Friday, December 04, 2009

A few more thoughts about US Healthcare

There has been a weird dislocation in the debate between at least four important groups of people- health care public policy experts, pundits, Congresscritters and the general public. In Britain we have many public policy working groups and think-tanks which analyze private sector industries and organisations, and public sector ones too. These public policy wonks would be very high profile if it was a British healthcare debate. I have seen and read virtually nothing of their US counterparts during the whole duration of the debate. Where the hell are they? Can they not get on FOX? Do they not bother with the blogosphere at all? The depth and breadth of the debate in the US has, to my eyes, suffered significantly because of their absence from the high profile debating forums.

It has also meant that the great big facts about US healthcare often get no mention- US healthcare is NOT in 'crisis'. It is expensive, but the best in the world overall. Many aspects of the legislation controlling US healthcare are accidents of history, and are in no sense either logical or essential. This is especially true of the legislation governing the sale of health insurance.

Another downside is I have not heard or seen any comparative studies of US health care and health care provision in other countries. Occasionally, people on FOX news or on popular blogs will bring up anecdotal cases from the Canadian or British socialised medical systems, but that is hardly the same thing. Where are the side-by-sides showing the significant stats for longevity, cancer outcomes, major disease survival rates, infant mortality and all the other relevant measures of success of a health care system, adjusted for population size? Haven't seen something like that once. Where is the properly-reasoned fact-based discussion of the relative merits of a system funded by insurance receipts and one funded out of general taxation, or indeed personal health savings accounts?

The US healthcare debate has been dominated by Democrats lying about their ultimate objectives, about costs and about future provisions on the one hand; and Republicans defending the status quo from some pavlovian reflex, and lying about what the current system is like (for instance, blipping over the fact that Medicare is a government-run program).

Because of the scarcity of real information, much of the 'debate' has been the constant repetition of slogans and catchphrases. Fun though it is, it is not really a substitute for actual debate. But amazingly, if it had been up to Obama, Reid and Pelosi, even this sad excuse for a debate would not have happened- Obama wanted this legislation passed before the summer congressional recess in early August. Maybe that is why the whole way along, the debate itself never really got started.

The public got involved in the 'debate', but never really got their hands on meaty substantial information processed enough to be comprehensible to someone of average intelligence. So they have fallen back on partisan certainties and focused largely on cost. It could have been SO much better.

Maybe in thirty years when they have the next healthcare debate, some of the normal things that should happen during extremely important public policy discussions actually will... but don't count on it.

1 comment:

Sophist said...

"It has also meant that the great big facts about US healthcare often get no mention- US healthcare is NOT in 'crisis'."

Well, I suppose that depends on your definition of "crisis". Those who think the US health care is in crisis, usually cite the following sort of statistics:

I prefer to think that the US healthcare system - employer based - is sunsustainable. And for pretty much the same reasons as employer based pensions are unsustainable: in a global market they are uncompetitive.