The Heavy Burden of Level-Headedness

“Those who sit down to watch Sicko without a broad knowledge of the US healthcare system will leave the theatre with a shallower understanding of the crisis than the one they arrived with. One should face up to the fact that this is the way Americans increasingly choose to get their information on all sorts of issues, not just healthcare policy. The appetite for slanted ideological dramas grows.”

This seems entirely accurate. So you’re just saying that they are part of the problem that they accurately identify, right?

part of the problem that they accurately identify

I assume that is Holsclaw-speak for “hypocrite”…

That’s the problem with the Hollywood mentality. Instead of seeing the vast profits to be made in making movies that appeal to that numerous sector who have a broad and wide knowledge of the U.S. Healthcare system, a sector that could easily fill your average 300 seater theater at least once, on a rainy Sunday, more or less, they chose that odd lib-left route and try to appeal to the small minority who don’t have a broad and wide knowledge of the U.S. Healthcare system. Who can understand this? And surely we need to lament it. And to lament it, we need to blame – the Internet! The blogosphere!
Interestingly, the right has never seemed so, uh, worried about the misinformation that might be spread out there on talk radio. Hmm. Wonder why that is? Somehow, if the blogosphere was dominated by the likes of Instapundit, I have a feeling you wouldn’t hear any complaints about it from the Weekly Standard.

Where does Caldwell relentlessly oversimplify? I was under the impression (thanks to Eric Alterman) that Caldwell was a member of the ‘decent right’.

I don’t imagine many people go to Michael Moore films expecting subtle analysis of the complexities of policy reform. He doesn’t, unlike the rightwing thinktanks and journals, pretend to offer this. And derision would be justified if Moore started criticising people on the other side for being loud and unsubtle (or, for that matter, fat).

On Alterman & Caldwell, a quick Google produces “I keep looking for an honest Neocon to praise because I believe in the value of civic discourse …I could probably settle for Chris Caldwell, whose reporting on Islam in Europe has been uniformly terrific, but Al Franken’s chapter in “Lying Liars” on Caldwell’s report on Paul Wellstone’s funeral takes a continent-sized chunk into Caldwell’s reputation as an honest reporter and thinker, and I’m not sure it survived it.”

steve labonne wrote:

“They will learn a great deal of FACTUALLY ACCURATE information that very few people of my acquaintance are aware of. And as numerous reviews have demonstrated, they will be misled, if at all, on rather trivial details.”

The issue is not that Moore’s film doesn’t contain a lot of facts (it does). Or that it contains a lot of falsehoods (it does not). The issue is that it takes an issue of incredible complexity and boils it down into a white hats and black hats polemic.

It is for example very true the the U.S. spends much more per capita on healthcare than other wealthy nations but has lower life expectancy and higher infant mortality. Which of course makes the U.S. system look bad by comparison. But its also true that the U.S. population is more sedentary than the populations in almost every other wealthy democracy. We eat more fatty, processed foods. We probably drink less alchohol in the aggregate but our consumption of booze is more heavily concentrated and more likely to be binged. We drive way more miles per year than citizens of most other peer nations. We have a lot more violent crime than most countries.

In short, we would damn well expect U.S. life expectancy to be shorter than that in other countries, even if we had a better healthcare system. But the simple minded argument that “Gee, if we had single payor care we would save 50% of our costs and live 2 years longer!” ignores this.

It ignores the fact that U.S. doctors and nurses (what us business wonks would tend to call “the majority of the cost bar”) are accustomed to making a lot more money than their peers in most of the nations with single payor healthcare, and thus are not likely to be happy with the economics of a system where we pay significantly less of GDP on healthcare. It ignores the fact that most of the global pharma profit pool comes from the U.S. market – and its simply not tenable to think that pharma R&D wouldn’t slow down if all of a sudden a single payor negotiated the prices of drugs down to something close to what European and other similar systems pay.

The U.S. system is fucked up. I support moving to universal healthcare because I think that we can afford to extend to all of our fellow citizens security from medical ruin and have an obligation in a just society to do so. And I’m prepared to pay higher taxes to make this happen.

But I do not – not for a minute – think we can simultaneously move to universal coverage and reduce the percentage of GDP that we spend on healthcare. People who think we can are no better than the Iraq war hawks who thought we could re-configure a failed state with a third of the troops that Pentagon planners thought would be neccessary to keep basic order. They are certainly not “reality based.”

