As Paul Krugman pointed out yesterday in the New York Times, the real crisis in America is healthcare. It's poorly organized, expensive, and inefficient. "The United States has the most privatized, competitive health system in
the advanced world; it also has by far the highest costs, and close to
the worst results." The doctors and nurses are dedicated and professional, but they work within a system that discourages preventive care, complicates communication among providers, interposes untrained insurance gatekeepers, and spends up to 20 percent on administration and paperwork.
Kash at Angry Bear has some data, showing "that the US does not have a very good health care system when measured in terms of the health of its people, or when measured in terms of how its citizens feel about the health care they get... and it has a horrible health care system when these mediocre outcomes are juxtaposed with its astronomical costs." He compares spending and outcome in seven developed countries, and the US spends the most but comes in last.
Yes, it is time to look at how other countries provide healthcare. Several of them seem to be doing something right. That's certainly been my experience.
In the late nineties, my wife and I spent a few months in France. Hiking through the Dordogne countryside one day, she tripped on a downed barbed-wire fence, puncturing her leg. We drove to the nearest small town and—after a 20-minute wait—she saw a friendly, efficient doctor, who administered a tetanus shot. Total cost, $60 out of pocket; for a French citizen it would have been essentially free.
Living in London in the early nineties, we found medical care just as competent and even cheaper, though the wait for a nonemergency appointment was sometimes several weeks. The system was not as well organized or funded as the French system, but obtaining healthcare there was also easy, congenial, and professional—without the reams of paperwork and insurance hassles common in the US.
Visiting Canada recently, we had a medical emergency. The neighborhood walk-in clinic was open on Easter Sunday, and the excellent doctor saw us in 15 minutes. Total cost $50; for a Canadian, free. Two quick followup visits, also pleasant, simple, and cheap.
The US is a much worse place to get sick than any of those countries, unless you are extremely rich. It doesn't make sense for us to spend twice as much as other countries and end up with sicker citizens. And it's not a happy experience to joust with the insurance company to get the right specialists and appropriate medication. It is, I'm sure, an even less happy experience for the 45 million Americans without health insurance.
I grew up in an Army family, and I took it for granted that the US government provided us with excellent, free healthcare wherever in the world we lived. From Tokyo to Grand Island to Sitka, the medical officer was always there. Clearly, I thought, single-payer medicine works. And they take care of the paperwork, which is records of healthcare, not bills and receipts.
That's the kind of system we need, a nationwide single-payer system that provides care for everyone. It would be cheaper and healthier for everyone, and better for the society. The political path from here to there is not going to be easy—with the Clinton-bashing specter of Harry and Louise hanging over any sensible proposal—but it is essential that we find some way to cure the current system. It's very, very sick.
Several bloggers are writing about healthcare this week:
- Kevin Drum has posts on medicine in France here and here.
- Brad Plumer lists three reasons the American media doesn't provide good information about healthcare in other countries.
- Matt Ygelsias lists seven more reasons.
- Matt Welch tells his sister's cautionary tale, and has more to say about France.
