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The Media on Health Care

Brad Plumer offers some thoughts as to why the U.S. media presents such a distorted picture of other countries' health care systems. I endorse pretty much everything he says, but will add a few more considerations of my own:

  • The England Problem. For linguistic and other reasons, the European country Americans are most cognizant of is the United Kingdom which happens to have a health care system (the NHS) which goes very far in the opposite direction from the U.S. system in terms of command-and-control health care and which, consequently, offers a very exaggerated version of the downsides of government-run health care.
  • The France Problem. While the NHS model actually has a certain appeal to me (leave that for another day), it's something that utterly lacks political appeal in the USA and isn't a realistic model for any American reforms. The most likely candidate for something we would want to imitate is France. Unfortunately for the cause of American health care reform, France and the United States have a long-term history of cultural antagonism that makes "we should do it more like they do in France" a public policy kiss of death. Worse, most people are aware that the French economy does not perform in a manner many Americans would want to imitate. People tend not to peer too closely at what it is about the French model that leads to those results, and instead the whole thing gets tarred as bad. But nothing about adopting a French-style health care system would require us to adopt French-style labor rules, French-style housing projects, French-style approaches to cultural diversity, French-style dirigisme, etc., etc., etc. Perhaps most crucially, it wouldn't force us to adopt French-style tax rates.
  • The Canada Problem. The US-Canada health care dynamic is assymetrical, because wealthy Canadians can travel to the United States to take advantage of the aspects of our system that work better (for relatively prosperous people) than does their system, while working- and middle-class Americans can't go to Canada to take advantage of the aspects of their system that work better than ours. The result is that you have lots of anecdotal evidence of people fleeing Canadian waiting lists to get their hips fixed in the USA, but no anecdotal evidence of people taking their kids to Canada to get affordable, high-quality preventative care for their kids. In the limited domain of pharmaceuticals, this has changed and Americans now can (and do) go to Canada to get cheap drugs. Not coincidentally, I think, this is the area in which you have the most public support for left-wing solutions.
  • Cost Underestimation. Apropos of the French-style taxes, it seems natural to assume that governments which provide health care for all their citizens are spending more than are government which provide health care to only some citizens. It's natural to assume, but it isn't true. Reporting on the actual composition of federal spending is always dismal, which leads people to grossly underestimate the extent to which your tax dollars are already going to pay for health care, since Medicare is a universal coverage program for the segment of the population that is by far the most expensive to treat.
  • Hidden Costs. On the private-sector end, few people understand exactly how much is being spent on health care. This is because the employer side of insurance premiums is hidden from the view of all but payroll people and policy wonks. Additionally, the scale of tax subsidies provided to the health care industry is basically unknown to all beyond the elite.
  • Bipartisanship as Fairness. Perhaps the biggest problem is simply that since single-payer isn't the official view of the Democratic Party. One problem with "he said, she said" writing is that if he is lying, he gets to get away with it. Perhaps a bigger problem is that if he and she agree that we shouldn't do X, it winds up going without saying that X is, in fact, a terrible idea. If a major political official started insisting that France had a great health care system, you might be able to browbeat the press into acknowledging that he was right. But until someone does it, it will simply continue to be taken for granted that it must not be.
  • Rich Journalists. Last but by no means least, one must point out the obvious. If you're well-off and seriously ill, the American system probably is the best in the world. Even if you are wealthy, you might never have gotten so seriously ill if you'd been living in a country with proper health care, but once you are seriously ill, the USA is the place to be. Journalism is dominated by relatively prosperous people, and perceptions of the health care system are dominated by people who have a great deal of experience with it, which is to say people who have been seriously ill who who've had close family members fall seriously ill. The things the American system is really, really bad at tend to be hidden from view.
Beyond all this is a very serious meta-problem, namely that, somewhat counterintuitively, giving people high-quality health care isn't very effective as a means of producing good health outcomes. Certain medical problems -- getting shot, or hit by a bus, or falling off a ladder -- really are best dealt with by having doctors, nurses, etc. take care of you. It's also pretty easy to design a health care system that will cope with this stuff. Most things, however, are much easier to cope with on the front end through preventative lifestyle choices than on the back end through the provision of health care.

April 12, 2005 | Permalink

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Comments

The other France Problem is that their health-care system can take August off, leading to 15,000 deaths from a heat wave. Which is another aspect of socialized medecine - after all, why would any health care providers want to work during August, if it is impossible to make any money? - that Americans would not likely want to emulate.

Posted by: Al | Apr 12, 2005 3:42:54 PM

Aren't French workers more productive than US ones [on an hourly basis]?

