Health
Care Excuses
By Paul Krugman (Nov. 9, 2007)
 The United States spends far more on health care per
person than any other nation. Yet we have lower life expectancy than most other
rich countries. Furthermore, every other advanced country provides all its citizens
with health insurance; only in America is a large fraction of the population
uninsured or underinsured.
You might think that these facts would make the case
for major reform of America's health care system - reform that would involve,
among other things, learning from other countries' experience - irrefutable.
Instead, however, apologists for the status quo offer a barrage of excuses for
our system's miserable performance.
So I thought it would be useful to offer a catalog of
the most commonly heard apologies for American health care, and the reasons they
won't wash.
Excuse No. 1: No insurance, no problem.
"I mean, people have access to health care in America," said
President Bush a few months ago. "After all, you just go to an emergency
room." He was widely mocked for his cluelessness, yet many
apologists for the health care system in the United States seem
almost equally clueless.
We're told, for example, that there really aren't that
many uninsured American citizens, because some of the uninsured
are illegal immigrants, while some of the rest are actually
entitled to Medicaid. This misses the point that the 47 million people in
this country without insurance are an ever-changing group, so that the experience
of being without insurance extends to a much broader group - in fact, more
than one in every three people in America under the age of 65 was uninsured
at some point in 2006 or 2007.
Oh, and finding out that you're covered by Medicaid when
you show up at an emergency room isn't at all the same thing
as receiving regular medical care.
Beyond that, a large fraction of the population - about
one in four nonelderly Americans, according to a Consumer
Reports survey - is underinsured, with "coverage so meager they often
postponed medical care because of costs."
So, yes, lack of insurance is a very big problem, a problem
that reaches deep into the middle class.
Excuse No. 2: It's the cheeseburgers.
Americans don't have a bad health system, say the apologists,
they just have bad habits. Overeating and teenage sex, not
the huge overhead of America's private health insurance companies - the
United States spends almost six times as much on health care administration
as other advanced countries - are the source of our problems.
There's a grain of truth to this claim: Bad habits may
partially explain America's low life expectancy. But the
big question isn't why we have lower life expectancy than Britain, Canada
or France, it's why we spend far more on health care without getting better
results. And lifestyle isn't the explanation: the most definitive estimates,
such as those of the McKinsey Global Institute, say that diseases that are
associated with obesity and other lifestyle-related problems play, at most,
a minor role in high U.S. health care costs.
Excuse No. 3: 2007 is better than 1950.
This is an argument that baffles me, but you hear it
all the time. When you point out that America spends far
more on health care than other countries, but gets worse results, the apologists
reply: "Sure,
we spend a lot of money on health care, but medical care
is a lot better than it was in 1950, so it's money well spent." Huh?
It's as if you went to a store to buy a DVD player,
and the salesman told you not to worry about the fact that
his prices are twice those of his competitors - after all,
the machines on offer at his store are a lot better than
they were five years ago. It is, in other words, an argument
that makes no sense at all, yet respectable economists make
it with a straight face.
Excuse No. 4: Socialized medicine! Socialized medicine!
Rudy Giuliani's fake numbers on prostate cancer - which,
by the way, he still refuses to admit were wrong - were the
latest entry in a long, dishonorable tradition of peddling scare stories
about the evils of "government
run" health care.
The reality is that the best foreign health care systems,
especially those of France and Germany, do as well or better
than the U.S. system on every dimension, while costing far less money.
But the best way to counter scare talk about socialized
medicine, aside from swatting down falsehoods - would journalists
please stop saying that Rudy's claims, which are just wrong, are "in
dispute"?
- may be to point out that every American 65 and older is
covered by a government health insurance program called Medicare. And
Americans like that program very much, thank you.
So, now you know how to answer the false claims you'll
hear about health care. And believe me, you're going to hear
them again, and again, and again.
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