Health Care
Over at Washington Monthly, Kevin Drum highlights an article in TNR comparing US and European cancer care. The article does some apples to apples comparisons between the US and several European nations and concludes:
[The authors] were kind enough to respond when I contacted them. “Overall,” I asked, “was one country significantly and consistently better than the other three?” Wilking’s response: “Not really.”
Kevin writes:
the conclusion here is pretty much the same as it is every time you look at the U.S. vs. Europe: the differences are almost entirely about money. If you have a national healthcare system but you spend way less than the United States (as Great Britain does), you can provide good but not great service. If you spend modestly less than the United States (as France does) you can provide healthcare every bit as good as ours — and cover every single citizen in the bargain.
And what if you actually spend as much as the United States — but you have to put up with our ragtag private delivery system? Then you get healthcare about as good as France’s, except that it doesn’t cover everyone, it bankrupts large companies, and it goes away anytime you get laid off. And all for only about 40% more than anyone else in the world pays. Pretty good system, eh?
The US health care system is grotesquely expensive, slow and inefficient for a very simple reason - we have insurance companies doing everything they can to make a profit which means they have bureaucracies whose job is to make sure the insurance company doesn’t pay for our health care. Delivery of health care is a secondary concern. In the broadest scope of the debate over health care, the original TNR article raises the central question:
Truth be told, if you really care about which country has the best health care system, you may have to answer a far more complicated question–namely, whether paying for the newest treatments, which are frequently the most expensive, is really the best way to spend money on health care. Some would argue that it makes more sense to spend that money on other treatments, like preventative care, that yield much greater improvements in health at much lower cost. This seems to be what countries like England, among the lowest-spending countries around, are trying to do.
The big picture remains unchanged: In th US we spend way more and get quite a bit less than other nations.  I’m trying to find the link now, but a few months back I read an article that showed that Canadians were in fact healthier than Americans - a poor Canadian was as healthy as a middle class American and so forth all the way to the top of the economic ladder.
The usual fear mongering about waiting and rationing and bureaucrats is sure to come up every time we talk about health care in the US. The usual examples are the worst rather than the best. Why not a system like France’s which, from all I’ve heard, is in fact superior to our own. Other models include Ireland’s, which has a system whereby nurse practitioners visit households on a regular basis to check on patients. Why not take the best from all the systems worldwide and figure out how to deliver them.Â
Right now, Dubya is threatening to veto the expansion of CHIP on the grounds that it is an attack on the private insurance industry - no matter that it means several million children will go without insurance.Â
Our current system is grotesquely expensive, inefficient, provides poor care and is overly complicated.  The Clinton plan from the early 90s was pretty good if a bit on the complex side but, IIRC, it was similar to Germany’s and their system works better than ours. (I actually read a good bit of the proposed change back in the day; it was a highly technocratic solution to the problem of healthare; Republicans killed it for purely political reasons having nothing to do with the good of the nation.)
The more I ponder, the more I think the ultimate outcome will be a public health care system of some sort and the question remains will it be planned and implemented well or will it be piecemeal and badly implemented.