It is suprising to me that some young, ambitious politician would not advocate some type of Universal care -- this is obviously going to be a big battle in the somewhat near future, and getting name recognition with the issue, even if it would be politically damaging in the short term, would be just the kind of thing that might make a candidate not ridiculous to consider.

Posted by: theCoach | Apr 12, 2005 3:48:09 PM

socialized medecine

Sheesh, Al, get it right. France has a single payer system--imagine Medicare expanded so it covered everyone. England is the country with "socialized medicine", where the doctors work for, and the hospitals are run by, the Government.

And by the way, right now our government agencies, state and federal, spends as much money on medical care, as a percent of GDP, as France does to cover its entire population. So there is something seriously wrong with our system.

Posted by: Freder Frederson | Apr 12, 2005 3:54:00 PM

Big Brother Government funded health care is the road to the 1984 Nazi state tyranny that Democrats envision.

Posted by: Modern Crusader | Apr 12, 2005 3:59:28 PM

"while working- and middle-class Americans can't go to Canada to take advantage of the aspects of their system that work better than ours."

Never shopped for laser eye surgery along the norther tier of states, have you? That IS one area where there's traffic going in the other direction.

Anyway, it seems to me you've omitted from hidden costs, the extent to which other countries benefit as free riders on American new drug development. And we can't all be free riders, if we want new drugs to be developed.

Posted by: Brett Bellmore | Apr 12, 2005 4:03:52 PM

The model for American universal health care should be Social Security.

Through Medicare, there would be a basic single payer health care benefit for all citizens. And much like Social Security, most Americans would supplement this basic benefit with additional insurance.

Without additional insurance, you would face a Canadian style system with all of its delays and problems. If you can afford it, you would get a more first class health care experience.

Posted by: Petey | Apr 12, 2005 4:09:26 PM

The model for Nazi-style universal health care, if we want it to fail, should be Social Security.

Big Brother Government funded health care is the road to the 1984 Nazi state tyranny that Democrats envision.

Posted by: Modern Crusader | Apr 12, 2005 4:12:13 PM

"Journalism is dominated by relatively prosperous people"

Hence the lack of media support for a wide variety of progressive programs, and the perennial support for cutting entitlements.

Media folk are the prototypical Dean Democrats.

Posted by: Petey | Apr 12, 2005 4:12:25 PM

Could somebody explain the French system in more detail? I found this on wikipedia:

*

* In France, most doctors remain in private practice; there are both private and public hospitals. Social Security is a public organization (actually, several of them) distinct from the state government, and with separate budgets. It generally refunds patients 70% of most health care costs, and 100% in case of costly or long-term ailments. Supplemental coverage may be bought from private insurers, most of them nonprofit, mutual insurers. Until recently, social security coverage was restricted to those who contributed to social security (generally, workers or retirees), excluding some poor segments of the population; the government of Lionel Jospin put into place the "universal health coverage".


It seems like a pretty good system, but I'd like to find out a bit more. I'd also be interested in hearing a good liberal response the "free-loader" issue with prescription drugs.

Posted by: John | Apr 12, 2005 4:26:42 PM

Matt, you know more than me about this. How much do top journalists earn? I'm not talking NYT op-ed writer or cable news talking head, but a veteran journo at a major daily. The one guy like this that I know makes about $65k. A good salary but a lot less than he or other smart journalists could make in finance, law or medicine. The ultra-wealthy media figures argument is one of the right's most useful in disparaging the "mainstream media," and I think it's time we put it to rest.

Posted by: Jeff | Apr 12, 2005 5:01:59 PM

As a relatively junior Prospect writer, Matt only makes around $200k/year. He doesn't get his own private jet the way TNR writers do.

Posted by: Petey | Apr 12, 2005 5:09:01 PM

good liberal response the "free-loader" issue with prescription drugs

There is no "free-loader" issue other than free-loading pharmaceutical companies. Drugs R&D is paid for by taxpayers and then the results are handed over to the private sector for patenting, manufacturing, marketing, distribution and getting completely undeserved super-profits.

Posted by: abb1 | Apr 12, 2005 5:13:06 PM

"There is no "free-loader" issue other than free-loading pharmaceutical companies. Drugs R&D is paid for by taxpayers and then the results are handed over to the private sector"

To a limited extent, I have no problem with the general fund subsidizing some pharma R&D that the private sector later profits from. What I do have a problem with is U.S. consumers being forced to subsidize pharma profits. It's both regressive, and morally unacceptable when many U.S. consumers can't afford the drugs they need.

