What Americans Do Not
Understand about Healthcare
I was intrigued to watch Charles
Krauthammer’s extended interview with Jon Stewart on The Daily Show the other day.
Here’s the link (sorry if the
link changes or whatever, but I don’t run the host site):
(Krauthammer’s* a go-to
right-wing Fox “News” flack who has written a book about himself, or summing up
his thoughts in recent decades, or whatever.)
I was struck by how it was a
mature discussion, the kind of thing you see/hear in America about as often as
a ’58 Edsel (I was going to say “UFO,” but of course Americans on mass-popular
overnight talk shows see those nightly and repeatedly, strangely unlike
citizens of every other country on the planet, who instead tend to see things
like stars and clouds).
Of course Krauthammer was
against “Obamacare.” He referred to it,
constantly, as all on the right do, as an “entitlement.” Going to the global well again, I can’t
believe that there would be another country anywhere on the planet, even the
poorest and without any tangible resources or means whatsoever, which would
call “health” or “care” or the compound word “healthcare” an
“entitlement.” Americans are proud of
their 200 years, but attitudes like Krauthammer’s could explain why it could
take them another 200 to catch up with the rest of the world and stop seeing
well-being not as an “entitlement,” but as a matter of civic concern and,
ultimately, of tremendous fiscal import.
Krauthammer did allow in one vague moment that the really destitute
should maybe get some care, somehow.
His key point about the
Obamacare entitlement, though, was that it would bankrupt the nation. He felt that adding yet another
“entitlement,” on top of others, would just destroy the U.S. fiscally
(as if it hadn’t, through its financial sector, made any efforts in that
direction itself). Krauthammer cited the
example of “Europe,” in particular. This one, of course, was laughable, but I
guess Krauthammer could refer to “Europe” as
some medical-basket-case-wasteland because most Americans couldn’t find it on a
map, anyway. What I was of course
immediately thinking was, “are you honestly saying that Germany has bankrupted itself, while America hasn’t,
over healthcare??” Europe, with its
socialized medicine, has actually done incredibly well, from Germany to Holland
to Belgium to Switzerland and
on an on—to say nothing whatsoever of the Scandinavian countries. Those countries really in dire fiscal straits
either already had them or were sent on the way by American fiscal
precedents. Look at what American
financial deregulation did for Ireland—a fantasyland of growth for a brief
period that ended up like California, with endless suburban homes with no-one
to buy them or live in them once actual financial reality, instead of packaged
debt sales, came home to roost. Ireland’s gorging was so alluring even Iceland, a
formerly stable place, tried to get in on the American act with its banks and
now the whole country feels the shame and crippling debt that left behind. Portugal
and Spain? Well, these are countries barely more than a
generation out of fascism; they could hardly be expected to stand on the same
footing as France or Britain. Greece? Well, it’s hard to think of Greece as “European,” but it’s got the same
problem most basket-case countries like the U.S. have—a huge percentage of the
populace doesn’t pay taxes. And besides,
why not also look at the central/east often landlocked European countries that
are rapidly advancing, like Poland
or Croatia or Slovenia or the Czech
Republic or Slovakia—weird how they can embrace
healthcare and have burgeoning economies even from very daunting circumstances.
I guess Krauthammer could
also have referred to Canada,
which, at least until the unsound economic policies of the Harper government,
had conquered its deficit problems and had begun to gnaw furtively at its giant
debt. But Krauthammer probably didn’t
want to do that, because Canada
was maybe just close enough that a few Americans might have known something
about it. Then again, perhaps not. I’ve had American colleagues for years,
highly educated university professors and the like, who still actually look at
me from behind their coke-bottle glasses and brown teeth and declare that they
could never allow themselves to be in situations in which “they could not
choose their own doctors.” The vein of
ignorance amongst even the most educated Americans is so deep that they probably
ought to mine it for shale gas and pay their premiums that way. (Stewart did later obliquely bring up Germany.)
Stewart observed that
“Obamacare” was actually a Republican idea Republicans were now repudiating
barely a decade later, that it was actually a half-measure thing that was nothing
like more single-payer models used in advanced democracies, that it would still
allow American insurance companies to rape and pillage Americans, that only a
fraction of Americans might benefit, and that all Americans could still choose
their own health plans, and so on.
Comically, Krauthammer gestured to American businesses like chain
restaurants that were now cutting down workers’ hours so those businesses
weren’t hurt by draconian employer healthcare premiums. Ah yes, those McDonaldian workers’ paradises,
now threatened by Obamacare!!
Krauthammer was really just looking out for people he’d never met
before, and if that isn’t a gesture of altruism, I just don’t know what
is. In fact, it may be the most purely
American gesture there is: thinking about others you have never broken bread
with and then advancing proposals based on what you think.
The elephant in the room that
was never brought up in this discussion, though, was that Americans, and the
American government, already pays the highest costs for the least healthcare in
the developed world. There is nowhere,
nowhere that the gap between money paid and health results gained is lower than
in the U.S. For a quick primer, look no further than the
exhaustive TIME article by Steven
Brill.
