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.