Posted by: Petey | Apr 12, 2005 5:17:35 PM

Imagine if we take the amount we're overpaying big pharma by in Bush's bloated prescription drugs package and turned that money into bounties for researchers to solve problems. I find it hard to believe progress will not come out ahead.

Big Pharma spends much, much more on ads than on R&D. Their profit margins are also much fatter than most other industries. It's time they have to go down.

And Al et. al.: The summer of Dead Grandmas canard has already been thoroughly debunked. The numbers are not meaningful because they include all old people who happened to have died during that heat wave, not just those who died because of it. Secondly, many of those who did die because of the heat succumbed in their homes. Their family was not around to take them to the hospital because August is vacation month in France. You can blame the French for not getting better air con, but not their medical system because those grandmas never got near the medical system.

Face it guys. In this case it's just embarrasing to go "USA numba one!" when the evidence is so glaringly to the contrary.

Posted by: battlepanda | Apr 12, 2005 5:39:55 PM

Matt,
Could one of your Big Media magazines assign someone to do a story on the State of Oregon's health care system? As I understand it, it works much like France's. Has it been successful? Have costs gone down? Is preventative medicine working?

Cranky

Posted by: Cranky Observer | Apr 12, 2005 6:02:32 PM

"Could one of your Big Media magazines assign someone to do a story on the State of Oregon's health care system? As I understand it, it works much like France's. Has it been successful?"

Oregon's interesting experiment was terminated in 1992 by Bush the Elder's administration.

It is a decent model for a US single payer system modeled on Social Security.

Posted by: Petey | Apr 12, 2005 6:09:47 PM

http://www.marginalrevolution.com/marginalrevolution/2005/03/the_sources_of_.html

My suspicion is that there are two outcomes to a reform that pushes US expenditures per head down to levels similar to Canada:

1) The gaping hole left by the US consumer is filled with tax dollars, at which time everyone's healthcare plans would need to be reevaluated for cost vs. efficacy. Nevermind whether the tax hike would have negative effects on growth itself.

2) The hole is not filled and innovation slows to a crawl.

I am a reluctant member of the 'leave it alone' camp for these reasons. I would love for everyone else to actually pay for the drugs they use, so we can see how the economics of single payer works out absent a monstrous subsidy. I just don't know that it would actually work out that way.

Posted by: Jason Ligon | Apr 12, 2005 6:58:59 PM

Speaking of going north of the border for medical care, here is my real life example of my experience with the Canadian system:

I went skiing at Whistler, BC in January of 1997 and tore my ACL. I ended up in the clinic in Whistler. I saw the Doctor, received X-rays, got crutches, a knee brace, and a prescription for tylenol 3. Overall I would rate the care as excellent. My entire bill was CN $400 (U.S. $300) plus CN $5 to fill the prescription at the pharmacy across the street. Total costs associated with the surgery back in the states was over $20,000.

Nine months later I was riding my bicycle in Washington, D.C. and had a collision with a car. I split my chin open and needed 27 stitches. Total bill for that emergency room visit at GWU Hospital, $3200. Granted they did do a CT scan, but without that it would have still been over $2000.

Posted by: Freder Frederson | Apr 12, 2005 7:16:43 PM

And Al et. al.: The summer of Dead Grandmas canard has already been thoroughly debunked. The numbers are not meaningful because they include all old people who happened to have died during that heat wave, not just those who died because of it.

Battlepanda - that's just an outright lie. The French government itself put out the 15,000 number, which constitutes the number of EXCESS deaths, blamed on the heat wave, not the number of total deaths. Moreover, the French government put out a report that blamed the deaths on "hospital understaffing during summer holidays, chronic bureaucratic snags and a dearth of elderly care". It added that the reason that many elderly died at home was that "a 'massive' exodus of doctors on August vacation left many elderly to fend for themselves." http://www.kansascity.com/mld/kansascity/news/breaking_news/6721173.htm

There's the result of your fabulous single-payer system. I realize that 15,000 excess deaths is what all the pro-socialized medicine advocates are hoping the US could get for itself, but I'll pass.

Posted by: Al | Apr 12, 2005 7:21:44 PM

The lack of information on pharmaceutical research evidenced on this board is awful.

"There is no "free-loader" issue other than free-loading pharmaceutical companies. Drugs R&D is paid for by taxpayers and then the results are handed over to the private sector for patenting, manufacturing, marketing, distribution and getting completely undeserved super-profits."


A) The NIH doesn't develop drugs.

B) It doesn't develop drugs because it is really bad at it.

