Health Care Costs
HereÃ¢€™s a figure showing the relationship between the Ã¢€œPublicnessÃ¢€ of the health system and the amount spent on health care per person per year. Data points are each countryÃ¢€™s mean score on these measures for the years 1990 to 2001. You can also get a nicer PDF version of this figure. As you can see, health care in other advanced capitalist democracies is typically twice as public and half as expensive as the United States.
Now, this picture doesnÃ¢€™t resolve a whole bunch of arguments about the relative efficiency of public vs private care or the right kind of health system to have. (Brian [Weatherson] discussed some of these issues last year. ThereÃ¢€™s not much evidence that the quality of care in the U.S. is twice as good as everywhere else.) Things are also complicated Ã¢€” or made worse Ã¢€” by the fact that, despite not having a national health system, U.S. public expenditure on health in the 1990s was higher in GDP terms than in Ireland, Switzerland, Spain, Austria, Japan, Australia and Britain. But a picture like this makes it easy to see that mainstream debate about health care in the U.S. happens inside a self-contained bubble, and that one of its main conservative tropes Ã¢€” the inevitable expense of some kind of universal health care system Ã¢€” is wholly divorced from the data.
Most of the conservative arguments against socialized medicine are about quality, choice, and convenience rather than cost. Indeed, one of the fears is that, by giving government responsibility for the program, it will naturally follow that Big Brother rations care and regulates social conduct. You’ve eaten too many cheeseburgers; no bypass for you. Smoker? You’re not getting that expensive operation. You’re 75. Sorry–no hip replacement for you; it’s just not a good investment.
Kevin observes that
Note that the chart doesn’t really demonstrate any special trend, but it does show that conservatives who insist that national healthcare systems are nothing more than vast boondoggles that inevitably produce huge amounts of waste and higher costs just isn’t looking at the evidence. As near as I can tell, France has a better healthcare system than the United States on practically every measure, and does it at half the cost.
If the Economist magazine description of the French system is accurate–and I have no reason to believe otherwise–it does sound preferable. Of course, the countries aren’t exactly comparable. France is roughly the size of Texas but vastly more populated. That should translate into the need for far less redundancy than our geographical spread requires. Furthermore, other issues impact health care costs as well. Presumably, we require more expensive trauma centers given our dependence on the automobile and greater propensity to shoot one another. We’re more prone to obesity owing to lifestyle differences. I’m guessing France also has far fewer medical lawsuits and less need for expensive medical malpractice insurance.
A major problem with our system is that it’s neither fish nor fowl. We’ve already adopted socialized medicine in pockets, which is probably the worst of all worlds. The poor, the old, the military, the disabled veterans, and others get publically financed health care. Most of those who pay for health care themselves really don’t–they rely on insurance. Either way, hardly anyone pays for health care out of pocket, which means no one has any incentive to minimize costs.
The discussions in the comments section of both Political Animal and, especially, Crooker Timber also explore other possible reasons. Indeed, as Kieran readily concedes, the correlations are all over the place–the US is a giant anomaly.