Jonathan Adler on healthcare (with minor editorial changes)

by Henry on October 29, 2007

AMERICANS FLEE NATIONAL HEALTH CARE SYSTEM: The Daily Ezra Klein reports:

Record numbers of Americans are travelling abroad for medical treatment to escape the American healthcare system – with 100,000 patients expected to fly out this year _for cosmetic surgery alone_, more than the sum total of “Britons seeking any type of services in foreign lands.” And by the end of the decade 200,000 American “health tourists” will fly to one hospital in Thailand alone on current trends to avoid extortionate costs, according to a “new report”:http://abcnews.go.com/Business/IndustryInfo/story?id=2320839&page=1.

_und so weiter_.

For original, see “here”:http://volokh.com/archives/archive_2007_10_28-2007_11_03.shtml#1193675968.

{ 26 comments }

1

notsneaky 10.29.07 at 5:08 pm

Eye-talics. Close’em. Then delete this message

2

Alex 10.29.07 at 5:09 pm

3

Henry 10.29.07 at 5:13 pm

A problem with Textile not playing nice with standard html code when they are up next to each other … sorted, thanks.

4

bi 10.29.07 at 5:21 pm

Still doesn’t work for me… seems a blockquote tag got stuck inside an a href tag.

5

Henry 10.29.07 at 5:22 pm

yep – that should be sorted too, thanks.

6

P O'Neill 10.29.07 at 7:12 pm

On a slightly related note, there’s the belated discovery of MRSA in the American media, where it used to exist only in conjunction with Heh Indeedy references to the NHS.

7

engels 10.29.07 at 7:53 pm

So is the NHS morally equivalent to Communism? Or, as sensible people like Klein say, merely “bad” but “very, very cheap”? Ah, the joys of being a football in the American political debate…

8

Watson Aname 10.29.07 at 8:28 pm

The NHS seems an abject lesson in what happens when you underfund an otherwise reasonable health system, but I really don’t understand why it comes up as the alternate model of choice in many US discussions. There are several better examples.

9

nick s 10.29.07 at 10:11 pm

I really don’t understand why it comes up as the alternate model of choice in many US discussions. There are several better examples.

It doesn’t, though. No Democratic presidential candidate is offering it. No liberal health wonk recommends a single-provider approach, nor even considers it feasible.

It comes up as the model to bash from the right, in part because it’s in a relatively large English-speaking country, sufficiently far away from most people’s experience. Never mind that US visitors who encounter the NHS (often at its most nimble, in A&E) tend to view it favourably.

engels has it down: to Americans, the NHS is a strawman, an Aunt Sally system.

(Note that health tourism doesn’t include the US as a destination; when Britons do travel to the US for treatment, it’s generally for highly experimental treatment with a very low chance of success.)

10

Watson Aname 10.29.07 at 10:36 pm

Nick,

Fair enough. What I probably should have said was that I don’t understand why people seem unable to effectively articulate that this is a straw man, and counteract it. Because I really don’t hear much else.

11

Brett Bellmore 10.29.07 at 11:50 pm

Because it actually exists, which to some extent precludes, (But admittedly not completely) it from being a strawman?

You want a great deal of government involvement in the provision of health care. Opponents of this point to an example of this in the real world. You reply, “Dear God, no! I don’t want that! To which the reply is, presumably the British didn’t, either, but they got it none the less. And you explain why we won’t get it here… And so the debate is joined.

It’s more a argument starter than a strawman, I think.

12

Thomas 10.30.07 at 12:51 am

1. Adler’s sin is apparently republishing bits about the NHS that were first published in the Telegraph and Daily Mail. He didn’t write the copy, merely quoted it.

2. The reaction here and at Ezra’s seems oddly defensive. I mean, what’s wrong with saying that NHS doesn’t work, given that no one sensible wants to import it? Unless…

3. The US is 5x the size of the UK. Sum totals can be misleading.

4. The US health care system isn’t a closed system in the way that NHS is (or purports to be). Medical tourism from the US is a continuous choice with, and not an escape from, the rest of the US system; that’s different from NHS. What is a feature in one is a failing in the other.

5. Given the expense of US health care, shouldn’t we expect (and be grateful for) many Americans to go abroad for medically unnecessary cosmetic procedures?

6. If one believes (as Ezra does, and I don’t) that the US is driving medical tourism, is that a good thing, or not? If the US were to change its health care or health care financing system such that medical tourism from the US declined, would that be good for provider countries? Good for the UK? Should those effects be counted in deciding whether and how to reform?

7. The underlying study driving these stories appears to be a marketing poll. The poll, apparently conducted for a medical tourism company, finds that more people than ever are using their services, and the trend can’t help but continue. In other words, exactly what these sorts of polls always find. I’d think we’d want better data than anything provided in this story (or in the stories that Ezra links to) before building too much of an empirical case.

