Health Care: Beyond Dogma & Sentimentality

No one should die because they cannot afford health care, and no one should go broke because they get sick.

People supporting health care reform are posting this sentiment on Facebook and Twitter. I agree with the sentiment, but literally, I don’t think it’s true. For example, if some 90 year old white supremacist pedophile needed to bankrupt the nation for an extra two weeks of life on a ventilator, I’d say he should die because he can’t afford health care and, better he should go broke than everyone else.

I think we need to abandon our system, not because a person can die for lack of resources or because poor health can cause financial hardship, but for the more mundane reason that it’s not working well. And, we ought to model our system after one of the ones that is working better. “Better” in what way? Less medical expense per capita in exchange for better results. Infant mortality would be one metric. We rank 33rd there. We’re the most productive country in the world, we and we can’t do any better than 33rd in terms of keeping our kids alive for their first year. Clearly, we’re doing it wrong.

More is spent on health care in the United States on a per capita basis than in any other nation in the world. A study of international health care spending levels published in the health policy journal Health Affairs in the year 2000 found that the U.S. spends more on health care than other countries in the Organization for Economic Co-operation and Development (OECD), and that the use of health care services in the U.S. is below the OECD median by most measures. The authors of the study conclude that the prices paid for health care services are much higher in the U.S. Medical debt is the principal cause of personal bankruptcy in the United States, weakening the whole economy.

According to data compiled and published by the international pharmaceutical industry, the US is the world leader in biomedical research and development as well as the introduction of new biomedical products; pharmaceutical industry trade organizations also maintain that the high cost of health care in the U.S. has encouraged substantial reinvestment in such research and development. Despite that, the US pays twice as much yet lags other wealthy nations in such measures as infant mortality and life expectancy, which are among the most widely collected, hence useful, international comparative statistics. For 2006-2010, the USA’s life expectancy will lag 38th in the world, after most rich nations, lagging last of the G5 (Japan, France, Germany, UK, USA) and just after Chile (35th) and Cuba (37th).[9]

We shouldn’t keep doing it wrong because of ideological fears of “socialism” or dogmatic notions that “taxation = theft.” Abstract figments of our imagination and word games shouldn’t stop us from getting better results. Similarly, in my mind, we shouldn’t structure our system around sentimentality about how every life is worth unlimited resources. Instead, we should strive for efficiency. How are we going to most effectively use our money to get the healthiest population we can?

I don’t know the *right* answer — if there is one *right* answer — but we should look to systems that are working better than ours: single payer systems like Canada or Australia; government run systems like England; multi-payer, public/private systems with compulsory premiums like Switzerland; or whatever works.