[Mb-civic] Krugman

[Mike Blaxill]

http://www.truthout.org/docs_2005/110705O.shtml

Pride, Prejudice, Insurance
    By Paul Krugman
    The New York Times

    Monday 07 November 2005

    General Motors is reducing retirees' medical
benefits. Delphi has declared bankruptcy, and
will probably reduce workers' benefits as well as
their wages. An internal Wal-Mart memo describes
plans to cut health costs by hiring temporary
workers, who aren't entitled to health insurance,
and screening out employees likely to have high
medical bills.

    These aren't isolated anecdotes.
Employment-based health insurance is the only
serious source of coverage for Americans too
young to receive Medicare and insufficiently
destitute to receive Medicaid, but it's an
institution in decline. Between 2000 and 2004 the
number of Americans under 65 rose by 10 million.
Yet the number of nonelderly Americans covered by
employment-based insurance fell by 4.9 million.

    The funny thing is that the solution -
national health insurance, available to everyone
- is obvious. But to see the obvious we'll have
to overcome pride - the unwarranted belief that
America has nothing to learn from other countries
- and prejudice - the equally unwarranted belief,
driven by ideology, that private insurance is
more efficient than public insurance.

    Let's start with the fact that America's
health care system spends more, for worse
results, than that of any other advanced country.

    In 2002 the United States spent $5,267 per
person on health care. Canada spent $2,931;
Germany spent $2,817; Britain spent only $2,160.
Yet the United States has lower life expectancy
and higher infant mortality than any of these
countries.

    But don't people in other countries sometimes
find it hard to get medical treatment? Yes,
sometimes - but so do Americans. No, Virginia,
many Americans can't count on ready access to
high-quality medical care.

    The journal Health Affairs recently published
the results of a survey of the medical experience
of "sicker adults" in six countries, including
Canada, Britain, Germany and the United States.
The responses don't support claims about superior
service from the U.S. system. It's true that
Americans generally have shorter waits for
elective surgery than Canadians or Britons,
although German waits are even shorter. But
Americans do worse by some important measures: we
find it harder than citizens of other advanced
countries to see a doctor when we need one, and
our system is more, not less, rife with medical
errors.

    Above all, Americans are far more likely than
others to forgo treatment because they can't
afford it. Forty percent of the Americans
surveyed failed to fill a prescription because of
cost. A third were deterred by cost from seeing a
doctor when sick or from getting recommended
tests or follow-up.

    Why does American medicine cost so much yet
achieve so little? Unlike other advanced
countries, we treat access to health care as a
privilege rather than a right. And this attitude
turns out to be inefficient as well as cruel.

    The U.S. system is much more bureaucratic,
with much higher administrative costs, than those
of other countries, because private insurers and
other players work hard at trying not to pay for
medical care. And our fragmented system is unable
to bargain with drug companies and other
suppliers for lower prices.

    Taiwan, which moved 10 years ago from a
U.S.-style system to a Canadian-style
single-payer system, offers an object lesson in
the economic advantages of universal coverage. In
1995 less than 60 percent of Taiwan's residents
had health insurance; by 2001 the number was 97
percent. Yet according to a careful study
published in Health Affairs two years ago, this
huge expansion in coverage came virtually free:
it led to little if any increase in overall
health care spending beyond normal growth due to
rising population and incomes.

    Before you dismiss Taiwan as a faraway place
of which we know nothing, remember Chile-mania:
just a few months ago, during the Bush
administration's failed attempt to privatize
Social Security, commentators across the country
- independent thinkers all, I'm sure - joined in
a chorus of ill-informed praise for Chile's
private retirement accounts. (It turns out that
Chile's system has a lot of problems.) Taiwan has
more people and a much bigger economy than Chile,
and its experience is a lot more relevant to
America's real problems.

    The economic and moral case for health care
reform in America, reform that would make us less
different from other advanced countries, is
overwhelming. One of these days we'll realize
that our semiprivatized system isn't just unfair,
it's far less efficient than a straightforward
system of guaranteed health insurance.