Monday, October 12, 2009

Catching Up, More on Health Care

From last week:

Megan McArdle has a long, rambling response to a commenter who asks this question:

And Megan, no one on your side of the argument seems willing to answer two simple questions. If every other country (don't split hairs, you know what I mean) can cover ALL of their citizens for LESS than the US does, with better outcomes, why can't we do that?

It's a good question and I think Megan spends too much time dancing around the differences between the United States and Europe. The answer she ultimately gives is that we can't do it in America because it's politically unfeasible, which I don't disagree with at all as a practical matter, but probably isn't the answer the commenter was looking for. I think the commenter's point was meant to be much more theoretical than practical: Why not a single-payer system (or something similar), if such a system would cost less than our current system and provide better results?

I'm not at all qualified to delve into the nitty gritty of health care economics, so we'll stick solely to theoretical here. I'd question the assumption on which the commenter's question is based- does Europe truly get better results for less money? The money part is easy- Europe does spend less money- but the results part is a bit more difficult. After all, any attempt to quantify health care results is going to be far less of an exact science than say, adding up dollars. I have two major problems with this idea of health care results and I'll outline them below:

1- Nations have their own standards for reporting health care statistics. I beleive I've read in the past that infant mortality is one of those areas where the technological status of the United States tends to count against us. I don't have a link readily available, but from what I recall, the United States saves more premature babies than most of the rest of the world, but this tends to count against the U.S., because premature babies are far less likely to make it through their first year of life and therefore far more likely to be counted in the infant mortality category.

2- Various measures of health care effectiveness can be impacted by factors outside the health care system. Take something simple like life expectancy. Obviously health care plays a major role in the average age people live too, but so do a great many other factors. In the United States for example, people are far more likely to be in a fatal car accident or to be a victim of a murder than they are in most Western European nations. And beyond the obvious, there's the very complicated: Just how do you factor lifestyle choices into health care effectiveness?

And let's just go back to that money for a minute. The numbers tell us that the United States spends more per capita on health care than do most European countries. But those are huge numbers in regards to huge populations that don't take into account who is spending what and how. How much do the wealthy of the United States spend in comparison with the wealthy of other nations? Given we're closer to a free market system than most of Europe, it's quite possible that the health care dollars spent by the wealthiest Americans skew the numbers in terms of what ordinary Americans are paying.

My point isn't to shutdown debate, but only to point out that such a simple statement on health care dollars and outcomes is really loaded with all sorts of complexities. Ultimately, this is the problem in judging any government run program because you're dealing with statistics, not individuals. The reason for a true free market in health care or any other area is to allow individuals to make choices about what they want based upon their own unique circumstances.


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