What Americans Do Not Understand about Healthcare

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):

 

^{http://www.thecomedynetwork.ca/shows/thedailyshow?videoPackage=140192
I'm sorry.  The Daily Show is banned in Canada by the comedynetwork.  They prevent Daily Show content from being shown in Canada.  I'll offer a link to the first part of the interview that _can_ be shown in the U.S.: http://thedailyshow.cc.com/videos/g4whw7/exclusive---charles-krauthammer-extended-interview-pt--1  For similar shows, similar websites can be consulted.  The comedynetwork.ca, actually based out of Beijing, does not allow paying subscribers access to content (comedynetwork.ca observed "it was the last place in the world we could match up our initiatives with those of willing parties; we kind of like this Xi guy")/} 

 

(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:

 

http://content.time.com/time/magazine/article/0,9171,2136864,00.html

 

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.”