Saturday, August 29, 2009

Wishful thinking

Kevin Drum asks .

Let's recap: the United States spends about twice as much on healthcare as any other developed nation in the world and in return receives just about the worst care. Can someone remind me again why there's even a debate about whether we should put up with this?

This encapsulates liberal wishful thinking on health care reform.

I will grant there is a problem (although I think Drum is exaggerating just how poorly the US does in international comparisons). However polls show most people are satisfied with their own care. This means there is no crisis atmosphere and people feel free to argue about how to improve things. Democrats don't even agree among themselves about what to do so it should be no surprise they are having trouble selling their inchoate proposals to the country as a whole.

The contemporary Republican party is justly criticized for its apparent conviction that tax cuts are the solution to every problem. However the Democratic party has its own blind spots. The current health care reform proposals appear to be inspired by various forms of Democratic magical thinking that are as unmoored from reality as their Republican counterparts.

Perhaps Drum will explain exactly how the Democrats propose to improve care while reducing costs. I see little reason to believe their proposals will do either and hence little reasons to support them.


  1. I dare to doubt both points of his premise: 1) worst health care? I believe there are a lot of people claiming US health care (per se) belongs to the best in the world (I am distinctly referring to care, not to the way it is distributed), and 2) I would like to see the source of the claim that US spends twice as much as any other country on health care before believing this statement. Also, what is meant by "US" - the insurance recipients? the government? His whole writing sounds like populistic poopoo.

  2. The US does spend more (as a fraction of gdp) on health care than other countries but it is not twice as much as the next highest. See here for example.

    As for quality people claim health care in the US is relatively poor because the US ranks low on international comparisons of life expectancy and infant mortality. But this is misleading because these are influenced by many things besides health care. I suspect most advanced counties are effectively about the same in health care. This is because they have reached well into the region of diminishing returns. There are a number things that are cheap and effective. But after that you end up spending more and more to achieve less and less.

  3. An article in the Denver Post, Sunday, August 30, 2009 written by Nicholas D. Kristof, The New York Times, detailed the story of Wendell Potter, an executive for Humana and Cigna for 20 years. He ended up leaving the profession, although he himself was quite comfortable receiving a huge salary and benefits. He teestified before a Senate committee regarding some of the things the insurance companies were doing....One was to deny requests for expensive procedures and a second being "rescission, where the company seizes on a technicality to cancel the policy of someone who has regulary paid premiums and suddenly gets cancer or some other expensive illlness. Blue Cross Blue Shield of California used these tricks to cancel 20,000 policies over 5 years, saving the company 300,000,000 dollars.Since the purpose of insurance is to spread the risk around, I find this dispicable. Mr. Potter also stated that his colleagues in the insurance industry weren't bad people, but they were quite removed from the consequences of their impact on people's lives. It all appeared to be due to an obsession with the company's stock price.
    Even when you have health insurance, you can never be sure that your company won't do something like that to you. We have spent more than forty years arguing about this. Nothing seems to make any difference.

  4. "... explain exactly how the Democrats propose to improve care while reducing costs."

    Improving care and reducing costs are two separate problems. I would support a reasonable proposal that does either one. I think that an important way to improve care is to distribute costs more equitably. The way it is now some people (like myself) get good health care at rates that they easily can afford, while others, through no fault of their own, face costs so high that many must go without.

    Of course the result might be that I would pay more so that others could have health insurance. So be it. Right is right, even though it may affect me adversely.

  5. I like your attitude, although no doubt it is going to be very expensive if this goes through.