Push-polling and essay competitions

by Henry on October 10, 2004

When doing research interviews in Brussels last week, I was intrigued to come across a free pro-business rag called the “EU Reporter” in several places, and even more intrigued to find that it contained an advertisement from our old friends, Flack Central Station, for a euro 2500 competition for the “best commentary piece” on European Health Care Reform. As the ad describes it:

bq. “Europeans endure long waits for medicines, treatment and surgeries – and pay high taxes for this substandard level of care” says TCS Europe editor, Craig Winneker. “Patients lack choice and access to the best medicines.”

TCS is looking to engage “Europe’s best minds” on the question of how to improve their countries’ health care system. I reckon that it’s a safe bet that proposals to improve European health care by increasing the role of state provision are unlikely to win the 2,500.

I’m intrigued by the increasing frequency of ‘competitions’ of this sort, frequently (but by no means always) funded by right wing lobbies or think tanks. Health care reform is a particular topic-du-jour – the Simon Fraser Institute in Canada has run a similar competition in the very recent past, touting, as best I could understand it, for attacks on the Canadian system of health care provision. I wonder why TCS (which seems to me to be a very US-centric organization) is funding the competition. Given PhRMA’s role in funding TCS, my best guess is that this is an effort to trawl for stories about the horrors of European health care, which can then be used as ammunition in the internal US debate about health care (let me note in passing that the WHO ranks the US health care system as being “worse”:http://www.who.int/whr/2000/en/whr00_annex_en.pdf than the systems of all fifteen of the EU’s rich member-states). Other essay competitions seem to me to have the more straightforward aim of encouraging intellectuals and journalists towards certain policy questions (and certain ways of considering those policy questions).



Shai 10.10.04 at 8:07 pm

well, the fraser institute is actually half reasonable. their health policy page says that canada should look to japan which has universal health insurance but private health care delivery. (although the piece is unrealized as an argument since it isn’t a comprehensive comparison)

but elsewhere they claim that the canadian health care system is collapsing by age adjusting the costs and then extrapolating the health system as it is currently structured into that future older population demographic (and using biased, selective outcome metrics). but they continue to claim that it’s collapsing in the current day, when their actual conclusion would imply : if current inefficiencies in money allocation, competition, etc. continue — which I don’t think is plausible, or follows


Matthew Yglesias 10.10.04 at 8:16 pm

I don’t think it’s that complicated. Note the repeated reference to the alleged unavailability of “the best medicines” in Europe. I take it they’re looking for an essay about how if European nations de-controlled pharmaceutical pricing, all their problems could be solved.


Shai 10.10.04 at 8:35 pm

well i’d like to see someone make that argument. i think it’s more likely we’ll see another variation of the r&d free rider argument. there’s a big vacuum on the internet where no one actually knows what they’re talking about, which doesn’t stop either side betting their prejudices.



Henry 10.10.04 at 8:39 pm

Matt – I think that’s exactly right – that was more or less my own hypothesis but for lack of time (my wife was summoning me to do the shopping) I didn’t spell it out.


Henry 10.10.04 at 8:40 pm

Matt – I think that’s exactly right – that was more or less my own hypothesis but for lack of time (my wife was summoning me to do the shopping) I didn’t spell it out.


Giles 10.10.04 at 9:48 pm

I think your post might have a bit more credibility if you didnt then mention the WHO – who are about as impartial over the matter as TCS.


Henry 10.10.04 at 10:29 pm

Giles – the WHO survey is also cited this week by that notorious source of anti-free-market bias and left wing bile, “The Economist.” Have they been taken in too?


antirealist 10.11.04 at 3:30 am

…the Simon Fraser Institute in Canada…

The Institute is named after the river, not the explorer who traced its course.


