Thursday, March 23, 2006

Universal Health Care: Now

TNR's current lead editorial makes an argument for universal health care that is once moral and pragmatic. It begins by noting that "liberalism has lost both its good name and its sway over politics" since the defeat of President Clinton's plan in 1994, then launchs it's long and ambituous argument for liberalism to reclaim it's lost credibility by going back to the begining.

Money quote (moral argument):
Alone among the most developed nations, the United States allows nearly 16 percent of its population--46 million people--to go without health insurance... Across the United States today, there are diabetics skimping on their insulin, child asthmatics struggling to breathe, and cancer victims dying from undetected tumors. Studies by the Institute of Medicine suggest that thousands of people, maybe even tens of thousands, die prematurely every year because they don't have health insurance... These are not the sorts of hardships that an enlightened society tolerates, particularly when those hardships so frequently visit people who, as the politicians like to say, "work hard and play by the rules.
Money quote (pragmatic argument):

Such widespread insecurity might be understandable (though not necessarily forgivable) if it were the unavoidable consequence of an otherwise well-functioning health care system. After all, economics teaches us that tradeoffs between efficiency and equity are inevitable. But medical care in this country is inequitable and inefficient. The United States pays more for its health care than any other nation on the planet: 16 percent of our national wealth, at last count. Money spent on health care is money not spent on other things, like corporate investment and wages. That's an exorbitant cost that even Americans with secure health insurance pay.

"Exorbitant," to be sure, is a subjective word: Money spent on well-applied medical technology might be worth it. But, perversely, our extra spending doesn't seem to buy us better medical care. According to virtually every meaningful statistic, from simple measures like infant mortality to more carefully constructed data like "potential years of life lost," Americans are no healthier (and are frequently unhealthier) than the citizens of countries with universal health care. Nor do Americans always get "more" medical care, as is commonly assumed. The citizens of Japan, for example, have more CT scanners and MRI machines than we do. And the French, whose system the World Health Organization recently declared the planet's best, have more hospital beds. They get more doctor visits, too, perhaps because their access to physicians is nearly unfettered--a privilege even most middle-class Americans surrendered with the spread of managed care. In fact, aside from cost, the measure on which the United States most conspicuously stands out from other advanced nations may be public opinion: In a series of polls a few years ago, just 40 percent of us said we were "fairly or very" satisfied with our health care system, fourth worst of the 17 nations surveyed.

So given that disaster our health system has become, what are the arguments for leaving it unchanged?