C) Investing in Pharma companies is VERY risky. The profit margin in those that survive has to be high or else no one would ever take a huge risk of investing lots of money and not only making zero profit, but getting none of your investment back. I live in San Diego, with a huge pharma research industry. I know dozens of doctors who have worked their entire careers without ever working with a drug that made it all the way to market. Those failures have to be paid for.

"Big Pharma spends much, much more on ads than on R&D. Their profit margins are also much fatter than most other industries. It's time they have to go down."

Ughh. The stat you are alluding to involves advertisement AND operating overhead such as secretaries, patent lawyers, copiers, buildings, etc. Every company that does anything has expenses like that.

Please go read Derek Lowe on a regular basis. Please.

Posted by: Sebastian Holsclaw | Apr 12, 2005 7:28:37 PM

In France, a country with a population of about 60 million people, about 15,000 people died during the heat wave.

In Chicago, Ill., a city with a population of 2.7 million, about 740 people died during the 1995 heat wave.

If you do the math, you will see that the percentages are approximately equal (.0248% for France as opposed to .0273% for Chicago).

Why are you so concerned about the French who died when the same proportion of Chicagoans died right here in the United States, Al? The French counted the number of heat deaths nationwide -- how many nationwide heat deaths were there in the United States in 1995? Nobody knows, because every state and municipality reported them differently, or not at all.

A hidden problem is still a problem.

The terrific book about the Chicago Heat Wave has a FAQ here:

http://tinyurl.com/22mvp

Posted by: Mnemosyne | Apr 12, 2005 7:51:57 PM

The lack of information on pharmaceutical research evidenced on this board is awful.

It's nice that you believe that profit motivated pharmaceutical research is the most beneficial for mankind, but it just ain't true. No matter how you slice it, the pharmaceutical firms in this country spend more on both profits and marketing than on R&D, so obviously their priorities are 1)making money, 2)selling drugs 3)helping mankind, in that order--no matter how many heart warming commercials they put out. Also, because the drug companies are more interested in making money than saving humanity they spend a lot more money on developing and marketing drugs that will give you a four hour erection than, say oh, getting serious about developing the next generation of malaria drugs. Not to mention dreaming up new diseases or uses for old drugs or slightly altering the formulation to extend patents and trying to prevent third world countries from developing alternatives to expensive AIDS drugs. And don't forget, if it turns out that a drug, say a flu vaccine, is low profit, our pharmaceutical industry won't even bother to produce it, even if it is in the public interest. So they really aren't doing us any favors, are they?

And just because some shill for PHARMA has a website doesn't mean we should swallow his propaganda.

And by the way, there are a lot of European pharmaceutical companies that do just fine thank you, even though they have evil socialist healthcare systems and price controls on drugs.

Posted by: Freder Frederson | Apr 12, 2005 8:05:04 PM

"And by the way, there are a lot of European pharmaceutical companies that do just fine thank you, even though they have evil socialist healthcare systems and price controls on drugs."

See the Marginal Revolution link in my post above. The European pharma companies make their money in the same place the US pharma companies make thiers ... in the US market.

Posted by: Jason Ligon | Apr 12, 2005 8:12:16 PM

I'm afraid Sebastian hasn't added much to the "wonder drug" discussion.

The major advances in our longevity and well-being came from better food and safer working conditions. Arguably, the good that pennicillin did originally is now being eroded by promiscuous prescribing by MDs- that's right, the same MDs who receive, each and every one of them, $11,000 worth of drug company "information" each year. If you could see the toys the drug companies send the doctors you would understand why the basic necessary message isn't getting through.

Drug companies don't add that much. After working community health for 12 years I went back to work in the hospital. There was one (1) drug that was new to me, and it wasn't that important.

As for Sebastian's canard about the NIH not developing drugs, of course it doesn't, it's an umbrella organization.

Americans are basically children, fascinated by pills and shiny machinery, convinced that maybe anyone can turn into Superman if the right wonderdrug or antigravity device is "discovered". That's just a psychological shortcoming, not a plan for advancing health.

Sheesh, enough with the wonderdrug claims already.

Posted by: serial catowner | Apr 12, 2005 8:18:51 PM

I would have no problem with a single payer system, but perhaps the Swiss model would be more palatable in this country.

In Switzerland, the insurers are private and the health care providers are private. The government's role is primarily regulatory.

These are the rules as I understand them:

It is mandatory for every citizen to have health insurance. The government may provide subsidies for those who cannot afford it.

The government specifies the coverage that must be provided by the insurers.

Insurers must accept all applicants.

The system is comparatively expensive among European countries, but is far cheaper per capita than the US.


Posted by: Mike McK | Apr 12, 2005 8:23:01 PM

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