Thursday, April 23, 2009

Sowell: U.S. medical care the best?

Here's one rebuttal to Thomas Sowell who said that U.S. medical care is the best:

"There is evidence that patients in the U.S. are getting less medical care as the economy worsens.  A March report from the Deloitte Center for Health Solutions said 25% of consumers have delayed medical care they couldn't afford because of the bad economy.  A recent analysis by the Associated Press found that diabetics were cutting back on care, possibly to the detriment of their health."

U.S. medical care may be the best, but only for those who can afford it.  And in a bad economy with higher unemployment, medical care is becoming even more inaccessible.  U.S. medical care is more than twice as expensive as the average in other industrialized countries, with health insurance costs rising 2-4 times above inflation year to year, and total costs for insured employees expected to rise 8.9% in 2009.  Sowell says Americans don't have to wait for medical procedures, but obviously they must wait if they are uninsured or underinsured and have to save up the money first.  Likewise, a Mercedes is a great car, and maybe I will own one someday, but I can't afford one now.  So what good is to me if I need to go someplace today?

The high cost of medical care leads directly to the high cost of health insurance.  Sowell is wrong (or just pedantic) to separate the two.

Most people who use the emergency room as their primary physician don't do so to reserve money for a "more upscale lifestyle," as Sowell claims.  It was callous and blue-blooded of Dubya to say that Americans can "just go to an emergency room" for medical care, and it's even more callous of Sowell to repeat it.  Emergency rooms are extremely expensive*, and they do not provide regular preventive care, which is essential to keeping medical costs down.

(*Last year my wife went to an emergency room with flu-like symptoms.  After being put under an IV for a few hours she felt 100% better.  But before she left the hospital, nobody could tell her how much her treatment had cost.  Weeks later, still nobody could say.  We received bills and corrections to previous billings from various doctors and specialists for months afterward, since the fact that she was uninsured and wanted to pay out of pocket confounded their whole billing and collection system based on private insurance.  The total came to nearly $1,000.  I guess if we were too poor, we just wouldn't have paid, and the hospital would have eaten it, or passed on the cost to the insurance companies.  Is that Sowell's idea of economic efficiency?  We cannot even call that a health care "system.")

Sowell is right that people's lifestyle choices affect their health.  But not all health costs are due to lifestyle.  America's high infant mortality rate is a prime example.  We are the richest country on Earth but we rank 29th in the world for infant survial.  If a mother is uninsured, she likely won't get the care she needs.

Nobody said we have to emulate one country or another's health care system.  Countries and health systems vary.  We can pick and choose what suits us best.  Regardless, what makes any kind of insurance work is pooled risk.  There is no bigger pool in the U.S. than the population of the U.S.  If government is the provider of health insurance, then it can spread risks and costs among 300 million insured and negotiate with doctors and drug companies for lower prices.  Meanwhile, we can keep private clinics and medical care for those who want to pay out of pocket.  The two systems don't have to be mutually exclusive.

I think a grand compromise on national health care will happen.  The U.S. gov't will probably become the single payer for health care, or else mandate employer coverage and pay for the unemployed.  But rising costs will bury any system, public or private, so Obama is correct to focus on controlling costs. Building on state pilot programs launched by Bush, Obama is investing $100 billion over 10 years to establish electronic medical records, which could save the health industry $200-300 billion a year.  The gov't must also offers doctors malpractice protection.  This would cut costs in at least two ways, the other being that doctors won't order so many expensive tests (like MRIs) to insure themselves against misdiagnosis.  Another piece of the compromise might be federal assistance to drug companies in the form of tax credits or subsidies for their drug development costs (which run into the $ billions each year); in exchange the gov't would get discounts on prescription drugs.  There are surely dozens of other ways to cut medical costs, like relying on nurse practitioners and "quick clinics" instead of doctors for treatment of colds, flu, and other common, easily treatable illnesses.  Returning to our reliance on the traditional family doctor (primary care physician) would also cut costs by reducing patients' visits to expensive specialists at the first sign of a problem.

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