Nick Simmonds 10.11.04 at 5:21 am

Part of the goal here, I think, is simply to put an incentive in front of mighty thinkers so as to have them justify the preferred system; it’s patently obvious to anyone who would enter the competition with a chance of winning what sorts of answers will be acceptable. The far right in the U.S. is constantly sponsoring attempts to justify their beliefs with ex post facto reasoning, because they arrive at conclusions and then look for justifications rather than the proper way around. The left is inevitably able to demolish these arguments, but unraveling them takes time, by which point they’ve usually moved on to a new “reason” for the belief they’ve held all along.

The Bush administration is the ultimate genesis of such a process, applying these techniques willy-nilly to everything from minor appointments to justifications for war. However, we’ve seen them for (at least) decades in the tactics of the anti-choice movement and the “creation scientists”, as well as the anti-environmental lobby.

Insert disclaimer about intellectually honest conservatives eschewing these techniques.


rc 10.11.04 at 6:22 am


ArC 10.11.04 at 6:46 am

The Institute is named after the river, not the explorer who traced its course.

And as an alumni of the university actually named after the explorer, I react with horror to the institute sounding any more similar.


Andrew McManama Smith 10.11.04 at 8:18 am

The system in the US is certainly unfair and non-univerisal to say the least, but you can’t really say that the care itself is worse.

I’ve lived in Europe, the US and Japan, and I still think the best system I’ve seen is the Japanese system. It gets very little mention, mostly because the Japanese are rarely complaining about how bad it is (imagine that). In japan the insurance is national, but the hospitals are 100% private. This way everyone has insurance, but the hospitals compete to provide good care.


Sandriana 10.11.04 at 10:15 am

Given that the EC signed GATT and WTO agreements to force member countries to open up public services, such as healthcare, to commercial providers ( most of them US owned or controlled corporations), it’s now merely an issue of which commercial provider to choose. Hence the intense lobbying – there’s an awful lot of money to be made. The agreements we have signed mean that all public services must be open to competition, *except* where it physically or logistically cannot be provided other than governmentally.

We on the far left have been shouting as loudly as we can for a couple of years about this. It means that international corporations, with all Wal-Martisation that implies, will be so intricately enmeshed in our public services we’ll never get them out. At least you can vote out a government.

This situation fatally undermines the democratic accountability of European governments (I’m sure we’ve all had experiences trying to get some sense out of contracted out services like garbage collection – imagine that on a huge scale).

There is now no public service that cannot be privatised, and it’s too late to do anything about it. It doesn’t make me at all happy to say “We told you so”.


Sandriana 10.11.04 at 10:37 am

OK, on further thought perhaps that last para was somewhat disingenuous: so let me clarify. It does make me personally happy to say I told you so, because that means we were right. However, I’m definitely not happy to see public services sold off to the highest bidder (and don’t get me started on Best Value…).


a different chris 10.11.04 at 4:13 pm

>will be so intricately enmeshed in our public services we’ll never get them out

People cannot, or will not, understand that the government does not, and cannot, procure services like you buy an automobile.

Due to the unique needs a government must address and the demand for public accountability, enormously detailed requirements must be generated, and huge investments in very specialized skills are required for the bidders just to bid, and the winner is faced with further enormous investments to comply.

Well, once one company gets a multi-billion dollar bid, it’s quite hard for any other company to get the next bid on a similar project. If I just finished building a statewide tollroad, I have have a fleet of construction equipment, a Rollodex of sub-contractors, and file cabinets full of procedures blessed by state auditors ready for the next job.

How do you match that? How do you convince your board and your shareholders that ramping up to compete with me is not a billion-dollar crapshoot? Well, maybe you could purchase Tom DeLay…

Now, possibly the Japanese HC system is a counter example to what I’ve said. But it also highlights another problem with American hubris – we will never, ever, EVER admit that something somebody else does is worth looking into, let alone better.

So if we have a problem we either start from the ground up and come up with boneheaded ideas like HillaryCare, or we kludge and kludge and kludge until we have some nightmare that nobody knows how to back out of.


harry 10.11.04 at 7:55 pm

I only know about contracting out of schools, not hospitals, but what I know about schools suggests to me that the contracts with hospitals would be an absolute nightmare to manage. How does the Japanese government manage its contracts? IN the case of schools, from what we can gather, basically the contracting authorities rarely have the anbythign like the information needed to manage the contracts (and competition for them) so as to yeild efficiency gains. There are ways around this (building in very stringent consumer choice) but they look much more feasible for schools than for hospitals (or even primary care providers).


