I don’t know enough about health care to render a definite verdict on future US policy. My baseline preferences were almost identical to what Brad Delong proposes, minus the nanny state vans of medical professionals and not-necessarily-well-supported sin taxes. This, however, is based solely on my basic intuition about incentives and behavioral economics. There’s no real nitty gritty analysis behind it.
I am swayed by the fact the people like Ezra Klein, who do know the nitty-gritty, seem to be in favor of a more traditional single-payer program. What doesn’t sit well with me are some the arguments from those who are opposed to single payer.
Everyone seems to accept that the United States has a lower life expectancy than most OECD nations but pays much more, in some cases twice as much, for health care. This is a damning piece of evidence on its face.
The claim by some commentators such Megan McArdle and Greg Mankiw is that this fact should be disregarded because the US does much of the medical innovation and has worse health habits. Yet, the claim that we should disregard this key fact — that we pay much more and our primary outcome indicator is worse — is an extraordinary one. I have not yet seen extraordinary evidence to support it.
Its not enough to point to some factors which might justify a higher expense for seemingly no gain. You need to show that these factors really do add up to the gap between Europe and the US. Otherwise, the weight of the evidence still falls in favor of those who want a more European style health care system.
2 comments
Comments feed for this article
Friday ~ July 17th, 2009 at 5:11 pm
Milton Recht
Actually, the unadjusted OECD life expectancy numbers are misleading. The US has the highest teenage pregnancy rate in the OECD and probably the world. About 8x Denmark, around 5x that of Europe and 3x Canada’s.
Teenage pregnancies are lower life expectancy and higher risk births for many reasons. It is a cultural and population diversity issue.
Also, due to our culture, country size, love of automobile, risk taking, homicide rate, etc life expectancy is lower for many reasons, such as accidents and homicides, that have nothing to due with medical care, disease prevention or treatment.
When one looks at any single disease, such as breast cancer, survival after heart attack, etc, where medical care is the relevant issue for surviving, the US does better than almost any other country. When it is an apple-to-apple comparison of medical care, the US shines. When it is apples to oranges, the US looks bad. Cost even needs to be looked at skeptically.
When there is delay in receiving effective treatment, many patient costs do not count as medical costs. For example, the US and the UK use two different antibiotics for eye infection. The US antibiotic is newer, more expensive and covers a broader spectrum of infections. The chance of curing the eye infection with one visit to the doctor is high. The UK uses an older, cheaper antibiotic that covers a smaller spectrum of bacteria. Many more cases in the UK require a second doctor visit and a different antibiotic. However, enough cases are resolved with the cheaper antibiotic that the costs of the second visit are less than the monies saved by using the cheaper antibiotic. In other words, the UK saves money. However, if one factors in the unmeasured social costs of the need to take time off from work for a second doctor visit, the lost work efficiency and extra days off due to an uncured eye infection, the US medical system is not more expensive. This is one of many reasons that the US has one of the highest worker productivity rates in the world and the UK’s is middling.
These thoughts occasionally are written about on some other blogs, but for some reason are not mainstream. Also, most teenage pregnancy problems are in minority groups and I can understand why the press does not want to mention it.
Friday ~ July 17th, 2009 at 9:22 pm
teageegeepea
What about McArdle’s claim, that I mentioned before, that America is more poorly governed and so if we expanded Medicare to cover anyone we’d still have high costs and little return?