Editore"s Note
Tilting at Windmills

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August 23, 2005
By: Kevin Drum

HEALTHCARE BLUES....Via Ezra, Malcolm Gladwell asks the key question about American healthcare in the New Yorker:

One of the great mysteries of political life in the United States is why Americans are so devoted to their health-care system. Six times in the past century during the First World War, during the Depression, during the Truman and Johnson Administrations, in the Senate in the nineteen-seventies, and during the Clinton years efforts have been made to introduce some kind of universal health insurance, and each time the efforts have been rejected. Instead, the United States has opted for a makeshift system of increasing complexity and dysfunction. Americans spend $5,267 per capita on health care every year, almost two and half times the industrialized worlds median of $2,193; the extra spending comes to hundreds of billions of dollars a year.

What does that extra spending buy us? Americans have fewer doctors per capita than most Western countries. We go to the doctor less than people in other Western countries. We get admitted to the hospital less frequently than people in other Western countries. We are less satisfied with our health care than our counterparts in other countries. American life expectancy is lower than the Western average. Childhood-immunization rates in the United States are lower than average.

....Nor is our system more efficient. The United States spends more than a thousand dollars per capita per year or close to four hundred billion dollars on health-care-related paperwork and administration, whereas Canada, for example, spends only about three hundred dollars per capita. And, of course, every other country in the industrialized world insures all its citizens; despite those extra hundreds of billions of dollars we spend each year, we leave forty-five million people without any insurance.

Gladwell suggests that although politics has a lot to do with America's weird and dysfunctional healthcare system, so does elite economic opinion. Read the whole thing to get his take on "moral hazard" and how it's warped the way American economists think about healthcare.

Aside from that, I think the passage above also highlights the big problem among non-elites: for some reason, Americans aren't pissed off enough about their healthcare to demand change. Americans are bizarrely obsessed by stories about six-month waits for hip surgery in Canada, and thus have no clue that virtually every advanced country in the world has healthcare that's better than ours, cheaper than ours, and covers more people than ours. All they can think about is that six month wait for hip replacements.

Sadly, this points to a serious problem: there will never be any dramatic change to American healthcare until more people realize just how bad our system is and get seriously angry about it. If this were a conservative issue, that wouldn't be any problem: the politics of anger is their standard approach to most problems anyway. For liberals, it's not quite so appealing.

Kevin Drum 2:24 PM Permalink | Trackbacks

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