(This link:
is just to TIME and the article page.)
Stewart actually had Brill on
his show, and expressed amazement that an organ such as TIME would even attempt something like long-form journalism. I was so astonished after seeing Stewart that
I asked my dad a province away to hang on to a copy for me. And Brill’s piece is one long, long piece on
health care; many Americans might spend almost as much time reading it as
filling out insurance forms. It took me
more than a few turns of the treadmill to get through it. It was repetitive and too long, but it
observed basic journalistic tropes: focus on a few individuals, extrapolate,
research, do some interviews, offer on tiptoe faint conclusions actually
bellowed by your research. Anyone
outside the U.S.
would wonder why it was so long, but, well, you have to consider the
audience. To get it past editors, and then
people, Brill must have had to amass so much evidence that it would be like
proving a Sasquatch sighting (Damn. I
forget Americans see them everyday, too.
I’m all mixed up on my mixed metaphors.)
Anyway, things Brill observed were that Americans paid massively more
for the most basic services than anyone else in the world. An aspirin that costs .69 in France cost $69 in the U.S.; a Q-Tip costs nothing in Romania, but $50 in the U.S., and so on. And, whenever Medicaid was involved,
bureaucrats were tough bargainers and costs were massively reduced everywhere,
with the government introducing competition and sanity that helped every
taxpayer. And if a company that
willingly sells a drug into France for $2/pill, but says in America that it
can’t keep afloat if it can’t charge $100/pill, then someone—obviously never
Charles Krauthammer—ought to be asking questions. Someone has to help the American people. They’re good people, and they can’t help
themselves.
Well, it doesn’t matter, in
the end. Americans, in the end, will go
on paying much more for worse healthcare than any other advanced
democracies. It is hard-wired into
American DNA. It will not change. Obamacare is simply an incrementalist
approach; it’s one president (and any credit probably goes to people like
Pelosi, not Obama) trying to get one little thing done so as to help to show
Americans that medicare can actually work and bring up in large relief just how
massively Americans are paying for a stunningly cost-ineffective system. If America’s Medicaid system had
simply been larger, its government treasury, and the health of its citizens,
would have been billions and millions of dollars and hearts better. But what does it say on the American dollar
bill? “Ideology before reason.”
The cute elephant in the room
in all of this is—what if Americans actually were healthy and productive? That would be good for competition and
business and so on, surely. What if more
Americans were healthy? I mean, how can
anyone pretend that being healthy isn’t on a direct line to workplace
productivity? Well, I’m sure Americans
have an answer for that one, too, how being fat and addicted to cheeseburgers
and 86 oz. Cokes is actually a way of warding off government plots to take away
guns, and so on. Talk about defending
yourself by killing yourself.
Any posts here are obviously
written mainly for a Canadian audience,**and I strenuously try not to address
American topics, for various reasons not dilated on here. However, when American issues obviously inflict
Canadian ones, one feels a need to say something.
It doesn’t matter how much I
love American people; in the cold, hard light of day, they are trying to
bankrupt themselves by shutting down their government and making sure that many
of them can’t access healthcare, and that those who do pay much more for it
than anywhere else—this just isn’t good.
If you share “the world’s longest undefended border” (and that one is really in quotation marks now. . .quick
note to Americans—Canadians are not in charge of admitting terrorists to
America; Americans are), then it’s a concern.
If Americans can’t buy Canadian stuff, let alone Chinese, then that’s a
problem. And if Canadians can’t get
high-quality American goods made by Americans because all American jobs have
been shipped overseas, that’s a problem.
If anyone has actually gotten
down this far on the post—if anyone has actually read this far, well, then, I
owe you one of my Croatian burgers. But
let me close like this. This issue is of extreme moment to Canadians and
Canadian taxpayers. One of the
comparatively apparently small, but hugely, hugely rapidly increasing cost
factors in health care is drug costs.
Krauthammer not only said that healthcare was an “entitlement” (which I
disagree with), but he also did sound an alarm that many have been sounding,
that healthcare costs have been going up astronomically because of technology
and, yes, drugs. Look, no-one anywhere
expects their tax dollars to pay for a Mayo Clinic. Life isn’t that complicated. You get born, you grow up, you age, you
die. The idea that we should all have
millions shed on us when we’re 50 or 60+ is perverse—it would have been utterly
perverse to Tommy Douglas. That’s where
the “care,” not the “health” part comes in.
First you have “health,” then you have “care.” The more you have “health,” the less you need
“care.” No-one ought to suggest that in between these two there ought to be a
30-year bonus gap where billions are spent on life-extendency, and so on. The idea that ALL people can have their
bodies cryogenically frozen and have access to the same healthcare that Tom
Cruise does is ludicrous. But that all
people should have access to decent healthcare?
That’s a plausible and desirable goal.
