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Not Too High on The Hog

Jun
1
2007

One of the more annoying facets to the health care debate is a little phenomenon I like to call “study envy.”
I have my research, analysis and data. And the free marketeers, like David Hogberg, have theirs. Jonathan Cohn, whom I defended from another free-marketeer David Gratzer a few weeks ago here, has his views–belief in the need for what’s called a single-payer system–most of which I agree with. And Hogberg, who recently responded to the rhetorical questions I asked of the free-marketeers in the American Spectator, has his.
The free health care market crowd claim that, compared to other nations, Americans are buying better care with all the extra money spent on doctors and hospitals and medicines and care. I say that the differences between care in different nations are a wash and are basically dependent on cultural factors anyway. So the important point is the consequence of spending all that money, and who’s suffering because of the way that we spend it.
This discussion on care comparisons is basically fruitless. It’s an engagement of rhetorical tricks since either side can “outprove” the other by selecting their studies. Hoggy may prefer the three reports he’s cited suggesting that American care is better than British or Canadian but I prefer this one which is a meta analysis of some 20 odd studies (all ranked in a not too dissimilar way to which Hogberg wants to rank studies) showing that the Canadians do better in many more areas that we do.
We can keep that going all year! Hogberg can show why only his studies match his criteria. And I’m sure the multiple authors of the meta-analysis and the Commonwealth Fund studies which showed that we have a worse health care system than five other developed nations can refute this claim. My point is that the difference in care is a wash. And has not much to do with care delivery (and yes, as Hoggy says the life expectancy and infant mortality data that gets quoted alot by liberals doesn’t matter much either). Attempts, as Hoggy makes, to extricate care delivery from the social and medical culture in which delivered in are totally messy, and not helpful as if we’re going to import another country’s system wholesale (which we’re not going to), our care will still be delivered in our social and medical culture.
What does matter is a) the price Americans are paying compared to other nations and b) who gets shafted in the process. And on that the evidence is clear.


When it comes to price, essentially the U.S. healthcare system is the New York Yankees or Boston Red Sox with their $200 million dollar payrolls up against the Oakland As. You’d think the guys with the expensive hitters and pitchers would win every time. But as anyone who has done comparative work in health care systems knows that’s often not the case. The reality in health care (as it is in actual baseball) is that the As with a limited payroll are a whole smarter about how they spend their money and doing pretty well in comparison. Give what we’re spending the record should be a bit clearer–more like the Yankees vs the Milwaukee Brewers. So Americans shouldn’t be making excuses for how we are doing. Instead, we should be getting furious, firing the general manager and getting the Oakland A’s system installed in our front office (as apparently the Red Sox actually tried to do).
As for b) who gets shafted? Hoggy asks me this question: Since [studies] show that single-payer systems are inferior in some vital ways, let me end this by asking Holt a question: Why do you want to give the U.S. a health care system that leads to more sickness and death?
Well, as Hoggy knows, even if you allow him to select the “studies” that back up that claim and ignore the ones that refute it, we don’t have to have more sickness and death while getting everyone covered and removed from the threat of financial cataclysm if they do get sick. Long-standing analysis has shown for years that there’s plenty of waste and mismanagement that could be redirected to get what everyone wants — a more efficient system that delivers better clinical value for less money.
It’s just that Hoggy and I have radically different ideas of how to get there. I’d argue my comprehensive solution of a single insurance pool is complete and rational, while the free-marketeer answer cannot possibly work. It relies on voluntary insurance and consumer choice at the point of care, while ignoring the large amounts spent on people who are too sick to effectively make a choice and whose care is largely controlled by providers.
I also want to ignore “sickness” in his question because, like comparisons between nations, it’s mostly cultural. The U.S. leads the league in excessive care of the nearly dead, and we do things to people in their 80s and 90s that I think are just bad care period. So I think we add to human misery just as much as any “rationing” system does. And I think we do a poor job of treating the elderly – particularly by ignoring pain for cultural reasons when we could deal with it by using more opiates. I’d claim that’s systematically worse than any of the anecdotes about Canadians enduring delays in surgery that nutty film-makers can come up with.
But I’m not afraid to continue on about the “death” part. I would absolutely take a little more early death at the margin particularly amongst the very infirm elderly–to whom we do way too much. I would happily stop those “heroic” interventions and use that money to improve quality of life, including financial viability, for those at the socio-economic bottom who are being punished by our current insurance coverage system. For them one bad break destroys their financial life and there’s loads of incontrovertible evidence from the Institute of Medicine, Jon Cohn and a raft of others about how that group is getting screwed. Yet we’re spending at least half a million bucks per life year to keep, for example, 93-year-old ex-Presidents going a few more months.
I am in favor of cost-effectiveness of how we spend all of our money. The market sorts that out well in many areas. It could do that in health care, so long as the competition was very, very carefully regulated as I’ve described elsewhere. But I don’t sense that’s the way that Hogberg et al would like it to work! And until someone on the free-marketeer side of this debate starts talking about the issues of who’s really suffering because of our lack of a universal coverage system, then they’re going to be stuck in this increasingly irrelevant game of study envy. And I’m not going to play anymore.

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