greatest burden and stress at exactly the weakest point in a person’s life.

Except that what the American health care professionals have tolerated. Indeed they have defended it out of their own self-interest.

The NHS, for all its well known issues and its chronic under-funding, at least avoids that mistake. It is about health care. Not profit.

Most of you already realize this, but the thought is worth repeating relentlessly: if you get your health care coverage through an employer you do not have health care insurance. You have an employee benefit. Insurance is something attaching to you wherever you are and for whomsoever you work. It is personal. If you lose your job and the health care coverage goes with it then you do not have insurance.

Conflating the two situations, insurance and employer provided benefit, is one of the greatest muddles in the current all too muddled discussion about health care.

The American system has two predominant ways to get health care coverage: government programs like Medicare which provides about 45% of all dollars spent on health care; and employer provided benefits, which provides a further 35%. Of these two only Medicare acts like insurance: the benefits relate to you regardless of your employment situation.

The other thought to carry with you as the debate rages is that Medicare, and other government provided health care such as the Veterans program, consistently receive higher customer satisfaction ratings than most, if not all [I haven’t come across any yet], of the privately provided care options. And the difference is significant.

The reason I mention these two quick thoughts is that I met my friend Joe today – I use him as my bellwether for right wing thinking – and he rolled out the standard Republican line of attack about how no one likes Medicare and about how most people have private insurance anyhow so why are we debating getting the government involved.

Lastly some of you may have seen this stupid editorial at Investors Business Daily. I am not the first to pick up on this – Paul Krugman mentioned it, as did Jay Bookman – but for those of you who want to see how absurd some of the opposition to health care reform has become here’s the key quote:

‰ÛÏPeople such as scientist Stephen Hawking wouldn‰Ûªt have a chance in the U.K., where the National Health Service would say the life of this brilliant man, because of his physical handicaps, is essentially worthless,‰Û?

The editorial uses the UK health care system [a.k.a. The National Health Service] as representative of all the evils of a government provided program. And it settles on poor Stephen Hawking who suffers from a horrendously debilitating disease as an example of the kind of person who would not be cared for on the basis of their extreme condition. Hawking being the world’s foremost physicist of the past twenty years the Investors Business Daily wants to highlight the enormous waste of talent that this lack of care would represent.

Except of course that Hawking lives in the UK and gets his care through the National Health Service.

Oops.

I suppose it would be too much to ask that opponents of reform actually have a credible argument. You know, one not littered with falsehoods and scare tactics.

Sigh.