SOCIALIZED MEDICINE REDUX
Kevin Drum, citing a NYT report that Public spending accounts for “45 percent of all health spending in the United States, compared with a 72 percent average in O.E.C.D. countries,” argues
The government already pays for 45% of healthcare costs in America, which means that public healthcare spending accounts for 45% of 15% of GDP, or 6.75%.
In other western countries healthcare costs are about 10% of GDP, which means that public spending accounts for about 72% of 10%, or 7.2%. That’s barely more than we spend in percentage terms and less than we spend in actual dollars per person. And by most conventional measures they deliver care that’s as good or better than ours. For everyone.
A long discussion follows in the comments section, with many pointing out that it is certainly arguable as to whether health care is comparable in other countries, given long delays, denial of access to expensive technologies, etc.
I’m rather leery of going to a single payer system although I agree that our current one is deeply flawed as well. If we take profit out of it, I’m not sure what incentives there would be toward invening new techologies, drugs, and the like, for example. For those who can afford it–which is to say, most of us–the U.S. system is almost certainly better than that in Canada or Western Europe. Even rural hospitals here have up-to-date technology and near-instant availability of care. But for those without deep pockets or decent health insurance, our system is less desirable than that of our peers.
Yeah, yeah, I know, it’s socialism. But wouldn’t it be nice if we could put the scary namecalling aside and instead just work together on building a real healthcare system to replace the creaky, dysfunctional, and out of control one we have now?
I agree that calling socialized medicine “socialized medicine” shouldn’t be the end of the debate. As Kevin correctly notes, we’ve already got socialized medicine, it’s just that some of us aren’t yet covered. I therefore don’t dismiss arguments that some sort of single payer system might be an improvement over what we have.
[I moved this paragraph down, so that it would be read with the update that follows.] But one major flaw that most of the comparisons with the US and Europe have is they don’t account for the vast difference in population density. (The same is true, incidentally, with the public transportation argument.) We’ve got a little over 30 people per square kilometer, compared to 110 for France, 15.4 for Finland, etc. It’s going to be more expensive as a portion of GDP to provide equivalent health care regardless of the system.
Update (1519): A commenter on Kevin’s post, where I introduced a much shorter version of my population density argument, notes that many countries with a lower population density than ours have a higher life expectancy–which really doesn’t have anything to do with anything–and that my math was off by an order of magnitude on Finland (I had written 154 rather than the actual 15.4) which rather undercuts my argument.
So, a little more research appears to be in order, and it’s not looking good for my theory: Brian Weatherson provides OECD stats for dollars spent per capita on health care adjusted for purchasing power parity. While there is some variation among the most modern of the OECD countries in that amount, there doesn’t seem to be any obvious correlation between that variation and population density (from this Canadian government list). Now, of course, I can’t account for variability in provision of expensive services here, but it’s baffling to me that Australia and Iceland, who are off the charts with population densities of 2.5 and 2.7 residents per square kilometer, don’t seem to spend more per capita than The Netherlands and Belgium, who are on the other end of the range at 390.3 and 336.1 (the figures are $2224, 2559, 2310, and 2114, respectively).