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September 29, 2005

AEI Hackery

I wish people would stop saying things like this. From the description for AEI's new book on health care:

America’s health-care system is the envy of the world, but it faces serious challenges.

No, no it's not. The developed world is packed with better health care systems than ours while the developing world knows it wouldn't be covered under our incarnation, it'd have to turn towards our Medicaid/Medicare attempts to copy European systems that they could simply covet instead. Much easier to slice out the middle man there and just envy France.

In fact, Americans don't even want our health care system. It's not like we can't dig up numbers on this. Indeed, you just have to surf over to PollingReport for the polls:

"Canada has a universal health care system run by the government that covers all people. Compared to Canada, do you think the overall health care system in the United States is better, worse or about the same?"
Better: 29%
Worse: 37%
Same: 23%
Unsure: 11%

For those struggling with the numbers, "Canada Rocks!" is clearly in the lead. As for the book, it couldn't look hackier. By stamping down on anticompetitive behaviors and reforming the way we tax, we'll save $60 billion and make health care more affordable, thus extending it to 6 million or so folks who don't already have it. That every other industrialized nation boasts full coverage for significantly less is the sort of thing that doesn't make it onto the dust jacket. This is wonkishness with blinders. What makes it so irritating is that these guys know all this. They know Americans aren't satisfied with our care, they know our health system is widely thought regressive, they know single-payer delivers better results for less money. But with ideological tunnel vision and selective statistics, they make the opposite case.

If our health care system was the envy of the world, other nations would duplicate it. That, instead, all those who can afford first world systems have copied the European model really says all you need to know.

September 29, 2005 in Health Care | Permalink

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Tracked on Sep 30, 2005 7:42:29 PM

Comments

I think people who say "America’s health-care system is the envy of the world" mean "if someone had to choose between the medical services provided at an American hospital and those provided at a/an [insert any other country here] hospital, most people would choose an American hospital." Unfortunately they internally divorce the quality of treatment from any other factor (e.g. ability to pay).

So, assuming everyone can afford the treatment, America's health care is the envy of the world, unfortunately the assumption is wrong.

Posted by: Ugh | Sep 29, 2005 7:48:04 PM

I don't think you're right Ezra, that Americans know we aren't the envy of the world. I was suprised when I saw the statistics of how much more we pay per capita for healthcare than the rest of the world, and we cover less people. Coupled with the data that shows we are behind in infant mortality and other measures of health, it's quite shocking.

I think the problem is that the pundit class and the active political class (people who vote) don't really get this. America has two systems, one for the haves, which undoubtedly is envied by many in the world, and one for the have nots. My Canadian in-laws do indeed envy us in that we don't have to wait for procedures, have more choices, etc. The people who struggle with the healthcare system are largely unseen.

So, I think there's a lot of room to show Americans what a real healthcare system should be like. I'm really surprised that corporations aren't pushing for universal healthcare, since they would be big beneficiaries.

Posted by: Unstable Isotope | Sep 29, 2005 7:56:58 PM

First rule of opinion polls: don't expect them to represent anything remotely resembling physical reality.

This is true for any poll, on any subject.

Futures markets tend to do a much better job (something to do with putting your money where your mouth is), but even they fail every so often.

Posted by: Mastiff | Sep 29, 2005 9:11:11 PM

Ah yes, don't listen to the people, when given a clear question they don't know what the hell they think, even if they say they do.

Folks -- that's not an ambiguous poll. People think Canadians get better care than they do. They may be wrong, it may not translate into policy support, but you can't really argue with the belief.

Posted by: Ezra | Sep 29, 2005 9:20:15 PM

The AEI have consistently shown themselves to be the hackiest of hacks. If it weren't for the parlous state of journalism in America it would amaze me that anyone takes them seriously. If you want a serious conservative thinktank, go to Cato. They may be equally loony right wingers, but at least they've got some intellectual integrity.

Posted by: Ginger Yellow | Sep 29, 2005 10:28:08 PM

France doesn't have single payer.

Posted by: Drew Miller | Sep 30, 2005 12:05:13 AM

First rule of opinion polls: don't expect them to represent anything remotely resembling physical reality.

Here's the thing-- the AEI didn't make a definitive statement regarding the objective quality of US healthcare. The AEI said that the system was "the envy of the world." That is precisely the sort of thing that can be measured by opinion polls.