8. Nick, of course Britons don’t come to the US except for experimental treatment. That’s where the greatest value added is, and in any case, if Americans can’t afford US health care, Britons certainly can’t. Some from the Middle East and South America may have a different view.

13

c.l. ball 10.30.07 at 3:13 am

It certainly is a sad commentary on any country’s healthcare system that it is more effective or efficient for patients to travel abroad for treatments available in their own countries.

It is not poor Americans who are medical tourists but relatively affluent ones who lack insurance. That self-employed people cannot get reasonably priced insurance in the US is a scandal. It clearly shows how flawed the US system is. Most of the Americans mentioned in the articles would have stayed in the US if the cost was reasonable.

I prefer market solutions to government ones, but it is clear that there is a massive market failure here. It is over 12 years since the Clinton plan was shot down and “the market” has failed to reduce prices or improve coverage.

14

bad Jim 10.30.07 at 7:32 am

Medical tourism has always been with us:

A dishwasher from Nancy, Vital Frérotte, who had just come back from Lourdes cured forever of tuberculosis, died Sunday by mistake.

Those who strive to defend America against “socialized” health care are so blind to the deficiencies of the status quo that they highlight any sign of inadequacy in competing systems, utterly unaware of what it reveals about their own.

15

Tracy W 10.30.07 at 8:48 am

It certainly is a sad commentary on any country’s healthcare system that it is more effective or efficient for patients to travel abroad for treatments available in their own countries.

What happened to comparative advantage?

16

pj 10.30.07 at 1:49 pm

“On a slightly related note, there’s the belated discovery of MRSA in the American media, where it used to exist only in conjunction with Heh Indeedy references to the NHS.”

Really? The US has higher rates of MRSA than the UK from my understanding.

17

'As You Know' Bob 10.30.07 at 2:00 pm

No to quibble with the larger point, but, strictly speaking, cosmetic surgery is not ‘health care’.

If 100,000 Americans fly overseas to save themselves some money on some vain notion of voluntary self-improvement, it’s not really much to do with their health or with their health care.

18

Hogan 10.30.07 at 2:10 pm

I don’t understand why people seem unable to effectively articulate that this is a straw man, and counteract it.

Because counteracting it would mean explaining the policy issues in a way that most Americans don’t have the patience to listen to. Anyway it’s not like we don’t also use stories of Canadian health care to frighten our children.

You reply, “Dear God, no! I don’t want that! To which the reply is, presumably the British didn’t, either, but they got it none the less.

Brett, is there any particular reason to think that last part isn’t a complete load of crap?

19

Sebastian Holsclaw 10.30.07 at 3:32 pm

Why is the fact that 100,000 people from the US travel looking for cheaper cosmetic surgery considered relevant to the discussion?

20

john b 10.30.07 at 3:35 pm

PJ @ 16 – yes, that’s the point. Previously right-wing American commentators would say “the NHS is terrible because of all the MRSA”, despite the situation in the US being worse…

21

Watson Aname 10.30.07 at 5:50 pm

Hogan, Of course one problem with that is that the Canadian system has it’s problems — but overall it’s a better system. What surprises me about the NHS is the frequency that it seems to come up, given that there are more obvious examples (Canada) and better ones (France), etc.

22

Watson Aname 10.30.07 at 5:53 pm

I’m still being inarticulate; sorry. My overall complaint is that often the debate seems to polarize into the laughable idea that the choice is between the current system and the NHS. This is of course ridiculous, and made even worse by the seeming refusal to accept that the NHS isn’t even a particular good example of what NHS-like systems could be. So the whole discussion often goes uselessly down this rathole.

23

PJ 10.31.07 at 7:31 pm

“Previously right-wing American commentators would say “the NHS is terrible because of all the MRSA”, despite the situation in the US being worse…”

Ah, that probably explains why the complete uselessness of the NHS is taken as a matter of fact by most US commenters here and on the original blog – whereas the data might suggest that it is at least reasonable value for money compared to other countries, and no worse for national health outcomes than the US system.

24

Brett Bellmore 11.01.07 at 3:30 pm

But that last is largely a consequence of how little health care systems really have to do with outcomes, once you’ve got epidemic diseases under control. (Which is mostly a matter of public sanitation.)

The outcomes are mostly driven by lifestyle choices, diet and exercise. Which is kind of a bummer for anybody who wants to seriously improve public health by changing the health care system, as well as being really uncomfortable for multi-culturalists to face.

25

engels 11.01.07 at 5:12 pm

More of a problem for shcmibertarians, I’d have thought, even (especially?) if they are white, male and middle-aged.

26

PJ 11.02.07 at 4:58 pm

“The outcomes are mostly driven by lifestyle choices, diet and exercise.”

Surely an argument for the cheapest system possible, which is not, however you look at it, the US system!

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