But I do not – not for a minute – think we can simultaneously move to universal coverage and reduce the percentage of GDP that we spend on healthcare.

Do you really think this was the main message of Moore’s film?

No no no. This is the most ridiculous tu quoque.

Either Sicko presents a broadly accurate picture of the health care crisis, or it doesn’t; either its simplifications are justified to reach a broad audience, or they’re not. Personally I answer these questions in the affirmative, but that has literally nothing to do with whatever the Standard has said about Iraq or whatever.

Well, those issues have nothing to do with the Standard. And they are important issues. Now I want to know why you think these are the only issues Henry is allowed to talk about. I must have missed the memo that said you weren’t allowed to talk about hypocrisy (or was it only sent to Henry?)

And they are important issues. Now I want to know why you think these are the only issues Henry is allowed to talk about.

Not the only ones allowed, no; just much more interesting than the exact degree of blackness of Christopher Caldwell’s shrivelled little soul.

Regardless of what one thinks of Henry’s post, I think he should be congratulated for finding a Servants of the Wankh cover with a figure (the large statue one, not the strange bethroned one) that sort of looks a bit like Christopher Caldwell:
http://www.weeklystandard.com/aboutus/bio_caldwell.asp
As to the content: how much one should hold someone accountable for the actions/behaviour of his associates is a question I’m of more than one mind about. I don’t think that one should simply reject anything Caldwell says, or condemn his character, based on what other people who write for the Standard do. On the other hand, it isn’t like he wound up on the masthead by accident; and his association with the Standard does seem to imply approval of it — or at least sufficient approval of a sufficient proportion of its doings to maintain the association.
Back when I occasionally read the WS I always found that Caldwell was much the best of the regular contributors, at least among the more senior people (admittedly, the bar was pretty low). I don’t read the Standard much anymore; and it seems that Caldwell doesn’t write for it as much anymore — which may be telling.
Anyway, in general, I do think that addressing the susbtance of Caldwell’s argument would be more interesting and constructive — if less emotionally gratifying — than accusing him of hypocrisy (or whatever) based on his association with the Standard (accusing him of falling into the same habit of simplification as he accuses Moore of indulging in, based on Caldwell’s own arguments, on the other hand, strikes me as a more solidly effective and relevant response). On the other hand, given that Caldwell’s complaining about a more widespread tendency towards one-sidedness, it does seem worth pointing out that the publication with which he’s been closely associated is often guilty of that same failing — and that Caldwell fails to note this (though perhaps his declining rate of publication in the Standard is telling?)

I recently read a medic on scienceblogs.com write how, from his knowledge of the medical industry, he was impressed with Moore’s film, much more accurate than his usual stuff. And I wondered how a medic should know so much about e.g. the firearms question or international policy to so dismiss Bowling for Columbine or Fahrenheit 911. Then I realised this was a pattern I’d come across: I had read law enforcement professionals say how impressed they were by Bowling for Columbine, not like Moore’s usual inaccurate stuff, and military and diplomatic officials says how impressed they were by Fahrenheit 911, not like Moore’s usual etc.

Somehow people are hearing that Moore deals with inaccurate propaganda, and they believe it, until they see a Michael Moore film that deals with an area they know personally. I wonder how that comes to happen? It couldn’t possibly have anything to do with articles like the one reviewed here, could it?

Those who sit down to watch Sicko without a broad knowledge of the US healthcare system will leave the theatre with a shallower understanding of the crisis than the one they arrived with.

People who get sick or who have a loved one who is sick in this country get a pretty good goddamn education right fast. Your mom gets cancer, you learn a LOT about that kind of cancer, and how the treatment of it is paid for, and after a few months you are as versed in this stuff as anyone.

This first sentence is condescending and disgusting. Americans KNOW the American healthcare system already, or else they will someday get it chapter and verse. Life and death questions do tend to hone the mind, you know. You have a disease in your family, you start spouting latinate terms in a matter of weeks. And you gird yourself for the inevitable insurance battles like you are goddamn Hector and you see the enemy ships landing.

The real issue is that Americans have too much freaking expertise about our system, because we learned it the hard way, and not enough time for, you know, caring for the sick and ridiculous stuff like that. That it’s so hard to make the system less inhumane is just really fucking shameful.

Pardon my language.

