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Edited on Sun Jan-14-07 12:15 PM by WhaTHellsgoingonhere
I put this together last spring...because somebody had to. It's a compilation of articles written by NYT OP-ED columnist Paul Krugman.
“American health care is unique among advanced countries in its heavy reliance on the private sector. It’s also uniquely inefficient,” argues Paul Krugman, professor of Economics and International Affairs at Princeton University.
Why is this the case? Special interests and privatization ideology have long colluded to quash reform. Special interests – the American Medical Association, the Health Insurance Association of America, insurance companies – form a powerful lobby that spends millions of dollars to block legislation aimed at providing insurance to the uninsured. Meanwhile, privatization ideologues, whose faith in free markets and continuous demonize of government intervention persists even when evidence points to the contrary.
Myth 1. Americans are lead to believe that we have the best health care system in the world.
Advanced countries, including Germany, France and Canada, spend far less per person for health care than the US. In 2002, the latest year for which comparable data are available, the US spent $5,267 on health care per person, while Canada spent $2,931 and France spent $2,736. Yet, a 2003 study published in Health Affairs found that, while the US scores high on high-tech services, such as MRI’s, on more ordinary measures, like the number of doctors’ visits and number of days spent in hospitals, the US is only average, or below average; identical procedures cost far more in the US than in other advanced countries. And most notably, Americans have lower-life expectancy and higher infant-mortality figures. This administration’s favorite whipping-boy, France, consistently ranks much better on most measures of health care quality than the US.
Waiting lists, which vary in length from country to country, are often offset by one’s inability to find adequate on-demand care in the States.
Taiwan, which has a population and economy similar to ours, moved from a US-style health care system to a Canadian-style single-payer system a decade ago. In 1995, less than 60 percent of Taiwan’s residents had health insurance; by 2001 the number was 97 percent. A careful study published in Health Affairs concluded that this huge expansion in coverage came virtually free due to rising population and incomes.
Finally, Health Affairs found that the medical experience of sicker adults in six countries, including Canada, Britain, Germany and the US, don’t support claims about superior service from the US system. Most notable here, Americans are far more likely than others to forgo treatment because they can’t afford it. Forty percent of Americans surveyed failed to fill a prescription because of cost. A third were deterred by cost from seeing a doctor when sick or from getting recommended tests or follow-ups. As a result, many Americans end up disabled or dead.
Myth 2. The unimpeded competition of free markets will produce the best outcome.
Currently, 46 million Americans are uninsured. The Commonwealth Fund, a nonpartisan organization that studies health care, found that 41 percent of nonelderly American adults with incomes between $20,000 and $40,000 were without health insurance for all or part of 2005. How can this be? Employment-based health insurance is the only serious source of coverage for Americans too young to receive Medicare and insufficiently destitute to receive Medicaid. But good insurance is hard to come by, because private markets are driven by adverse selection, in which bad risks drive out good. Consequently, insurance companies devote a lot of effort and money screening applicants, selling insurance only to those considered unlikely to have high costs, while rejecting those with pre-existing conditions or other indicators of high future expenses. In fact, due to administrative costs associated with the screening process and advertising, insurers spend less than 80 cents of each dollar on health insurance.
Of the $5,267 the US spends per person, $2,364, or 45 percent is spent by the government, not private insurers (compare that to $2,048 per person spent by the Canadian government; and $2,080 per person spent by the French government).
Needless to say, American health care is desperately in need of reform. Ironically, there exists a single-payer success story in the US. The Veterans Health Administration is one of the best-kept secrets in the health care debate. Overcoming years of a tarnished reputation of bureaucracy, inefficiency and mediocre care, reforms beginning in the mid-1990’s transformed the system, and the VA’s success in improving quality, safety and value has allowed it to emerge as a leader in health care.
Last year, customer satisfaction with VA health care as measured by an annual survey conducted by the National Quality Research Center, exceeded that for private health care for the sixth year in a row. The secret of its success is the fact that it’s a universal, integrated system. Because it covers all veterans, the system doesn’t need to employ legions of administrative staff to check patients’ coverage. Nor is it burdened with advertising costs incurred by private insurers. And because it covers all aspects of medical care, it has been able to take the lead in electronic record-keeping and other cost reducing innovations. The VA avoids dealing with insurance companies and is in a better position to bargain hard with medical suppliers, and pays far less for drugs than most private insurers. In short, cost saving practices employed by single-payer providers, like the VA or Medicare, can allow them to spend as much as 98 cents of each dollar on medical care.
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