Nick Kristof hits on one of the most bizarre aspects of the health care debate: the inability even to agree that there is a problem in the first place:
We have the greatest health care system in the world. Sure, it has flaws, but it saves lives in ways that other countries can only dream of. Abroad, people sit on waiting lists for months, so why should we squander billions of dollars to mess with a system that is the envy of the world? As Senator Richard Shelby of Alabama puts it, President Obama’s plans amount to “the first step in destroying the best health care system the world has ever known.”
That self-aggrandizing delusion may be the single greatest myth in the health care debate.
I don’t think the delusion has much to do with health care. I think it has everything to do with how we speak about America.
Somewhere along the way it became required for any politician to describe America as the “greatest.” We expect it; odes to our greatness are the Hamburger Helper to every speech. A long political rally will feature several people extolling the virtues of America and exuding the every popular “confidence,” never mind the fact that their audience is American and, you would think, fully aware of the virtues of our country. And our weaknesses.
Presidents end addresses with “God bless the United States of America.” That’s how you know the address is over. It would be absurd in just about any other country. “God bless France”? “God bless Germany”? The politician who said that would be laughed out of office, both for the arrogance of being able to claim God’s mantle and the shirking of responsibility – don’t look to God for help, do it your damn self, President.
But that’s the way we look at the world. It would be treasonous to acknowledge that there are things that aren’t better here, even if it is damn near impossible to find American-made consumer electronics or watches because we were so wildly incapable of making things that worked.
There is overwhelming statistical evidence that the US healthcare system does not work well. It isn’t just the gunshot wounds or the driving accidents – although funny how the Republicans who use these red herrings never follow through by advocating gun control or mass transit funding – we fail from infant mortality all the way through to life expectancy.
It is clearly true that we have some wonderful specialists and some great institutions, but focusing on a few magnet clinics that draw patients from around the world is about as useful as deciding that since everyone in a West LA nightclub is beautiful, there must be no obesity in America. Very few people will ever be treated by the greats, and those who do under any system will be people with the means to ignore the government’s program. I have gotten sick in London, home of actual government-run medical care (not just insurance) and strict rationing, and if you are a cash payer the system works about as smoothly as it does for a rich guy in the US: you call, you come in, the doctor sees you, you pay, you leave.
The “health care” we are trying to reform is the health care for most people. Most people who have one insurance option – the option chosen for them by their employer, the primary care physician to whom they somehow were assigned, and whatever specialist that primary care physician is able to name when the situation warrants and the insurance company assents.
The last two steps are basically the same everywhere in the first world. The only difference is the first step – the insurance process – and somehow that process accounts for our spending dramatically more than any other country and having worse outcomes. Even our white people – who have the same genes and lifestyle as white people in Canada and Britain and France and Germany and make more money – have worse health than the white people of western Europe. You would think a loyal opposition would say something to the effect of “yes, we have a tremendous problem with medical outcomes, and we would have better outcomes if we stopped Medicare” or whatever their philosophy would dictate. But instead, the Republicans simultaneously advocate Medicare for people over 65 and oppose Medicare for people under 65. They really seem to believe it is completely arbitrary how the insurance is handled, except it cannot be handled by the government.
And why, might I ask, does the easy confidence that “we have the best [health care, education, utilities, auto workers] in the world” not extend to “we have the best government in the world?” We regularly hear that we have the best military in the world, which might not even be true if thought of on a per-capita or per-dollar basis (if you were being held hostage, would you rather hear that the Americans were coming to rescue you or the Israelis?). But civilian government, no. Other countries can discipline health care providers; our government isn’t competent to do this. Maybe that’s right – but it certainly calls into question whether the other assumptions of American superiority are well-founded.
This came home to me when Tom Tancredo had a debate with Markos Moulitsas on health care. Tancredo asserted that soldiers would prefer vouchers to buy private health insurance to VA care. It is a statement with no basis in reality – does anyone seriously think that a soldier would prefer a traditional indemnity plan with a deductible and copay drawn on his lavish military salary with the intention of discouraging consumption of care – but he said it as though it could be no other way; why wouldn’t someone want to buy the world’s finest care?