Thers nails it. A lot of Americans deal with a lot of very painful and depressing details, and are gradually realizing that essentially the entire governing appartus of their society has been quite calculatedly lying to them about how much of it is necessary, helped along by enthusiasts who have no idea how ignorant they are (like most libertarians who write about it) and propagandists who turn out not to care about anything but being spared a sense of responsibility for others (like most conservatives who write about it). Finding out that people just like you in other countries didn’t have to go through a bunch of the agonizing decision-making and sacrificing you did hurts. Realizing that your agony and sacrifice are being justified on grounds like “but we’re too evil and stupid to manage that sort of thing” and “but think of the CAT scans” angers. What Moore does, based on the clips I’ve seen, is give focus to those emotions with the affirmation that better care isn’t just possible, it’s the norm – we are the freakish outlier insisting on pointless misery, not the bold ground-breaker in superior care.

Even the best care in the world can’t make pain and death gleeful. What it can do is free us to deal with the illness and loss itself, rather than wasting our souls on the hoops set up by those who wish to profit from others’ misery.

Yes concern troll, the NHS has its flaws, mostly stemming from massive underfunding (and perhaps also the British inability to arrange a root in a brothel – look at their rugby team as an example of how quickly they can self-immolate a world-beating achievement). The general argument against these criticisms is encapsulated in one word: “Thatcher”. It would be hard to come up with a strong criticism of the fundamentals of the Australian system, however, except perhaps that it is not braced to deal with the imminent ageing of the population. This, however, is a problem of all health systems in the developed world.

Glenn, not many Canadians or Brits may praise their healthcare systems but they sure don’t want one like the US!

He’s nothing even like a journalist.

In light of the track record of the last 15 years of political journalism (in the US at least), one hardly knows how to interpret this sentence.

Perhaps several examples of the journalists that he is “not even like” would help. Dr. Sanjay Gupta of CNN maybe?

There is no doubt that Moore is a polemicist. At least he is a self-acknowledged one.

(The irony here is that several of Moore’s recurring motifs irritate the hell out of me. It’s just that I’m getting really tired of the standard BS arguments deployed against him and his work.)

pj – fine. that may be the case. But there are ALOT more foreigners who choose to get healthcare in the US, Canadians and Brits and Italians, and not jsut the rich ones, than vice versa. Nearly all – but of course not all – of the Canadians and Brits and Italians I know who themselves are knowledgable about the healthcare differences tell me they would choose the US healthcare (but not the system) over their own. That being said, we all acknowledge the extreme shortcomings and unfairness of the US healthcare system. (‘US healthcare is troubled, damaged even …’ boy that seems to be pretty evident of how I feel, doesn’t it?)

engels – for the record, I’m not at all a right winger and I used to be an idealist. I’ve become much more of a pragmatist, am happier for it, because I get alot more accomplished and change more minds. I’d invite you to join the real world, but you seem somewhat secure in your own little coccoon. (pssst – it’s not a perfect world, my friend, but I’ll pocket the needle as we’re too near your bubble)

jp – there was some irony there, but it was missed. I should have written “nothing even like a journalist should be.” You’re right he’s a self-acknowledged polemicist. That’s not to say he isn’t entitled to a good debate; I’m just saying he’s more biased than knowledgeable and seems to be more of an idealist than a pragmatist. He doesn’t seem the type to improve the system gradually (which is what will likely end of happening). He’d prefer tearing it down and starting over. That or nothing else. There’s likely little or no middle ground with him. “Compromise” is not likely to be a nickname for him.

rea – Lies? Really? Not once did I write lies, or frankly, even suggest it. Riding roughshod over the facts that few people are very supportive of their nation’s healthcare system doesn’t make a very compelling 2 hour movie, and it isn’t supportive of Moore’s points. rea, if you’re forced to put words in my mouth, first try forming some clever ones of your own. But it can be taxing to have yone’s own thoughts.

bruce – we can just agree to disagree. You think Moore’s out to educate, and I don’t think so. At least that’s not his main point. Educating is incidental. But I also don’t think he’s trying to pull the wool over our eyes. He is not unbiased, but nor does he try to be. Again, he doesn’t try or care to present the full truths, only half-truths: there are some positives of the US healthcare system, but it’s just not convenient for him to present a fair case, and he certainly doesn’t do that.

Glenn – Can you point to where I said anything resembling that, or are you just lying?

“Yes concern troll, the NHS has its flaws, mostly stemming from massive underfunding…”

Doesn’t that fly in the face of the “everybody is so much cheaper” argument?