However, it’s yet one more
goal that is being attacked by the Harper government. Apparently, a trade-off in the vaunted
European free-trade negotiations is that the Harper government will extend, yet
again***, the ability of multi-national pharmaceutical companies to jack up
charges on their drugs and throttle any generics. Of course, this will mainly hit seniors, but
in their clinical political caluculi, the Harperites have gathered that most of
their voters are already so rich or too poor that they’ll like or not vote
enough to know what Harper has done (Harper needn’t worry about his own family,
since he is not really one of us or a Canadian taxpayer). Even the most moderate of commentators on the
right-right Canadian media spectrum has touted that the Canada-Europe
free-trade deal will be a great thing.
These people are obviously so rich and unconcerned that they’d leave
their kids with Clifford Olson if they knew they’d have a chance to shag someone
they were interested in at a Hallowe’en party.
Since when does an advanced government leave its people utterly, utterly
in the dark about a major trade deal?
Since when? And since when is
it a good thing to bargain from a position of weakness? Harper isn’t just negotiating against
Lichtenstein; he’s negotiating against the European Union. That includes a lot of players, and they can
trade off amongst themselves like musical chairs. Meanwhile, Canada has a domestic government
desperate to fend off opposition at home and “change the channel.” This, this puts us in a good trade negotiation
situation? Is this what Andrew Coyne’s
dad taught him, that negotiating from a point of abject weakness and keeping
your family in the dark is a good thing?
Sadly, I guess it is, if Andrew and Andrew himself can find a new hair
dye and effective comb-over. Canadians
ought not to be held hostage to ephemeral political imperatives, but we are,
and pundits like Coyne abet the government and harm Canadian history by so
doing.
And so it goes—Canada
threatens to withdraw from the Commonwealth because it thinks there are enough
Tamils in Toronto to sway a riding; Canada votes against the UN small arms
treaty (http://www.un.org/disarmament/convarms/SALW/)
that even the US voted for, in some sort of misguided and drunken effort to
please gun-owners in Canada. Canada blindly, like no other country in the
world, addresses the Middle East peace process
by uncritically supporting only one side (oh yeah, that’s always sure to get a
resolution). One cannot imagine
Diefenbaker or Stanfield or even Mulroney peering over the border so as to
determine what domestic action they ought to take, but it’s what the Harperites
take to heart—what did Karl Rove say? What did Ayn Rand say? Back in the day, Canada
used to breed its own Conservatives; now it breeds only American wannabes like
Presto Manning and Stephen Harper, who learned from Texans and pundits who
couldn’t get a job in America
like Tom Flanagan and Margaret Wente. Canada has
become the backwater where frustrated bottom-feeders go to preach ideologies
they can’t preach effectually enough or get rich off enough in their home
countries. Cheap drones, is probably the
American intelligence file on it.
Healthcare isn’t an
“entitlement.” It’s not a “privilege,”
obviously, and it may not even be a “right,” whatever that is. Are doctors poorly paid? Are they paid strikingly more than doctors with
similar or greater educations in other fields?
Do doctors resent having to doctor to poor people? Do doctors simply hate the fact that they are
called upon to treat people who can’t pay their fees? Should medicine be taken out of universities
entirely so that people like doctors could not profit obscenely from the misery
of others? Ask yourself: which doctor is
the one you want: the one that can charge the highest fees, or the one who
demonstrates an interest in healing you?
An advanced democracy struggles eternally with this equation. Only once in a blue moon will you actually
hear a doctor address this issue because, well, doctors aren’t really
interested in medicine or in healing others; they’re interested in protecting
and advancing the massive wealth they can accrue. They’ll talk about “oh, well, I have to run an
office, and so on, and I have to pay taxes, and so on,” but notably, it’s never
actually about what they were trained for—supposedly, medicine. No, if you hang out with doctors, what
they’re chiefly obsessed about is not keeping up with the literature or knowing
something about medicine; it’s actually about rent and taxes and staff costs
and profit margins. That’s the key for medicine, from a doctor’s
standpoint. How many people can I cycle
in and out and get paid for the most.
Forget helping anyone; it’s about trying to maximize profit and minimize
time spent; I dare any doctor to contradict me.
I dare any doctor.
--zr
*Obviously I’ve seen
Krauthammer’s, ah, memorable face before, but I really didn’t know anything
about him, not getting Fox “News” and so on.
I didn’t know that his formative years were Canadian, that he started
out liberal, and so on.
**though I’m considering
going back what I originally intended, just some sort of miscellany in the
spirit of what I took this now-antique form, the blog, to be. Maybe I’m just too fat n’ lazy.
***The first was under
Conservative minister Harvie Andre in 1986.
In latter age, but knowing he could benefit from it while future
Canadians could not, Andre agreed to extend patents for European pharmaceutical
giants so that generics could not compete and enter the marketplace. In this way, Andre helped to kill off many
Canadians prematurely, the while enjoying massive benefits for overseeing a
deal that damaged thousands of Canadians and helping. . . ? Perhaps in his casket, Andre wore a sash saying
“Yeah, I helped to kill off a lot of poor people who probably didn’t donate to
us, but man what a ride it was.”
Posts
