January 31, 2007
Wednesday

Reforming the American health care system will be difficult as long as certain myths about it continue to flourish. Some of these myths include: In America, health care is provided by the market, rather than by the government. In countries where the government pays for health care, people don't have the freedom to choose their own doctor. American health care is expensive because it's of such high quality.

And, by the way, we have "the best health care system in the world."

Let's look at these myths.

- The government doesn't pay for health care.

In fact, in America the government pays more for health care, per person, than any other government in the world, including the governments of countries that provide comprehensive cradle to grave health care for all their citizens. Yet despite this very high level of government spending, nearly one out of six Americans has no health care coverage of any kind.

- Unlike in nations with "socialized medicine," Americans have the freedom to choose their own doctors.

It's a tribute to the power of ideology that people who haven't had the freedom to choose their own doctor in decades don't notice that this claim is flatly untrue. The vast majority of Americans under the age of 65 who have health insurance at all are enrolled in group health plans that severely restrict their health care choices at every turn.

- American health care is expensive because it's of such high quality.

Well it's certainly expensive: the U.S. spends about twice as much, per person, on health care, as other developed nations. Indeed, despite being the richest nation in the world, we spend a higher percentage of our GDP on health care than anybody else.

And what do we get in return for having what is by far the world's most expensive system? Lower life expectancy, higher infant mortality rates, and fewer physicians and nurses per capita than the average developed nation.

The U.S. health care system is the equivalent of a carmaker that produces Buicks, charges twice as much for them as it costs to buy a Mercedes, and then has the temerity to claim that it makes "the best cars in the world." Needless to say such a carmaker would go out of business in about two weeks.

In one sense, the U.S. clearly does have the best health care in the world: if you're rich, America is a great place to get sick. We do, in fact, have the best doctors and hospitals in the world. So why do we have below average health, as compared to other developed nations?

The answer is simple: If you're poor, America is a much worse place to get sick than any of dozens of other countries that, despite being far less wealthy than the U.S., find a way to provide good medical care for all their residents.

No country has a perfect health care system, of course, but the U.S. system, with its combination of extraordinarily high costs and mediocre overall results, is as clear an example of market failure as one could hope to find.

Fortunately, we have many examples of systems that are both much more efficient and far fairer. For example, the French system features both public and private funding, but the great majority of health care costs are covered by the government. Per capita, the French have more doctors, more than twice as many hospital beds, twice as many physician visits, vastly more consumer choice, and better overall health than Americans - and they get all this for roughly half of what we spend on health care.

On top of all that, the French smoke much more, drink a lot more alcohol, and eat 50 percent more fat than we do. Pass the Freedom Fries.

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