U.S. Healthcare: We Pay More, Get A Lot Less
by Ken Wikle
Posted on 2008-06-21 09:34:53
The June 2008 ABC News/Washington Post poll asked people which they believed more important: providing health care coverage for all Americans even if it means raising taxes, or holding down taxes, even if it means some Americans do not have health care coverage. The response was pretty clear: 66% said health care for all was more important.
John McCain sides with the one-third minority. He clings steadfastly to the time-honored conservative precepts that government involvement in the providing of healthcare is a bad idea, and that Americans want choices and should be offered a variety of voluntary plans. I would offer Senator McCain a twofold response: all the other industrialized nations have government systems and provide their citizens better healthcare than we get but at lower cost, and giving people “choices” in our market-based system means letting them select which insurance company gets to screw them out of their money.
Measuring the effectiveness of healthcare systems is not easy, but some indices are universally accepted. Healthy people live longer, are taller and less obese, and their babies are better able to survive the first year after birth. Americans used to be taller than people of other countries, now we rank ninth, but we’ve reached first place in the obesity category. Moreover our life expectancy ranking has slipped over the past few decades – the people of 41 countries now live longer than we do.
But the most telling statistic is a country’s infant mortality rate, the number of babies per 1,000 live births that die before they reach their first birthday. It’s a clear reflection the general health of the mothers and the quality of medical care expectant mothers and their babies receive, if any. As with the life expectancy category, 41 countries do better than we do, including South Korea, Cuba, Italy, Taiwan and Greece. In the US the rate is 6.37 babies dying – in Japan the rate is 2.80: Sweden, 2.76, but this tells only part of the story.
In Canada, to take an example, the infant mortality rate is 4.63. If you look at numbers comparing Canadian provinces and cities, the rates are all pretty much the same, indicating that the Canadian national health system for the most part provides a uniformly high quality of care for everyone. The picture in the United States is markedly different.
While our national rate is 6.37, the infant mortality rate in Detroit is 15.9, or 5.6 for whites and 17.9 for blacks, roughly the same as Bulgaria. The rate is 13.5 in the District of Columbia and 10.4 for the state of Mississippi. In South Central Los Angeles the rate is 13.8 and in the town of Shafter in Kern County, 13.4. In the poorest ZIP code in Berkeley the rate is 10.9.
By contrast the rate for Marin County is 4.6, San Francisco 3.1, San Mateo County 3.8 and Orange County 4.4, all well below the national average and below the state average of 5.2 unless you’re black, in which case the California state average is 12.3, about the same as Uruguay.
This tells us what is already obvious to a large segment of our population: Americans in the lower income brackets get lousy healthcare. Way too many people have no insurance, and far too many others are underinsured, meaning they accept coverage gaps or shortfalls so that they or their employers can afford the premiums.
Nothing McCain proposes would do much to change that. He says he will “work with governors” to create state programs to increase access to health insurance, which is more a half-baked idea than a plan, and he’ll fix it so people injured by medical negligence can’t sue. In my view, that doesn’t cut it.
Competition between private insurers isn’t the solution, it’s the problem. For the most part the health insurers don’t offer medical services, they just pay for them. They compete by reducing costs. They don’t insure for preexisting conditions, for example, so if you have a serious condition, tough – scrape up your own money to treat it or die, your choice. Most insurance companies will pay for routine stuff, although they’ll do everything they can to chisel the doctors. But if you turn up with a medical condition that costs a lot to treat, look out. Most companies will put big-money claims under a microscope looking for ways not to pay what they owe, and the average person who doesn’t understand the legalities of the insurance contract or how to battle a huge corporation is likely to get screwed.
The insurance company way of doing things explains in large part the enormous cost of our healthcare system. Even though there are babies dying needlessly by the hundreds in places like Detroit (where are the pro-life people on this issue?), we spend more per person for medical care than any other country. It’s well over $6000 per person per year in the US, more than twice that of France or Canada, countries that give their citizens better healthcare.
Where does all that money go? Huge portions of it get sucked up by the insurance companies who have thousands upon thousands of people sitting at desks trying to figure out how not to pay claims. In other words a major portion of the money we pay for healthcare goes toward figuring out how not to give healthcare to the individuals paying for it. From McCain’s point of view, this makes sense because it’s not socialism.
John McCain’s first priority is to save us from the evils of a government-run system. He often cites Canada as an example of the evil, explaining, usually with a pained expression on his face, how their system is awful and how Canadians hate it and want to be like us. This myth, no doubt spread by insurance companies but widely believed in the US, is utter nonsense. According to a study by the Canadian government’s Commission on the Future of Health Care in Canada, Canadians are quite pleased with their system, and wouldn’t take the US system on a bet. A strong national system with publically funded healthcare is important to 91% of Canadians. Asked if they agree or disagree with the statement “If I had a serious injury, I would prefer to be treated in the US,” 7% agreed, 75% strongly disagreed and 17% moderately disagreed. Moreover only 9% of Canadians think the US has a better system overall. In all due respect, Senator McCain is full of it.
Ken Wikle writes the Against the Flow column for the Russian River Times, a North Bay California newspaper
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