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I wonder at the appeal of the progressives. I suffered through two and a half hours of the September 12 debate of the ten Democratic presidential candidates. These talkers inhabit a different world from the one that I do — not that my world is the only one, but it is mine and they are not of it.

Consider medical care. All of the candidates accept that medical care is a human right. I don’t, but even if I did, I would have to admit there are problems with it. Some medical care is necessary for life and health, some is good but not necessary, some is questionable, some is useless, and some is positively harmful. It would seem obvious that whoever is paying for the care would make these distinctions before signing the check. Certainly a prudent individual would, if he were paying with his own money.

Well, we mostly don’t do that anymore. We have health insurance, in which the insurer pays. Are we to assume that a good and proper insurer should never say no? Listening to the Democratic candidates, you’d think so.

All of the candidates accept that medical care is a human right. I don’t.

In the September 12 debate, Senator Elizabeth Warren said the health insurance companies, which she wants to run out of business, make their profits “by saying no.” I’ll stipulate that when they say no, they are trying to save money, and even the not-for-profits among them try to do that. But does America suffer from a systemic problem of insurance companies saying no to necessary claims?

Not in my world. I’m 68, and I’ve had a medical condition that put me in the hospital for 23 days and that cost several hundred thousand dollars. My private-sector insurer never said no to any of it. At the end of my hospital stay, I paid about one cent on the dollar of what it cost. I know others of my age who have had expensive procedures, and not one of them bellyached about his coverage. On the contrary — all of them were glad to have it. Elizabeth Warren said in the debate, “I have not met anybody who likes her health insurance company.” Hm. Have you asked?

I’ve argued with progressives for years about medical coverage. American progressives believe deep in their bones that covering everyone for everything will cost less than people pay to cover some people for some things. Sanders and Warren both said this. Sanders was vehement about it. “I wrote the bill,” he insisted. (It must be true!) Under his bill, the Vermont socialist said, Americans would get medical care, including prescription drugs, and would pay nothing out of pocket. And the taxes to bankroll this, which Joe Biden claimed would cost $3.5 trillion a year? Warren addressed that. Taxes would go up for the corporations and the rich, she said, adding, “Middle-class families are going to pay less.”

When insurance companies say no, they are trying to save money, and even the not-for-profits among them try to do that.

Really? Do people believe this? Do middle-class families pay less in taxes in Canada? The UK? France? Germany? Sweden?

It’s true that Americans pay in ways other than taxes, so that medical care takes a smaller share of gross domestic product in those countries than it does in the United States. But is their care as good? Canada spends 6.6% of GDP less than the US and gets mostly good outcomes, but it falls short of US standards in some ways. I live a hundred miles from British Columbia, and I’ve heard the stories about hospital stays there. The B.C. system is notorious for making people wait months for elective surgeries such as hip replacements, which can be scheduled in Seattle in a few days. It has few of the robot-arm da Vinci Surgical Systems for prostate removal, which are routine across the US border. Hospitals in British Columbia also have mixed-gender four-bed wards instead of private rooms.

Canadians do pay considerably less for drugs by having the provincial health authorities act as the sole buyers. This comes at a price: Canadians get fancy new drugs several years later than Americans do.

I live in Seattle. In my career in newspapers, I used to cover the biotech industry here. Back in the ’80s and ’90s Seattle had a gaggle of little biotechs fed by money from floating shares on the NASDAQ. The biotechs were trying to develop new drugs, non-drug treatments (a blood filter to treat cancer was one), and medical devices. Everybody in liberal Seattle was in favor of biotech. The local economic development gurus promoted biotech as the city’s industrial future. Twenty years later, it has been a disappointment. Most of the ventures failed, though one of them, ICOS, failed to hit the target it aimed at, cancer, and developed something else, the ED drug Cialis. The bottom line is that drug development is risky, unpredictable, and high-cost. The critics don’t understand that. I remember the Seattle elite praising the biotech industry, then turning around and saying that the high cost of drugs was scandalous.

The B.C. system is notorious for making people wait months for elective surgeries such as hip replacements, which can be scheduled in Seattle in a few days.

Canada and the rest of the world rely heavily on US companies to develop new drugs. Being second-order users does save them money, but there are tradeoffs that the progressives don’t want to talk about. Somebody has to pay the costs of drug research.

I am wary of the promised cheapness of “single payer.” In the American cultural setting it’s not going to be easy to make medicine cheap, but if the socialists, such as Bernie Sanders, do make it cheap, Americans won’t like what they get. In my case, my medical condition was detected in a CT scan and diagnosed after an MRI. Later, when I had a blood clot and reacted against the usual drug for it — heparin — the doctors gave me a newer biotech drug, argatroban. The whole experience made me very appreciative of my surgeon (a hot-shot 32-year-old from New Zealand) and of high-tech medical equipment, high-tech drugs, and the private insurance company (Group Health, since then absorbed by Kaiser Permanente) that paid for it.

The progressives want Medicare for All. Since my operation I’ve gone on Medicare, and it has cut my cost of health insurance by at least two-thirds. But Medicare is a forced subsidy paid by taxpayers younger than I. If everyone is to be offered the same deal, there will be no group left to plunder. Furthermore, Medicare pays doctors and hospitals less than market rates. In the state of Washington, a Rand Corp. survey https://www.rand.org/pubs/research_reports/RR3033.html in 2017 found that Medicare pays 42 cents for each dollar private insurers pay for similar procedures. Hospitals make up the shortfall by charging private-coverage patients more. That’s a cross-subsidy in addition to the taxpayer subsidy — and the progressives don’t want to talk about that, either.

Canada and the rest of the world rely heavily on US companies to develop new drugs. Somebody has to pay the costs of drug research.

None of the candidates at the September 12 debate addressed any of the drawbacks of Medicare for All. They don’t mention drawbacks or tradeoffs — only problems of the current system, such as all the paperwork (actually computer work) that health insurers require providers to fill out. Does Medicare not have forms to fill out? Are we really going to have an insurer that doesn’t ask questions and always says yes? You’d think so, listening to Bernie Sanders and Elizabeth Warren. But do Americans really believe that a monopoly run by federal employees will cost less and always give them what they want?

Yes, some of them do believe it.




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Comments

Jacques Delacroix

Good development, Bruce, and I should be unreservedly with you but something is stopping me. I am fairly familiar with the French single-payer system. I think it works well. (For all it's worth - not that much - the French live two years longer than Americans. There are more important reasons why I think it works well.)

My obstacle is this: I keep reading that the overall cost of health care in France at the national level (not to individuals) is only a little bit more than 50% of the corresponding American overall cost. So, I wonder, why spend a lot more for not very persuasive reasons? I can see ethical and political justifications to do so but the bill seems a little stiff. Is it possible that the US has currently achieved the worst of two worlds?

Geezer

    I am fairly familiar with the French single-payer system. I think it works well.

If you build a better mouse trap, there is no need to force people to buy it; they will do so voluntarily. "Single-payer" health care always and everywhere requires governmental coercion. If it's such a good idea, why is it necessary to force people to buy it?

Chris Nelson

Those who would speak against "Medicare for All", as you and I and most readers here probably do, would probably have a better way to argue against it if we just changed the terms of the promotion: "VA Care for All".

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