attack on national health insurance by Ronald Bailey and then read this
analysis of the US health care system and alternatives by Paul Krugman and Robin Wells. Yes, Bailey's is a short aritcle and should not be easily compared, but let's remember that Bailey's views represent elite opinion in this nation--meaning the economic and media elite.
Bailey struts the usual attacks, i.e. long lines and people running across the border, with regard to Canada's national health insurance program. Bailey, however, doesn't want us to know that Canada lost hundreds of thousands of good paying
jobs and that its economy is far more weakened in terms of individual wages for the vast majority of Canadians than even Americans in the US economy. When Canada was doing well, up until the early 1990s, it had a health insurance system that its Business Roundtable had said was second to none (from a pre-Internet Business Week article in 1994 about the postive aspects of the Canadian health insurance system). Now, that system is somewhat struggling, though not as much as Bailey would have you believe. Want to think about it practically speaking, think of it this way: How great is the health care one gets in poor communities in the US compared to wealthier or even working class communities in the US? Answer: Health insurance and access in poor communities in the US is akin
to Third World conditions.
The other thing Bailey and his friends at the far-right Fraser Institute
, who are the anti-Canadian health insurance drum majorettes, fail to recognize is that we don't know how many Americans die every day because of delays in getting to a doctor due to inefficiencies in the insurance system, lack of insurance, or underinsurance. In Canada, because every citizen's medical history and treatment is coded and checked, we can find out how the system does with nearly any person at nearly any time. Here is one example of the Fraser Institute's own rhetoric against the Canadian system that Bailey finds so compelling:
"What is being quickly forgotten in Canada, however, is that any wait for care involves pain and suffering, lost productivity at work and leisure, mental anguish, and additional strain on personal relationships. The best wait time for patients is not the one that minimizes medical harm, but the one that minimizes waiting altogether. A truly patient-focused health care system, one that is truly deserving of the title ‘world class’, is one that delivers care without systemic delay."
How nice. Now, what do Bailey and his friends think would be the result if one applied that standard to our nation's "system" (and I use that loosely for what should be obvious reasons)? D'oh! Don't you love it when libertarians hit their own foreheads with a two-by-four?
Anyway, back to the reality-based analysis: Krugman and Wells remind us that the US spends two to three times what other European nations spend on health care as a percentage of Gross Domestic Product (GDP), which is beyond billions in difference--yet, we fail to insure 20% of our nation (and underinsure most likely another 20%). They also remind us that private insurers are woefully inefficient compared to Medicare in terms of administration (13% or more to a mere 2% in administrative costs). They also provide an interesting statistic:
"...The frequent claim that the United States pays high medical prices to avoid long waiting lists for care also fails to hold up in the face of the evidence: there are long waiting lists for elective surgery in some non-US systems, but not all, and the procedures for which these waiting lists exist account for only 3 percent of US health care spending (footnote omitted)."
The significance of that statement is that if the procedures for which the waiting lists exist in other nations only account for 3% of US health care spending, then we may not see the long waits for such procedures if our nation enacted a national health insurance program.
Or how about this information from Krugman/Wells:
"A comparison with, say, France, which spends far less than the United States but considerably more than Britain, would give a very different impression: in many respects France consumes more, not less, health care than the United States, but it can do so at lower cost because our system is so inefficient.
"Our Princeton colleague Uwe Reinhardt, a leading economic expert on health care, put it this way: our focus right now should be on eliminating the gross inefficiencies we know exist in the US health care system. If we do that, we will be able to cover the uninsured while spending less than we do now. Only then should we address the issue of what not to do; that's tomorrow's issue, not today's."
By the way, Reinhardt
, a Princeton economist, is one of the best minds on the health insurance systems of the US and most other nations in the Western world. I blogged about him last year, here
Oh, and let's defend Canada more directly, shall we? Read this
or perhaps this
debate about Canada's health insurance system. As noted in a recent post, the fellow attacking Canadian national health insurance programs and defending the US health insurance system has decided, upon further analysis and experience, that he was wrong
. And here
is the fellow setting straight some of his soon-to-be-former-friends in the libertarian sphere:
"In the comments on my about-face on health care, a number of people make the familiar criticisms of the Canadian system. Care is rationed. You wait a lot longer for certain elective procedures than in the United States. Technology is not as up to date, etc. etc. These arguments are, to some extent, entirely accurate. But I'm not sure they are relevant. They aren't criticisms of the system, after all. They are reflections of the how well the system is funded--and that's an important distinction. On a per capita basis, Canadians now spend on health care--and I"m not sure of the exact figure here--something like 60 percent of what Americans spend. If that were increased to, say, 65 percent, many of the rationing and wait-time problems would be alleviated. The problem with American health care, by contrast, is systemic. No simple increase in funding fixes the problem. In fact, we already spend far and more the most on health care than anyone else in the world. This was the mistake I made in my original debate with Adam Gopnik. I confused funding problems with structural problems."
Good for Malcolm Gladwell. But don't expect any change of heart from Ronald Bailey. He's just too tied up in his Ayn Randian ideology.