Shelby 10.11.04 at 8:28 pm

American hubris – we will never, ever, EVER admit that something somebody else does is worth looking into, let alone better.

Yes, that’s why we Americans don’t buy any Japanese cars or cameras, all our computers are made here, we don’t watch Indian movies, we don’t buy flowers from Mexico, we distrust German engineering and French wines…

Even leaving goods aside, it’s not as though the US has not adopted government institutions from overseas. The US welfare system was not developed in a vacuum. It’s true that there’s a lot of resistance to universal coverage, but I think that’s more because many people are aware of the shortcomings most such systems have shown.

In any event, healthcare cost trends in the US are forcing a more intense debate. Whether Americans realize it or not, much of that debate will necessarily involve discussions of what has and has not worked elsewhere. I’m not very optimistic about short-term improvements in the US, but in the medium term we’re likely to see at least some of the systems used elsewhere tried here.


Shai 10.11.04 at 9:32 pm

I can’t really answer Harry’s question, but I did find this OECD article interesting:

An Assessment of the Performance of the Japanese Health Care System (Labour Market and Social Policy – Occasional Papers no.56)

also see http://www.esri.go.jp/index-e.html. search for something like “health care” in the search bar.

I’m looking for other resources, so thanks in advance if you post anything here.


Shai 10.11.04 at 9:35 pm

‘japanese health care filetype:pdf’ on google has some good results too


Ross 10.11.04 at 10:35 pm


I don’t find your news surprising at all. Last Spring, I blogged about an article Robert Pear of the NYT wrote on PhRMA’s plans for winning/buying the hearts and minds of policymakers on both sides of the Atlantic. According to Pear:
The documents show that the trade association, the Pharmaceutical Research and Manufacturers of America, known as PhRMA, will spend at least $150 million [on lobbying efforts] in the coming year.
In its budget for the fiscal year that begins on July 1, [2003,] the pharmaceutical lobby earmarks $72.7 million for advocacy at the federal level, directed mainly at Congress; $4.9 million to lobby the Food and Drug Administration; and $48.7 million for advocacy at the state level. The drug trade group plans to spend $1 million for an “intellectual echo chamber of economists – a standing network of economists and thought leaders to speak against federal price control regulations through articles and testimony, and to serve as a rapid response team.” In addition, the budget sets aside $17.5 million to fight price controls and protect patent rights in foreign countries and in trade negotiations. The PhRMA budget allocates $1 million “to change the Canadian health care system” and $450,000 to stem the flow of low-price prescription drugs from online pharmacies in Canada to customers in the United States.


Andrew McManama-Smith 10.11.04 at 11:17 pm

Shai, I’ve found loads of stuff in Japanese and posted them to my website, not sure if you can read it, though…

Harry, I’m not sure what you mean by the primary care provider bit. The consumer chooses the hospital and the doctor they want to see. The goverment doesn’t say anything about it. You just bring in your national health insurance card…

No system’s perfect, I just think Japan’s and Korea’s are considerably better than other industrial nation’s. Though I reckon there are cultural reasons also, most of it can be explained pretty easily.

The reason the Japanese system is effective compared to the American system is because everyone, including the healthy, are paying into the insurance and this makes the insurance cheaper. Also, most of the costs that are associated with HMO’s and insurance companies that are not directly related to medical care are not present in the japanese system, i.e. there is no advertising nor bureacrats determining whom to cover, etc.

Compared to European/Canadian systems, in Japan it is profitable for private hospitals to exist, and they provide better medical care more cheaply. Also, there is enough of a personal payment (10% or something) by the consumer to deter most unnecessary doctor visits.


Henry 10.11.04 at 11:41 pm

Ross – could you either post or email me the link to your piece???

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