Posted by: Constantine | Sep 30, 2005 12:23:36 AM

... But with ideological tunnel vision and selective statistics, they make the opposite case.

... As it is, they're going to ruin some lives because it's the path of least resistance.

Are you starting to detect a pattern here? Like, oh, "substance be damned, who's paying my bills and what do they want"? Truly shocking, I know.

Posted by: tatere | Sep 30, 2005 12:46:06 AM

If you had a life-threatening illness, would you rather be treated at Sloan Kettering or the Mass General in the States, or at a Canadian university hospital? I don't think there is any doubt that the best of American medical care is the best in the world. I guess the Canadian system is OK if you like a system that rations healthcare bureaucratically, makeing people wait months for whatever some bureaucrat thinks is not essential, and prevents anyone from getting better healthcare than anyone else, even if nobody's is very good.

Posted by: DBL | Sep 30, 2005 9:57:11 AM

And I guess America's is okay if you're, well, rich, and like a country that rations health care by income, makes people wait forever for procedures they can't afford, lets treatable conditions balloon into catastrophic illnesses, and has shockingly poor health outcomes despite what many of its citizens seem to think.

Posted by: Ezra | Sep 30, 2005 10:24:27 AM

DBl's question is better phrased as:

"If you had a life-threatening illness and a big wad of cash or generous insurance, would you rather be treated at Sloan Kettering or the Mass General in the States, or at a Canadian university hospital?"

Me? The vast majority of "life-threating illnesses" are pretty well understood by most western industrialized medical systems. And playing the odds, I'd rather know that a serious illness wouldn't bankrupt me and my family. I'd rather know that we were't treating the poor exclusively in emergency rooms when their illness gets so bad that they can't take it any more (because that one's going to bite us in the ass for sure one day).

And of course the "nobody's health care is very good" line is kinda crap. AFAIK most Canadians are pretty happy with their health care. What if you average out the median health care in the US: Some people get very good health care, some people get zero. Works out to "not very good", except the effects on the zero people are pretty severe.

Posted by: paperwight | Sep 30, 2005 10:32:51 AM

Ah yes, don't listen to the people, when given a clear question they don't know what the hell they think, even if they say they do.

OK, just so we are clear here. This is one of the issues where Vox Populi counts, right?

Posted by: Fred Jones | Sep 30, 2005 10:50:33 AM

Ezra, Why do you think that bureaucratic rationing is more moral than price rationing? I think you assume that is so but it is not so obvious to me. Healthcare is just another economic good/service like food, clothing, entertainment, housing, transportation, communication, etc. Like all economic goods and services, it is characterized by scarcity. Why do you think allocating that scarce good bureaucratically is more fair than allocating by price?

Paperwight - If Canadians are so happpy, why do so many of them come to the US and pay out of their own pockets for treatment here?

I think that we can all agree that the best of American health care is the best in the world. Leading advances in medical procedures and development of new drugs for the most part come from the US, not from Canada or Europe or Japan. I would respectfully suggest that any changes you might propose to the US healthcare system not throw the baby out with the bathwater - whatever you do must not in any way limit the ability of the US healthcare system to deliver the best and most advanced care in the world.

I would also suggest that you forgo any changes that would eliminate the ability of people to choose their own doctors and select their own procedures with their own money; most people in this country are satisfied with their health care arrangements and screwing them to take care of the minority who are not would be politically stupid.

Posted by: DBL | Sep 30, 2005 10:53:48 AM

"Canada has a universal health care system run by the government that covers all people. Compared to Canada, do you think the overall health care system in the United States is better, worse or about the same?"

That's actually a pretty poorly worded question. People are astonishingly inattentive to the precise wording of survey questions, especially if they're part of a very long series of questions, and any question that puts the object of a comparison before the subject of the comparison is asking for trouble.

The question should maybe be worded:

Do you think that America's overall health system is better than Canada's, about the same as Canada's, or worse than Canada's?

What implications this has for the results are unclear.

Posted by: Jason | Sep 30, 2005 11:04:16 AM

Sloan-Kettering is a cancer-specialist hospital, I believe. If I had a life-threatening cancer that other groups couldn't handle, I'd prefer to be at Sloan. However, realistically, I'd have to see the statistics regarding whether going there would give me a better chance of surviving than anyplace else. In all likelihood, I'd probably die in both cases.

In the aggregate, do outcomes really differ that much if you have equal access to baseline medical care? Perhaps not.

