Health care reform

If we are going to be deprived of a single payer health care system as most of the civilized world enjoys, we must at least have a public option to widen the range of our choices. President Obama said it well the other day: “If private insurers say that the marketplace provides the best quality health care, if they tell us that they are offering a good deal, then why is it that the government, which they say cannot run anything, suddenly is going to drive them out of business? That is not logical.”

If only he would not swerve from that line of thought.

The USA’s healthcare system (if you can call it that) is actually a patchwork of heterogeneous systems: First is Medicare, covering our elderly, and until the Bush administration started messing around with it, a model of efficient delivery of services to the population it serves, at a cost unrivaled by any privately run system, inspite of the large amount of fraud private initiative commits against it. Then there is the Government run health care system for Congress (House and Senate); none of these clients complains of its quality, and cost is not even a consideration here. There is also the huge Veteran’s administration running a good, if stodgy, health provision for its clients, and doing some cutting edge research in many medical fields.

These huge systems cover close to 50% of the US population, leaving the insurance companies sharking around to make a buck from the rest of us. The first disfunction of what they offer is the health care plans offered through employers. In a world of frequent and numerous layoffs, the churning of clients adds a large administrative cost to this model, on top of the officialdom required to verify customer eligibility to receive service. The underlying prevailing attitude is denial of service to as many people as possible in order to safeguard shareholder return.

The more insidious effect of employer-provided health care is, in my view, the competitive burden it imposes on manufacturing companies. It may very well be the main reason driving manufacturing, the making of stuff, from this country. Thurow, the MIT economist, said long ago that we would not be able to survive as an economic power of the first order if we were reduced to doing brain surgery on each other, instead of employing the variegated skills of our population in the most productive ways possible. The wage stagnation of the middle class in the USA over the last fifty years is the result of the exodus of manufacturing, and the decline of union power.

The Obama administration talks a good game along these lines, but it may very well be that a democratic system such as ours is unable to summon the political will to undertake a radical rethinking of the underlying economic realities. When Congress talks about the costs of reform, it tends not to look at the possible economies of a different system. Yes, I know, outlays are a certainty, and income tends to vanish into the mists of the future.

The insurance industry, meanwhile, lies and spouts platitudes to consumers warning of bureaucratic meddling in healthcare decisions, as if we did not have that in their normal course of business; of long waits for surgery, omitting the word “elective”; of lack of all the technical, cutting edge gadgets in a public healthcare system…..as if the proliferation of MIR machines and CAT scanners on every corner were any more efficient.

The populations of countries where the provision of health services is a right of the citizen administered by the government, such as most in Europe, are well served. The costs are one third to one half of the costs of healthcare provision in the USA. You can always find horror stories “pour épater le bourgeois” in any of those countries, but nobody is driven to bankruptcy by pending medical bills.

As educational reading I would recommend http://www.newyorker.com/online/blogs/newsdesk/2009/06/atul-gawande-the-cost-conundrum-redux.html, or the full article posted in my blog Listen-up www.midnightepiphanies.blogspot.com/