a) At least based on often cited metrics of life expectancy, when they are properly adjusted (for all countries) for factors that have nothing to do with medical care, the claim that U.S. care is not the top drawer doesn’t hold.

b) If there is some aspect of health care delivery in other countries that lower the resource consumption, such as using pharmacists and nurses in many routine care scenarios instead of doctors (for example in the U.K. a chemist can dispense prescriptions without a doctor and a lot more is over-the-counter to begin with), having lower barriers to new drug introduction (there is no FDA in Europe) we should be taking note. As it happens, the corrective actions that would come from such learning imply less, not more government involvement in medical care.

c) Once supply curves (productivity) are equalized per point (b), what drives the price paid for services is demand. We have a pathological disconnect between a consumer and the cost, due to the structure of Medicare, employer subsidies for providing insurance and other laws that disassociate consumers from the incremental price of incremental care.

To say that insurance companies’ profits, let alone compensation of their CEOs drive healthcare costs has no basis in fact. Examine the healthcare dollar breakdown chart http://www.staysmartstayhealthy.com/healthcare_costs to see that insurance in total are only 3 cents of that dollar. And this is not the profit, it’s the cost of processing claims (which would exist in a government run public option) plus a not so big profit.

Drugs cost more in the U.S. because other countries impose price controls. Impose price controls here (let’s not go through the pretense of calling it “negotiated prices”) and what do we suppose is going to happen to profits, investment and consequently drug development itself? More about the misconceptions about profits below.

“[O]ur system has driven the prices up to a point where most people can’t afford the care they need” is an outright falsehood, as even the total number of uninsured do not add up to “most”.

To be factual about the 47 million uninsured (10 million of whom are not U.S. citizens and thus have particular barriers to being insured):

a) The absolute number has grown in recent years, but in proportion to the population growth, the relative percentage hasn’t changed much

b) A large proportion of the 47 million uninsured are uninsured voluntarily. 38% of the 47 million have more than sufficient incomes ($50K+) to buy coverage. See http://www.census.gov/prod/2007pubs/p60-233.pdf At the other end of the spectrum are 14 million of the uninsured who are eligible for Medicaid, but chose not to enroll.

c) Being uninsured doesn’t mean not getting medical care, as for better or worse by law emergency rooms can not turn anyone away, or even redirect to urgent care units, despite the fact that emergency rooms are overused for non-emergency purposes (among patients in the 20’s the hospitalization rate resulting from an emergency room visit is only 5%.)

d) However, it does mean delaying diagnosis and treatment of deadly progressive conditions, leading to well researched higher mortality rates (estimated 25% higher) among the uninsured. The studies controlled the best they could for tractable factors – health condition to begin with, socio-economic status, etc. What it could not possibly control for is the behavioral differences behind large numbers of people making a choice not to buy insurance. So it doesn’t actually show that not having insurance causes higher mortality. It may be just as easily showing that risk-taking, one of the manifestations of which is not being insured, causes higher mortality.

e) Once the non-U.S. citizens, 50K+ earners who can afford insurance and real low earners eligible for Medicaid are taken out of the total, 11 to 12 million remain that “fall through the cracks”. Yet the “reform” bill didn’t target just that group.

To talk about market price rationing of care in the same way as government rationing is intellectually dishonest as the meaning of the word is very different in each context. Just as when someone says, “the changes in my industry forced me do get more training” we know that “to force” used in that context is a very different concept from “the robber forced me to give him my wallet.”, and an honest person wouldn’t dream of calling the police to defend a person from “the force of change”.

Is a profit the problem with healthcare costs? Presumably we are talking about doctors and drug company profits (given that per above insurance company profits are a non factor; hospitals are mostly non-for-profit). This sort of thinking comes out of an entirely fallacious intuition about profits. To start with, if profits are so bad, let the anti-profit advocates be the first ones to give up their profit. Those who are gainfully employed should ask for a pay reduction down to a level that will be just sufficient to sustain the body and mind to perform the work, because guess what: economically everything above that is your Profit! And then want to we suppose drives investment into industries but the possibility of making a profit. Take away profits and what you are left with is government technocrats deciding winners and losers, a task proven impossible many times over.

What is problem, and it does show up in extra profits, is protectionism, such as doctor licensing, insurance regulation, that causes supply restrictions by effectively protecting established, particularly well-heeled players from competition.

In summary, there is just so much misinformation, misunderstanding and misinterpretation of data flying around, that debating particulars of various solution ideas is proving impossible until all that noise is reduced substantially.

The care in the US is good, but only if you can affors it and our system has driven the prices up to a point where most people can’t afford the care they need because we allow corporations to make unlimited amounts of profit by denying care and adding extra costs for CEO pay, bonuses, private jets and all the other goodies the fat cats get.

The fact that the US spends double per capita and doesn’t get results as good as other countries says a lot. We are the only industrialized nation that allows 45,000 people to die every single year from a lack of insurance. That’s 15 9/11s every year. 46 million are uninsured, 25 million are under-insured and those that are insured often go bankrupt or get dropped from their insurance plans when they actually get sick.

Do you want to know why we pay so much more than just look at today’s headline.

“2009 turned out to be a very good year for the CEO of the private health insurance company WellPoint. Angela Braly’s compensation package soared by 51 percent last year. She earned $13.1 million, up from $8.7 million in 2008. At least three other WellPoint executives received compensation increases of as much as 75 percent.”

Those profits are outrageous and that would never happen in a single payer system like a Medicare-for-all. Medicare is a popular system that has less overhead costs because there aren’t CEO bonuses and private jets etc.

With all due respect you just changed the entire point of your original op ed with this answer. Are you saying that our healthcare system is inferior (as your original writing suggest) or are you saying that we should simply provide free healtcare to 46 million people (many of that number being illegal aliens) on the backs of those of us who pay our share? Can you help me explain to my daughter why her healthcare will become inferior to what it is now so that illegal aliens can get free?

It doesn’t necessarily mean I support a public option, but I’m tired of phoney rhetoric that suggests the US has the best health care in the world. The facts say it’s not true.

I just researched the most accepted comparative studies that have been done. It is true that I didn’t dissect those studies and question their assumptions. But as I told Jim above, even if the quality of care for those who can afford it is excellent, how can we justify 46 million people not being able to afford it?

Those are good points. But even conceding that the US provides excellent health care, how does that help the 46 million Americans who don’t have insurance and, therefore, can’t pay for it?

Delores

Moreover, when talking about healthcare and life expectancy, we ought to separate other factors that affect health and life expectancy but are not functions of healthcare:

1. U.S. takes in large numbers of immigrants from the 3rd world, whose life expectancy is lower because of poor childhood nutrition and medical care.

2. Eating and exercise habits. U.S. lifestyle is more sedentary.

As to the supposed fact that we spend much more per capita on health care, expenditures expressed in currency per capita are meaningless when countries with government run healthcare use price controls and rationing. The question that should be asked is whether U.S. healthcare industry is less productive than healthcare industries in other countries. That is, if to achieve exactly the same end result (the same improvement in health from the same starting point), it takes more real resources – human labor, energy, amortization of equipment and facilities. Do you have any facts to show that to be true?