Wednesday, February 11, 2009

a letter

I wrote a letter to my parents this evening. I've reproduced it here for your reading pleasure.

A while ago you suggested that the US health care system met the needs of Americans par excellence. You gave as evidence for this high praise the wealthy that travel from all over the world for American health care, and voiced the opinion that the greatness of the US health care system is due to the free market for health care; in other words, that US health care is not “socialized.”

Looking for something else, I ran across the following articles today (links to abstracts) and thought you might be interested:

(1) http://healthaff.highwire.org/cgi/content/abstract/21/3/182

In Australia, Canada, New Zealand, the UK, and the US, everyone expresses dissatisfaction with their health care. People with low incomes are more likely to express that dissatisfaction, though few report trouble actually getting health care…except low income US citizens, who reported more difficulty.

(2) http://www.ajph.org/cgi/content/abstract/96/7/1300

Americans, compared to Canadians, are less likely to have a regular doctor and more likely to have unmet health care needs.

(3) http://content.healthaffairs.org/cgi/content/abstract/25/4/1133

The poorest Americans (bottom quartile) are more likely to have poor health than the poorest Canadians. No differences among the rich (top quartile). Canadians experience fewer unmet medical needs. And despite Americans spending more on their health care than Canadians, the two countries generally have similar health status and access to care, except that in the US there is more inequality between rich and poor.

(4) http://content.healthaffairs.org/cgi/content/abstract/24/4/903

Americans spend $5,267 per person on health care, 53 percent more than in any other country. Contrary to myth, the reason for the increased cost of care cannot be accounted for by the cost of defending malpractice claims, which only accounts for 0.46 percent of the cost of health care in the US. Nor can it be accounted for by queuing in other countries. “Services that typically have queues in other countries account for only three percent of US health spending.”


These are obviously only four articles, but they provide sufficient evidence to call into question your claim regarding the privileged status of Americans in regards to their health care.

So why, you might ask, do people come from all over the world to receive their treatment in the US? I don’t know that they do, which is to say that a quick search revealed no evidence of that conclusion. But let’s suppose, for the sake of argument, that this claim is correct.

I would argue that it’s not to the US, per se, that the wealthy flee to for their health care needs, but that it is to centers of medical expertise. To the extent that more (who have means) come to the US for their health care needs, they are likely coming (1) to meet exotic health care needs which require very specialized health care knowledge (e.g. cancer treatment, organ transplant) and (2) because more centers of health care expertise exist in the US than anywhere else. (Certainly the US doesn’t have a corner on health care expertise, but, perhaps, on average, there is more in the US than anywhere else.)

So we then might ask, why is there more medical expertise in the US than anywhere else? You may remember that I argued that this has nothing to do with a “free-market” health care system (see * below), but more to do with medical related scientific research funding available in the US. Which is to say that because, over time, there has been more medical related scientific research funding in the US than elsewhere, there have developed more centers of medical expertise in the US. (I actually don’t know if it’s true that there has been, over time, more research funding in the US than elsewhere, but it seems a reasonable suggestion, for a variety of reasons.)

The interesting thing about medical related scientific research funding is that this money comes, by and large, from the government. You and I, the taxpayers, support the institutions that have created our medical expertise, to the extent that we have any. Isn’t that socialism? (And, I should add, it’s a cost that is likely not considered in the per capita figures of health care expense cited earlier.)

An interesting opinion piece, tangentially related:

http://judson.blogs.nytimes.com/2009/02/10/guest-column-letting-scientists-off-the-leash/?8ty&emc=ty

You’ll remember that this conversation arose when I pointed out that we (Americans) enjoy the benefits of a great many socialized institutions. Public schools, public roads and other public works, police and fire departments, social security, Medicaid/Medicare (despite their many faults), tuition assistance, public transportation (in some cases), public parks, forests, recreation areas, etc. And, of course, public research grants. Because of this, it hardly seems that socialism is something to be afraid of. Or, at least, that when you cry foul to “socialism,” you’re ignoring the complexity of the issue.

That public goods (including health care) in the US are already socialized is undeniable. It seems that the questions of policy are (1) to what extent should we socialize (rather than rely on regulation to control inequalities) and (2) what does or should our socialized systems look like?

Regards,

[signed]

* Looking over the fact that a good part of the US health care system is socialized (Medicare and Medicaid) and that very little about the market for health care can be considered free (as a practical matter, Americans’ only real option for health care are the options their employers provide).

4 comments:

Elise and Lane said...

Wow you can not be serious. You really feel like our public school system, social security, and Medicaid/Medicare are virtues that can be used to defend a move toward socialism?

goat said...

Defend? In terms of policy, I'm not defending anything. I'm using those institutions as examples to illustrate that the idea that we live in a society devoid of socialism is false.

People (like my parents) use the word "socialism" as a slur, not recognizing how socialist American society is already, and likewise not recognizing the benefits they already enjoy from our socialized institutions.

My larger point is this: to imply that an institution is bad because it is socialist is simple-minded and, frankly, absurd. Some socialist institutions probably do not serve the public welfare well, but certainly others do.

Socialist systems, like market systems, are like wrenches--in and of themselves, there's nothing either virtuous or vicious about them...rather, it matters how, when, and where they are applied.

Elise and Lane said...

Valid points, there is no question that many services are or are becoming socialized. And the main point even better. The degree to which they, both the programs and the systems, are good or evil determined by the arm that yields them.

EG said...

I can't think of any example ... large and run by "the Government" -- public school systems, transportation, social security, etc. -- not worthy of the slur. You make good theoretical arguments, but enter the "government worker" and human nature ... I agree with the first comment "Elise and Lane". True, medicine in this country is largely supported through taxpayers, but a great majority of the institutions involved are held accountable to shareholders.

I also agree with you about the cost, and the perceived neglect of the poor. The reality is the poor get the best and fastest and most expensive free health care by leaching from those who pay. Go into any emergency room and see the immense number of non-emergencies.

The other 2 parts of the high cost are greed and insurance issues (maybe the same thing) -- neither of which enter your theoretical arguments. This country has a host of people employed to fight with another host of people employed to reject claims. Your health care dollars at work.

Yes, our system is broken, but as a first hand victim of socialized health care (England) I would rather fight with insurance companies than have my arm re-broken again because the first Paki doctor couldn't / didn't set it correctly. If you thought it was difficult to find expertise with your daughter here .....