“Umm, Glenn, the French have universal access to world-class care AND, though their system is the second most expensive in the world, it is quite a bit less expensive (as % of GDP) than our cluster**** of a “system”.”

Jane Galt made an interesting point last week. The portion of the US health care system which is already funded by the US government already approaches the level of spending made by the ‘cheaper but better’ systems. And it doesn’t come anywhere near universal coverage. If there aren’t major systemic issues (unreasonable expectations for non-rationed end-of-life care and free riding on medical advances to note two possible ones) why isn’t that pretty close to sufficient?

What people want is US healthcare but at the cost of Universal Care of the other first world nations. At present I do not find this possible. There are many specifics that tend to be ignored when discussing healthcare reform. An example using an area that is often miss-represented: Infant Mortality Rate. The US does not have the worst infant mortality rate compared with other first world nations. What the US actually has is an unfavorable comparison of mismatched statistics.

– The US includes still born births in its infant mortality rate numbers. The majority of other first world nations do not.
– The US will attempt extreme measures earlier compared with other first world nations. This both increases the average cost of births and the mortality rate.
– Some nations will record the birth of an infant at a later time (Japan as example), thus giving a window where infant deaths are not reported against the mortality rate.
– A portion of births in the US are to mothers who received healthcare in a third world country and only give birth in the US. Often this is birth occurs after a life threatening journey.

There are serious problems with the US healthcare system. Unfortunately the default comparisons and platitude answers will not result in a workable solution. It will only provide a new series of problems.

Jane Galt’s “point” is comprehensively stupid and dishonest, not “interesting”. Who pays for what will naturally vary in different countries and would be a prime subject for negotiation if we ever got real health care reform on the agenda here. But dragging it in at this point in the discussion is a transparent (and desperate) ploy to distract attention from the incontrovertible fact that the French buy a lot more care for considerably less money.

Sebastian, you seem to think that something can only be an explanation for the high US state spending with poor outcomes if it can (or in an oddly tautalogical way, has) been minimised. It is quite possible for high hospital admin costs, for example, to be a cause of high US healthcare expenditure without the government being able or willing to do anything about this (because, for example, it is a result of the structure of the wholly private US healthcare market).

But there are ALOT more foreigners who choose to get healthcare in the US, Canadians and Brits and Italians, and not just the rich ones, than vice versa.

I hear this ridiculous statement over and over again but no one ever bothers to back it up with anything but vague anecdotes. Are you telling me that some French Firefighter is flying his ass to the US, just to see a doctor about his persistent cough? That scores of Italian waiters shell out hundreds if not thousands of dollars to fly over here and wait in the doctor’s office? Line them up! show me the hundreds of British school teachers, Canadian librarians and Vianese office temps who have come all this way for our overpriced drugs and mountains of paperwork. it’s absurd.

I want people who insist that a change to a more effective and less expensive system of universal coverage isn’t possible to start by accounting for Taiwan’s experience since 1995. I never see this addressed by people who insist that way. It’s like the whole thing just never happened. But it did, and Taiwan is in fact spending less to get better outcomes and more satisfaction.

“And to anticipate the obvious rejoinder, Moore of course is also propagandizing (the word properly used does not imply falsity).”

Well he is doing so falsely too. For example the man who was denied the super-experimental and very-unlikely-to-work cancer treatment would have been denied under any of the alternate systems that Moore respects. To imply otherwise is a falsehood.

Moore slips up on a few relatively minor points odf that kind, as opposed to the wholesale lying of right-wing flacks for the private healthcare industry. I know which side I trust more.

Re Bruce Baugh @ #50- here’s an abstract.

“Moore slips up on a few relatively minor points odf that kind, as opposed to the wholesale lying of right-wing flacks for the private healthcare industry. I know which side I trust more.”

That was one of the key emotional points in the movie. It isn’t a minor point at all. The movie implies that the racist money-grubbing insurance companies denied the black man his needed treatment and he died. The same thing would have happened in France, Canada, Switzerland or the UK. Unless he was paying out of pocket, no one was going to pay for that long-shot experimental treatment.

Who said they can’t exist? They can’t exist with the current US level of expectations AND cost savings. That is a rather different story entirely.

“And that neither vitiates the ACCURATE overall message”

Which message is that? And when did “fake but accurate” become ok? A huge part of his message is that insurance companies are what is wrong with US health care, but the example he gives is of coverage denial that would duplicated in any universal system. That is not only inaccurate, it is misleading.

