USA! USA!
Here's Drum:
I find my head nodding quite a bit to those paragraphs. Matt Yglesias moves the ball a little further down the court by wondering whether this graph -- or at least an argument that put this graph into words -- would be a powerful point for Democrats.Well, there's a reason that data is rarely mentioned: it's because the Democratic plans on offer right now do very little to change it. For all the sturm und drang about rationing and killing grandma and so forth, the House and Senate bills currently on the table would have a pretty modest impact on the future growth of healthcare costs.
And there's a reason for that too: the only way to cut costs is to piss off the people who benefit from those high costs: doctors, hospitals, insurance companies, device manufacturers, and big pharma -- all aided and abetted by patients who never, ever want to be told no. It would be nice to think that we could enrage all these groups and still pass a healthcare bill based on sheer populist rebellion, but that's not in the cards. It just isn't.
The conventional wisdom, as expressed in this Third Way strategy memo, is that talking about foreigners is for losers: "Don't compare the U.S. to other countries, or assert that America does not provide quality health care. (i.e. Do not cite statistics that say the U.S. is 37th in the world in health outcomes)." They don't, however, share with us the research on which this is based...I don't see how failing to mention that results are actually better in other countries actually lets you avoid the argument. It seems to me to just avoid having a chance at winning it.I'm certainly not opposed to the kitchen sink approach to public relations. There are, after all, hundreds of town halls across the country, and our laboratories of democracy could potentially make good laboratories for incubating health care PR. But contra Yglesias, I think we do have research suggesting Americans don't want to be told their health care quality stinks. Here it is:
I think the counter-argument you're going to see to this is that US health care costs are high because we do so much of the research and innovation, which is expensive. In other words, those higher costs are a good thing.
I don't agree with this myself--if socialized medicine kills innovation, why is so much groundbreaking Cancer drug development done in Cuba? And wouldn't a socialized system have an even higher incentive, simply on cost cutting measures, to development news treatments and cures for terrible things like cancer?
But I digress. I think the real reasons our costs are so high are well articulated in David Goldhill's piece, and they don't have a thing to do with medical innovation.
Besides the political risks, another reason for not using this data is that it is misleading.
Cost-accounting probably explains much of the gap. For instance, in public systems, the high costs of training medical staff show up in public education expenditures b/c the state pays for the docs/nurses' education. Here, in our system, those same costs show up as health expenditures b/c the consumers reimburse the docs/nurses for the education costs through fee for services.
http://gregmankiw.blogspot.com/2009/06/physicians-incomes-and-healthcare-costs.html
Further, most the comparison countries (UK maybe excepted) do not have our underclass. Harmful cultural norms/habits associated with our American underclass have gigantic effects on healthcare expenditures. For instance, check out diabetes incidence (note WV; this probably mostly an income issue):
http://apps.nccd.cdc.gov/DDT_STRS2/NationalDiabetesPrevalenceEstimates.aspx
Further, as you mentioned, the comparison countries undoubtedly free ride off the R&D paid by Americans' through higher healthcare costs.
There are no doubt many other reasons explaining the gap.
Here's a good article written by an actual practicing economist with numbers, citations and other stuff that speculates on why we spend so much.
The place for opinion is: should we spend all that money? Personally, I like having great health care** and its more important that most of the other stuff I'd spend on. At the policy level, "we" shouldn’t decide what "they" pay. "We" should honor liberty and freedom. The government already pays 45% on the expense, so its entitled to get its house in order, but it shouldn’t take on more (either directly or by the public option Trojan horse).
Sorry to play mixed-metaphor police, but you need to be tased: a ball is moved down the field or dribbled up court.
** And we do have great healthcare if you measure actual care (e.g., diagnosis and treatment of cancer, heart disease, age-based general deterioration). You can't make U.S. healthcare worse than other countries by reference to actual medical care, you have to rely on proxies, like longevity, that are clouded by behavioral and distributive factors.
Down field, up court. You're absolutely right. Know that I feel the sting of your e-tase sharply. But your hyperlink isn't working for me.
Sorry, here it is: http://american.com/archive/2009/september/forecasting-the-cost-of-u-s-healthcare/article_print
Fogel is admittedly not definitive but is speculating; he makes some provacative points I had never considered.