Left vs. Right on Health Care

Two sides of the health care debate can be seen in this exchange. Andrew Sullivan quotes Ezra Klein:

In 2006, adjusted for purchasing power, the United Kingdom spent $2,760 per person on health care. America spent $6,714. It’s a difference of almost $4,000 per person, spread across the population. That’s $4,000 that can go into wages, or schools, or defense, or luxury, or mortgage-backed securities. And there’s no evidence that Britain’s aggregate outcomes are noticeable worse. But they do say “no” a lot more than we do. Their system refuses to pay high prices for medical technologies and pharmaceuticals that it judges insufficiently effective. They’ve forced themselves to make choice, because they have something we don’t have: A global budget. They are willing to spend a certain number of dollars (well, pounds) on health care each year, and no more than that. If resources aren’t unlimited, then choices need to be made. It’s not quite correct to say that those choice will mean letting someone die, but they do mean putting limits on what we will spend to keep them alive.

Sullivan comments:

One reason I’m a conservative is the British National Health Service. Until you have lived under socialism, it sounds like a great idea. It isn’t misery – although watching my parents go through the system lately has been nerve-wracking – but there is a basic assumption. The government collective decides everything. You, the individual patient, and you, the individual doctor, are the least of their concerns. I prefer freedom and the market to rationalism and the collective. That’s why I live here.

Philosophically I sympathise with Andrew Sullivan. Pragmatically we cannot ignore these differences in spending, especially considering the large number of American who are uninsured or under-insured.

The answer is somewhere in between the extremes of the far left and right. Having the government simply stay out of health care is not the answer as our system is unsustainable. That does not mean imitating the British model is the solution. We need a uniquely American model which might learn from the British system and other foreign systems but which still respects freedom of choice (even if such choice cannot be absolute). Fortunately the British system is not really on the table here.

Jonathan Chait also prefers a solution different from the British system and responds to Andrew Sullivan by looking from the perspective of adopting the American system:

Andrew is completely missing the point. Nobody is proposing to import the British health system to America. But the conservative habit of pointing out that getting health treatment in the U.S. is better than getting it in the U.K. (as long as you have health insurance, that is) tells us nothing. Is American health care nearly three times better? Suppose you offered every Brit a chance to pay almost three times the cost of what they’re currently paying for health care so they have an American-style system. Oh, and part of the bargain is that they have to accept a one-in-seven chance of having no insurance at all. How many of them would take it? Not very many, I’d say.

Ezra looks further at rationing, referring to an article in The New York Times on the British system:

The New York Times has a front page story today on the British system of rationing. It’s a long read, but an important one. And right up towards the top, you see why. The British system has made a choice. They have valued six months of life at $22,750. That’s all they can afford, they say. So here’s the question: In a government system in the US, should the government be on the hook for more than that? If six more months of life — not a cure, but a six month reprieve– would cost $50,000, should we pay for that, keeping in mind that that money is coming from priorities like education and food stamps and wages increases? Or should we have limits? Should the system itself ration?

Reason responds with regards to rationing:

A better system would allow people to purchase health insurance policies that reflect their own evaluation of how much an extra bit of life should cost. Some may choose gold-plated policies that pay for nearly any new treatment. Others may decide that it is more important to save money to give to their heirs than to try to purchase a few extra months of life that an expensive policy might provide. In other words, the “rationing” decision would made by individuals rather than by bureaucratic boards eager to protect the pocket books of taxpayers.

Sounds great in principle–if only everyone could afford coverage without risk of losing it when needed.

Update: This health care debate is discussed further in a follow up post: Satisfaction and Quality In Health Care Reform

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4 Comments

  1. 1
    Ray says:

    Speaking as a British citizen who now lives in the US, I have to take issue with Andrew Sullivan, who employs all the right-wing code words in his argument. I was particularly fascinated by his use of “collective”, for example. In short, I would say Mr. Sullivan is talking through the back of his head.

    I lived with the National Health Service for well over 40 years, and I have lived in the US for almost 20 years. There is simply no doubt whatsoever in my mind that the National Health Service, whilst of course it is not perfect, is vastly to be preferred over the special-interest-ridden, for-profit juggernaut that exists here in the US. Indeed, just about any universal system is to be preferred over what we have here.

    Yes, it is easy to find cases where patients are denied treatment, or have difficulty getting an appointment, or suffer due to malpractice. Note that I did not qualify the foregoing by specifying a country, since I can just as easily find examples here in the US as in the UK, or Canada, indeed any country for that matter.

    There is simply no excuse for the US to maintain the corrupt system that currently exists here, and I hope that the next administration will be able to make at least a start towards stepping into the 20th century (and no, that is not a typo) as far as universal coverage is concerned.

  2. 2
    Hugo Hackenbush says:

    I don’t hear people who don’t have access to inexpensive healthcare cheering the triumph of our completely non-socialized medicine.

    People who favor private insurance forget one thing, and that’s that a socialized system inherently costs less money since the profit motive is removed from the equation. Even when adjusted for supposedly hidden costs gov’t run insurance in the US is far more cost effective. And let’s not forget that government mandated health care doesn’t turn people away for made up reasons.

  3. 3
    cmhmd says:

    I always get a hoot when people call out OTHER countrties on lack of access: http://cmhmd.blogspot.com/search/label/Access%20to%20Treatment

    rationing: http://cmhmd.blogspot.com/search/label/Rationing%20Health%20Care

    and throw out all their great anecdotes: http://cmhmd.blogspot.com/search/label/%22Anecdote-Off%22

    I call Bull-Shine.
    Cheers,

  4. 4
    Ron Chusid says:

    Hugo,

    In general, people without health care coverage will support virtually any system which will give them coverage, while people who have coverage (and have not faced problems with it are happy.

    Many people with coverage do fail to realize how precarious that coverage is as they have not experienced problems of denial of coverage. However, while people with government health care are not denied coverage by their insurance carrier, many people on Medicaid (and smaller numbers on Medicare) do have problems with receiving coverage.

    Any system which will be accepted here must take into account the fact that large numbers of people with coverage would not be willing to trade their coverage for a government program, and certainly would not be happy under a system like the British system. On the other hand, those who oppose any changes need to acknowledge that large numbers of people do not receive sufficient health care under our current system.

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