“Sebastian, do you have any evidence that people with the worse US medical insurance coverage really get better treatment than ‘most’ Europeans (by which I assume you mean Western Europeans) or is it simply personal prejudice?”

It is a strong inference from the “8 Americas” study recently published. There we see that Middle America enjoys a much higher insurance coverage and life expectancy than 6 of the other 7 (Asians do better than everyone). (Though it must be admitted that the health care piece is a lot smaller effect than I would have thought for the differences). But even Middle America has a noticeable uninsured population, and unless you believe that the insurance does nothing or almost nothing it would bump up the insured statistics. (Is there a direct study comparing uninsured to insured? Not to my knowledge).

“I ask because my own knee-jerk reaction from the other side of the pond is the exact opposite, at least partly because universal healthcare systems don’t normally have the profusion of exclusions found in US policies.”

I’m not sure what you mean by that. Insurance companies look like they have a lot of exclusions because they have to be specific about them. But your average health insurance policies don’t exclude noticeably more treatments than would actually be unavailable in your average universal health care system. As above, long-shot experimental cancer treatments aren’t usually covered. MRIs are ususally easier to get in the US.

Most of the common complaints about insurance wouldn’t be better under a universal system. The most common complaint is about the need to go to your general practitioner before seeing a specialist. But that requirement exists in most universal systems too. Another complaint is about restricted access to experimental drugs. That is also a problem in most universal systems. Another common complaint is that bean-counters get to influence the decisions. That is true in most universal systems.

At no point am I saying that the US is perfect. I’m merely noting that for the improvements people seem to want, they don’t seem to be willing to make the tradeoffs necessary.

Can you point to where I said it could occur “without griping”? Hint- what I actually said is that I think it will take a pretty complete collapse (which I believe is in the cards) of the current “system”. But what is important is that Taiwan, like France, provides proof of princple that you’re wrong in claiming that quality universal care can’t be achieved at the same (and probably less) total cost than the current mess.

(Neither is there any good reason to think it can be accomplished in isolation by an individual state- yet another diversionary tactic.)

Glenn’s claim about Canadians, at least, runs counter to my experience. I’ve lived with and worked in both US and Canadian health care systems. While Canadians have some valid complaints about their system they are on the whole fairly happy with it, and the ones I’ve known who have actually seen the US system as well (as opposed to the caricatures presented in political rhetoric) are astonished, and would never trade. The number of people from Canada popping over the border to speed up an MRI etc. are balanced somewhat by the hordes of Americans going north for prescriptions, etc.

Well, Elliott, It’s obvious from such comments that Sebastian has absolutely no idea what he’s talking about. I must say that while I rarely agree with him, I have come to expect a bit better than that. Disappointing.

Elliott, I suspect the answer to your question is that, in fact, the French don`t cut granny off as a matter of cost-saving policy.

Sebastian`s argument that the US can`t have US health care expectations at national health care costs is self-defeating: if US health care expectations are so high, why is it that US health outcomes are lower than the french? It`s contradictory.

Jane Galt`s point is patently stupid, primarily because she makes the ludicrous assumption that the effect of government spending in a market is linear. Clearly with 45% of US health care spending being by the govt., this means that the govt. is a single player in a particular commercial marketplace. At 100% spending by the govt., the govt becomes the sole purchaser of services, and it`s negotiating power is much more than doubled. The expectation of national health systems is that this negotiating power is used to push down health care costs. In the case of the US, you are assuming that doubling the proportion of US govt spending overall will lead to cost savings which will reduce the overall health care cost by about 30%. Introducing an Australian-style drug price negotiating scheme (the PBS) would probably have a big impact on this overnight, as would providing free preventive health care measures (pap smears and breast screening particularly), since early detection of these diseases reduces the cost of their treatment. These are the kinds of ways in which national health systems excel.

Also, the 45% of government spending in the US is primarily aimed at the uninsured and the uninsurable, so it is working in the least efficient sector of the market. The next 45% would be spent a lot more effectively.

Also, government taking over the cost of healthcare will reduce the burden on employers to pay those huge insurance costs, presumably having flow on employment effects, increasing taxation and growth and thereby reducing the proportion of GDP being spent on health. Particularly if the claims about the unsustainability of current employer insurance schemes are true.

