Map of life expectancy at birth from Global Education Project.

Thursday, July 28, 2011

The nation in the bubble

One of the weirdest features of political discourse in this country (and that's obviously saying a lot) is that it often seems to take place on a planet where the United States is all by itself. Approximately half of the claims that politicians make are obviously false because all you have to do is look at the world around us where their refutation is plain for all to see. As neither the corporate media nor, it seems, the whimpering, cowering, inarticulate remnants of the Democratic wing of the Democratic party ever bother to engage in this simple exercise, allow me.

I mentioned a few days ago that all you have to do to answer Grover Norquist is to point out that of the prosperous democracies, the United States has the lowest taxes and the least activist government; yet all those overtaxed, overregulated, enslaved peoples are healthier and happier than we are, have similar economic growth rates, and are manifestly as well as subjectively at least as free. The countries whose governments have been drowned in the bathtub? You really don't want to go there. QED.

Conservatives also like to argue that the reason we have such high health care costs is because people have insurance and generally low out-of-pocket costs, so they don't care about cost and overconsume. Make 'em pay, and the discipline of the market will bring down health care costs. Again, just pull your head out and look around. The countries where everybody has insurance, not just some people; and where they pay less out of pocket than we do all have lower costs and better outcomes. If you think that's logically impossible, then evidently there is something wrong with your logic. QED.

Comes now the brilliant idea that we can make health care for old folks more efficient and responsive by trashing the current communistic Medicare system and giving people vouchers to buy private insurance. As Kieke Okma and friends in the new NEJM tell us (you can't read it because you aren't a Big Professor, nah nah nah nah nah), people in the Netherlands got so excited listening to smart people over here in the U.S. that in 2006, they dumped their social insurance system administered by non-profit funds for a mandated private insurance system like they have in Switzerland (Hi Ana!) and like we will have here if the Affordable Care Act is allowed to take full effect.

Yeah yeah, the private insurers aren't allowed to turn people down for pre-existing conditions, they have to charge community rated premiums, and they get payment adjustments depending on the risk profile of their pools. It's all regulated to tamp down perverse incentives and make it equitable and accessible and all that good stuff. But:

1) This brilliant idea did not slow the growth of health care expenditures;
2) A growing number of people are failing to pay their mandated premiums;
3) Consumer choice? Hah! Four conglomerates control 90% of the market;
4) Competition among insurers would have nothing but pernicious effects so they have to be very tightly regulated with a complex bureaucracy, which is a big hassle because the government bureaucracy is always tussling with the insurance company bureaucracy.

You see, the easy way to do this is to have one government sponsored insurance pool, which means you don't have to argue with anybody, you just do what you have to do. (One bureaucracy is exactly half the trouble of two, no?) And you don't have to chase people down to pay mandated premiums, you just take it out of their taxes. Oh no, taxes! That's evil! Hey, it doesn't matter what you call it, taxes or premiums, you're still paying it. So get over it.

As Okma and friends put it, "Discussions about U.S. health care reform are often parochial, with scant attention paid to other countries' experiences." Really? Do yuh think? They go on: "It is thus surprising that in the ongoing debate over Medicare, some U.S. commentators have turned to the Netherlands as a model of regulated competition among private insurance companies." As we have just seen, it is a model well worth not emulating.

1 comment:

Anonymous said...

hi...yeah the Swiss system (obligatory private insurance) limps along. However the direction of the limp is so inevitably towards Gvmt. control that one shouldn’t really call it private any longer.

First off, and this has always been the case, 30% or more of healthcosts are paid by the tax payer, and I don’t believe the accounting here is large, rather it is too narrow. The bulk of those payments go to those who can’t pay the premiums. The mechanism is hard to describe because it can vary from canton to canton. For ex. here (GE) I think I myself might be eligible for a 20.- dollar a month stipend (in view of my income) - all I’d have to do is request it and I’d get cash (! Imagine the paperwork..) My friend F, single mom with 3 kids, simply has her insurance paid by Social Aid.

The premiums and what they pay for are set by a ‘council’ - but The Gvmt. has the last say de facto.

By law, insurers are not allowed to make money from the basic package, and must bail each other out if they get creamed and/or pay their surplus into a ‘fund’...when an insurer goes bust (which happens often!) the Gvmt steps in and re-insures all the patients left and right to others. If the insurers find loopholes not to pay local Gvmt just takes up the slack with a ‘free clinic’ or ‘free meds’ or whatever.