Wednesday, May 21, 2008

Thy saving health among all nations

Harry Emerson Fosdick (1878–1969) wrote “I would rather live in a world where my life is surrounded by mystery than live in a world so small that my mind would comprehend it.” While I am inclined to subscribe to that sentiment, there are mysteries that I would not at all mind having unraveled. One of the mysteries I would love to see solved is why the United States of America has allowed itself to have the most expensive but the least efficient health care system in the industrialized world. A related mystery is why the people of the United States are as a rule so resistant to the models provided by various other countries.

In debates about the state of health care in the United States, I have heard people say firmly that they would not at all like to see the USA have a Canadian-style health care system. It is difficult to know exactly what that means, since Canada does not have a health care system. Each of Canada's provinces has a health care system, and each province has a different model. The only thing they have in common is that a person can receive higher-quality and more-affordable health care in any of them than one can get in the United States. So part of what Americans who reject Canadian models are rejecting, it seems, is quality, efficiency and affordability. Apparently, these Americans prefer overpriced mediocrity.

One of the arguments I have heard some of my fellow Americans use is that the United States simply cannot afford to provide universal coverage. Those who cannot afford health insurance policies must therefore either go into personal debt to get medical care, or they must do without medical care. This raises the question of why so many other countries can provide health insurance to every adult and child without going broke. Why is the United States alone among wealthy nations in being unable to provide reasonably priced health insurance to everyone, and to provide subsidized policies to those who cannot afford them?

Let me suggest a few speculative answers. One reason might be that the United States spends far too much revenue on maintaining a military that it really does not need, including military bases in around twenty nations around the world. According to The Arithmetic of America's military,

Our military deploys well over half a million soldiers, spies, technicians, teachers, dependents, and civilian contractors in other nations. To dominate the oceans and seas of the world, we are creating some thirteen naval task forces built around aircraft carriers....

The expense of maintaining all these unnecessary bases does not include the cost of waging wars that contravene international law and that do far more to endanger the American people than to protect them. It is estimated that the war in Iraq costs around $5000 per second. Supposing a health insurance policy costs $10,000 per year, the money being spent in Iraq could provide one year's worth of health insurance to 43,200 people for what it costs to finance one day of war in Iraq. For the cost of about three months of war, more than 4,000,000 Americans could be provided with health insurance.

Were it not for a bloated military, the United States could easily provide health insurance to all those who cannot afford it. But that still would not address the extraordinarily high costs of medical procedures and pharmaceuticals. The cost of those is held within reasonable bounds in Canada, most European countries and many Asian countries by simply putting a cap on how much profit a health-provider can make. Physicians, hospitals, and pharmaceutical companies are allowed to make reasonable livelihoods in Canada, Europe and Japan, but one will find no billionaires, and perhaps not even many millionaires, among health-care providers.

The United States has for a long time been married to an abusive ideology, an ideology that leaves Americans of all walks of life battered, bruised and impoverished. The principal dogma of that ideology is that unrestricted and unregulated competition keeps prices affordable for all consumers of every kind of product. Therefore, say those who propagate this dogma, the best way to keep costs reasonable is to make sure that providers of goods and services must compete with one another, and the best way to make sure of robust competition is to minimize government regulation and interference.

The argument may sound good, but it is demonstrably flawed. This is the system we have had since at least the time of President Reagan, and it has not worked at all. First of all, companies that are forced to compete in a free market are also forced to advertise in expensive media. Watch television for one evening and count how many advertisements you see for pills, salves, creams, ointments and powders. Who pays for those advertisements? The people who are persuaded that they need the product being sold. Who pays for those advertisements in other countries? No one. Medical providers usually do not advertise in other countries. Products there are plentiful and affordable. And the providers of those products are regulated. Their system works. The system in the United States does not work. It is perhaps time for our policy makers to stop preaching and to begin learning.

What we need to do to fix our broken health care system is no mystery. The only mystery is why we don't do it.