But as others have pointed out, even if a nationalised health system in the US cost the same as it does now, if it could ensure everyone got access to health care it would massively improve the nation`s health, without costing anyone any more.

concern troll, there is a problem I think with understaffing in the NHS. Whether this is to do with underfunding or problems of availability of nurses is debatable – the UK system is desperately trying to poach overseas nurses at the moment, so it might be a problem of lack of supply rather than lack of funds.

Also, there seems to be managerialism involved in the NHS, such as only the British can do. My grandfather`s recent experience seemed to involve a lot of confusion on the part of the hospitals, allied health organisations, community nurses, etc., not knowing what exactly to do and when. I`m not sure if this is a funding issue or an issue of general incompetence (this is the country which had British Rail, after all).

Also, one needs to bear in mind that most anecdotes one hears come from the British. Accentuating the negative is a conversational style over there.

Certainly my grandfather`s experience wasn`t great, but he was 86, had a stroke and then a series of increasingly severe bowel problems culminating in surgery. The surgery led to an infection, from which I think he recovered, and then he got a fever of some sort a little later and slid quietly away. All through this process he got free, decent quality health care that suited his condition. He didn`t get a private room, of course, and it`s possible his care was not top standard on account of the nursing complement being insufficient. At one point he had to spend at least a week in the hospital. All of this set him back precisely nothing, financially. So there isn`t a great deal to complain about, unless you don`t like sharing with the hoi polloi.

I think the NHS needs more money to recruit more staff, and I`d guess to improve its food (but this is the UK, so what hope have they got?); but overall, if they have to go from 8% of GDP to 11%, or whatever, to get a really good quality of care for everyone independent of income, in the end the British won`t complain and will cough up the cash. The fact that some people would think that 3% better spent on some kind of discretionary tax cut just staggers me.

Glenn, you’d be more impressive if you could point to any example of a nation which adopted universal coverage and suffered a decline in quality of care and outcomes as a result. I no longer really expect opponents of universal coverage to admit that there are no such examples, but I’m willing to keep mentioning it for the sake of bystanders. The fact is that adopting universal coverage leads to improved outcomes as well as reduced costs, everywhere it’s done, and there’s plenty of documentation for this, and all the puffery to the contrary is in fact purely baseless speculation made in denial of the data or thoroughly capricious cherry-picking or both.

What opponents of universal coverage do with their favored statistics is in fact precisely like what their customary enemies the champions of speech codes do with, for instance, Stormfront and other racist sites on the Web, using the existence of any negative anywhere as justification for smashing the whole thing. The irony would be entertaining if we weren’t talking about wasted lives and needless pain.

Steve, Glenn’s just pulling the usual rhetorical trick of saying “Well, for the people who do have access they can afford to the good stuff, how good is their care?” That lets people like Glenn feel they can separate the quality of care some get from the lack of care others get.

Ah, true enough!

Well, Steve, Moore has certainly been successful at wasting alot of our time, hasn’t he?

Bruce – I think you’re being disingenuous. I fully admit from the beginning that the US healthcare system is fucked up and unfair, but frankly, I also believe that those with coverage get pretty damn good care. I’m very happy to make US healthcare much more inclusive – it should be and needs to be – but people who think that it ain’t going to cost a helluva lot more and/or that quality will not deteriorate (I think from a high base, you think from a low base) are smoking something or just plain deluding themselves. Perhaps both.

Well, Steve, Moore has certainly been successful at wasting alot of our time, hasn’t he?

Wow, what a classic case of projection.

Indeed Steve. Things will proceed, changes will be made at a snail’s pace.

And that’s the way it should be.

Moore cashing in. Asking some pertinant questions. Critisizing without offering concrete and do-able solutions. Not presenting the full evidence. Getting people riled.

Two hours of Moore with popcorn and coke. Isn’t that the only and perfect venue for him?

(it’s already visbly dragging down our economy, to the consternation of business leaders in every industry except the healthcare – industrial complex.)

Below was written in 2003, …where is GM today

http://query.nytimes.com/gst/fullpage.html?res=980DE3D7173CF936A25754C0A9659C8B63&sec=health&spon=&pagewanted=print

The New York Times:
July 15, 2003

The absence of a national health system in the United States means that the Big Three take on social responsibilities that the governments in Japan and Germany bear. Gary Lapidus, a Goldman, Sachs analyst, referred in his recent report to the Big Three as ”H.M.O.’s with wheels” that only happen to make cars. G.M. alone provides medical coverage to nearly half a percent of the United States population, when dependents are included.