Posted by: Constantine | Sep 30, 2005 12:01:13 PM

In response to people who sill swallow the canard that Canada's system makes you wait months, and that. by extension, USA rocks, I published this: at my blog, SteveAudio.blogspot.com

But, now, for the first time, the Canadian Institute for Health Information has published actual data on ER waiting times and, on the surface at least, the waits don't seem too bad.

The research, for 2003-2004, the latest available, shows that half of emergency room patients are treated by a doctor in less than one hour.

"The median wait time is 51 minutes," said Jennifer Zelmer, vice-president of research and analysis at CIHI, a non-profit organization.

Posted by: SteveAudio | Sep 30, 2005 12:03:01 PM

One thing that would make me, an American living in England, think hard before returning to the States would be the healthcare mess. For all the complaining people do here about the National Health Service -- and there's good reason to complain -- people do get medical care, and sometimes very good medical care. People don't get bankrupted because of medical bills. People don't avoid going to get minor things treated because they're unable to pay for a visit to the doctor. And there's not much difference in the amount of taxes we pay.

Posted by: peter snees | Sep 30, 2005 12:46:21 PM

"The vast majority of "life-threating illnesses" are pretty well understood by most western industrialized medical systems."

Having been through several of life-threatening illnesses with family members, with a few exceptions, most major metro areas in the US have excellent facilities. In all reality, most people's health insurance is not going to cover them if they want "untested" treatments or to go out-of-network to the celebrity hospital of choice.

Posted by: CParis | Sep 30, 2005 2:36:23 PM

Whats is this nonsense about not waiting for healthcare in the United States? I had to wait 1 month just to SEE a digestive specialist and 3 months to see a pulmonary (sp?) one. You're saying Canada is much worse than that?

Posted by: Adrock | Sep 30, 2005 3:02:05 PM

Furthermore, it stands to reason that if we currently pay double per GDP what any other industrialized nation does, we should be able to institute a far more comprehensive system than those other countries if we just spent the same amount as we do now.

I pay roughly $1800 a year for myself, but its not as if that bankrupts me. If the tax system were arranged in a way that doesn't change that, but does cover everyone which in turn brings overall costs per person down due to preventative care, wheres the harm?

We can do better. We just have to have people seriously interested in changing it instead of me me me 'ing it out of the public sphere.

Posted by: Adrock | Sep 30, 2005 3:25:13 PM

DBL wrote: "Paperwight - If Canadians are so happpy, why do so many of them come to the US and pay out of their own pockets for treatment here?"

The answer is they don't come here. See Phantoms In The Snow: Canadians' Use Of Health Care Services In The United States

"we collected data about Canadians' use of services from ambulatory care facilities and hospitals located in Michigan, New York State, and Washington State during 1994-1998. We also collected information from several Canadian sources, including the 1996 National Population Health Survey, the provincial Ministries of Health, and the Canadian Life and Health Insurance Association. Results from these sources do not support the widespread perception that Canadian residents seek care extensively in the United States. Indeed, the numbers found are so small as to be barely detectible relative to the use of care by Canadians at home."

Posted by: SteveH | Sep 30, 2005 3:44:44 PM

In all reality, most people's health insurance is not going to cover them if they want "untested" treatments or to go out-of-network to the celebrity hospital of choice.

Are you saying that the Canadian system will fund "untested" treatments? And of course, you don't have the choice of going 'out-of-network'.

Posted by: Fred Jones | Sep 30, 2005 5:28:33 PM

Fred wrote: "And of course, you don't have the choice of going 'out-of-network'."

What do you mean? A Canadian can walk into any hospital or doctor in their country and get treated. It's totally their choice, unlike my health coverage here in the USA.

Posted by: SteveH | Sep 30, 2005 5:42:22 PM

Fred : Doesn't your policy have restrictions and limits ? Doctors are not required to accept medicare. But they are either in or out. Treatments have been funded out-of-country for Canadians where it was impractical or impossible in country. And U.S. treatment may be eligible for reimbursement ; not, however, at U.S. rates. Ouch ! So Canadians travelling shop for private coverage.

Posted by: opit | Sep 30, 2005 11:48:00 PM

Treatments have been funded out-of-country for Canadians where it was impractical or impossible in country.

So what mainstream procedures must Americans go out-of-country for?

Posted by: Fred Jones | Oct 1, 2005 8:37:33 AM

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