It’s the finest reaction since Jim Everett decided he had enough of Jim Rome calling him “Chris”:
I should add that while every time I watch the Everett video I hope that this time Everett will land a clean punch, Moulitsas could not have picked a nicer guy than Tancredo to taunt.
UPDATE/DIGRESSION
Bart Stupak – a Democrat, mind you – is on his way to a peculiarly American goal: barring abortion by technicality.
Here is the Stupak to English translation: current health care reform works by using two mechanisms, the “public option” and the “exchange.” The public option, which applies to individual insurance purchasers in states that do not opt out, is a standalone insurance company operated by the Federal government (either CMS or some new agency that will try to replicate CMS). Ostensibly, it does not regularly require Federal dollars – it pays claims and overhead out of premium revenue. Since tax dollars would not be going to the plan at all, it would be free to offer abortion coverage, and anyone appointed by a Democratic administration would be sure to do so. Stupak wants to stop this.
Stupak’s real target, however, is the exchange. Remember, the idea here is that individuals and small businesses get to buy coverage through a Federally-mediated pool. The Feds will gather a lot of small buyers into a big group and require plans looking to reach these people to conform to certain rules of basic coverage, to avoid junk coverage distorting the exchange. In many cases the Federal government will subsidize the purchase of these private plans – it’s the giveaway to the insurance companies that the Blue Dogs insisted upon when the world was told single payer was too disruptive and expensive. Stupak wants to end that. If you are in the exchange and taking Federal subsidy money, he wants you to be barred from purchasing plans that offer abortion coverage.
Since exchange buyers will be buying into larger pools – that is, Jane Smith is buying into the UnitedHealth pool – a strict reading of the Stupak amendment would mean that as soon as Jane’s Federally subsidized money goes in, the entire pool is tainted and cannot offer abortion coverage. Conveniently, this blows up abortion coverage in the private sector.
The game theory here is a bit odd. Stupak claims to have 40-41 Democrats on board for his amendment, as well as every Republican. That is enough to pass the amendment. Thing is, with the amendment in place, the bill fails, because once the bill itself comes to a vote every Republican will vote no and will be joined by all of the pro-choice Democrats. So either Bart will lost his pet issue or he will lose health care overall – and he claims to be in favor of health care reform. Pelosi is out of her mind if she lets this get to the floor.
Beyond the immediate bill, however, I would like to see some Federal official have the guts to stand up and say that it is completely asinine to try to legislate individual procedures. I don’t like paying for lung cancer treatment for smokers. You smoke, you know the risks, don’t come to me after the fact with your diseased lung. Have you ever seen a picture of a smoker’s lung? It’s disgusting, and we all know you cannot fund disgusting things. Does this mean that there should be a vote on whether smokers’ lung cancer treatments are insurable? Can we vote on this?
Every year there are roughly 1.2 million abortions in the United States. That is twice the entire population of Bart Stupak’s district. Slightly more than 30 million American women have had an abortion. If they were their own state, they would be the second-largest state in the country (significantly larger than Texas, with 24mm people). If they were a religion, they would be the second-largest denomination in the United States, about twice as large as Southern Baptists. More women have had an abortion than Americans (male and female) have cancer and diabetes together.
There are roughly as many women who have had an abortion in the United States as there are black people in the United States.
It is inconceivable – and I use that word advisedly – that today’s government would spend an instant discussing a bill to single out for adverse treatment any other group of thirty million people; the gay population, which is far smaller, is about the upper bound of acceptable bigotry. But somehow the position that women should be denied access to abortion, or made to jump through hoops above and beyond typical health care, is considered a perfectly respectable position.
Maybe it’s best for the weekend to keep focused and fob off Stupak with some parliamentary maneuver. But one of these days I’d appreciate it if a politician had the courage to say that the abortion opponents are out of their minds.