And although Toyota and Honda assemble in the United States most of the cars they sell here, their plants are much newer, their work forces younger and their retirees number in the hundreds, not the hundreds of thousands that depend on the Big Three. They are also not unionized, except in joint ventures with the Big Three.

While the out-of-pocket health costs of auto workers have not risen in years, many American workers have seen quite the opposite, and even white-collar Big Three employees can pay several hundred dollars a month in premiums and other out-of-pocket expenses. Auto union members enrolled in H.M.O.’s and P.P.O.’s generally pay $10 or less for prescriptions or visits to the doctor. Everything else is covered.

As a result, many analysts think that the domestic auto industry is in a bind similar to the one that crippled the domestic steel industry. Both feature shrinking companies burdened with health and pension obligations to armies of retirees, as well as labor contracts originating in a time of much less global competition.

Uwe Reinhardt, a Princeton University health care economist, calls the Big Three ”a social insurance system that sells cars to finance itself.”

”It’s insane to think that a company embedded in a fierce global competition can function as a social insurance system,” he said. ”It is a crazy, anachronistic idea. It’s an idea that worked in the 60’s, but lost its validity beginning in the 70’s when the car market became global.”

The Commonwealth Fund’s study for example, raises issues with lagging adoption of information technology, coordination and continuity of care,and management of chronic conditions that by no means affect only the uninsured. Think about how our system “works”- being insured will do you little good if you have had to change jobs and your new insurance excludes your pre-existing condition. The brutal fact is that only people who can pay cash have full access to care comparable to the best available in the top-ranking countries.

As some support for my latter comments, an example would be Boddiger (2006) Lancet:”the plan’s pre-existing condition requirements excluded employees with diabetes and other chronic illness. Such exclusions are common in plans offered by small companies”

Glenn, your asserted opinion just simply does not match my experience living (and working in, to some degree) under the US system (multiple states) and the Canadian system (multiple provinces), as well as minor experience as a consumer in the EU (multiple countries). Since both of our cases are anectdotal, I don’t think we can get much further than that.

Beyond anectdote and surmise, we have to rely on comparative studies. Certainly this is a difficult thing to do well, and I’m quite prepared to believe that the existing information is not as good as we might like. On the other hand, every single study I know of with any sort of weight, says the US isn’t getting much bang for it’s buck, relatively speaking. The evidence really is overwhelmingly supportive of that position. The only literature I’ve seen that contradicts it (and a fair bit that supports it, but there is plenty left over) is fatally flawed. So one could argue that the whole body of literature is hopeless, but that’s a pretty strong statement to make and would require some pretty strong support, which I’ve never seen so much of a whiff of. Of course, I’m no expert in the field and I’m quite prepared to believe that there is information I’m unaware of, but I’m hardly going to take someones word for it in the face of so much contrary evidence.

I’m certainly not going to take anyones claims about Canadian vs. US without a lot of support, because from everything I’ve seen on both sides of the border, the Canadians have a better system, both in terms of actual standard of care for the people in the country, and in my impression that the things that are broken in that system are more easily fixable than what is broken here.

Yes it is such a response, and though it is not exactly the kind of study about which you inquired I already explained precisely why some of the key comparisons in that report pertain very clearly to insured as well as uninsured USians. You might want to read it sometime.

Glenn et al, you’re missing part of the point here, which is that government-only (or almost-entirely government) nationalised healthcare systems push down costs regardless of how much they pay. If the US switched to nationalised healthcare on its current high % of GDP, it’s likely that the same level of care middle america is getting would be extended to everyone, uninsured and uninsurable, and that the overall cost of healthcare would drop, reducing the proportion of gdp you had to pay for the same level of care.

This alone is a reason to switch.

It’s easy to find papers with national comparisons of health outcomes, most of which are based on OECD data. These data are based on ICD-10 codings and are consistent across nations (none of this “the US counts stillborns” obfuscation). The US is actually younger than countries like the UK, with exactly the same rates of alcohol abuse and smoking, and similar rates of obesity. So why is it that it spends more than twice what Australians spend, to get higher infant mortality rates and lower life expectancies? If you do a search you’ll find that the main difference in costs in America is jazzy machinery and a much higher nurse-to-patient ratio.

(I had all the links to papers from the journal Health Affairs, and the OECD, with which to back these claims, but I can’t get them working).