Friday, April 25, 2008

Clearing some things up when it comes to health care

I have no interest in turning this blog into a critique of Ross Kaminsky. I debated whether to write a response to his post today entitled "Slowing the train (wreck) towards socialized medicine" but given that health care is an area I happen to have worked in, know a bit about and care about deeply I've decided to go ahead.

Right off the top can we just drop the use of the word "socialized"? Socialism is defined as community control of the means of production and distribution. No mainstream Democrat is calling for anything of the sort. Instead we have the presidential candidates calling for further utilization of private insurers with an expanded government insurance program to cover those who choose it. Others on the left are calling for a "single payer" system, whereby the government creates a substantial insurance program and enrolls everyone - while still leaving private insurers in place if one chooses to go that route.

There is no plan to make our nations doctors government employees or to nationalize our private hospitals. Even the plans that are the most progressive are merely calling for the government to become a major insurer. The government would merely be a purchaser (albeit a large purchaser) of medical services provided by private doctors, nurses and hospitals. It's a business model that has worked well for the Department of Defense and Lockheed Martin when it comes to weapons systems, yet conservatives routinely decry it as "socialism" when the same model is proposed in health care.

Kaminsky next trots out the United States cancer survival rates. The argument goes like this, we have a higher rate of cancer survival ergo our health care system is the best in the world. This is a pretty common point that conservatives like to argue but it's misleading because the statistics don't actually tell us much at all. I'll let noted health care policy wonk Ezra Klein explain, (emphasis mine)

Andrew Sullivan is quite pleased that the US is #1 in cancer survival rates. So am I! Problem is, we don't know what that means. The US has the most aggressive tumor screening in the world. That means we find some tumors earlier, but we also find many tumors that would have been non-lethal, or proven so slow-growing that something else would have killed the individual before the cancer did...The question is how many otherwise lethal cancers we're curing, not merely how many cancers we're curing (or slowing).

Moreover, simply having the highest survival rates isn't a particularly useful metric of whether we're getting good value for our money. Our 5-year cancer survival rate, according to the study Andrew links, is 62.9%. Italy's is 59%. Italy spends about $2,532 per person. America spends about $6,100. And these numbers, incidentally, are adjusted for purchasing power parity. Then there's the question of who our treatment is best for. Not the poor. Studies show significantly lower mortality rates for the low-income cancer patients in Canada than in the US. Is this all a good deal?..

At the end of the day, the question is never American health care: Good or bad. It's whether it can be better. It's whether we get good value for our dollar. It would be absurd if a system that spends twice what anyone else does didn't demonstrate superiority in some areas. The question is why so few, and why by such minor margins (a percent or two, in this case). It baffles me -- genuinely baffles me -- that conservatives seem so intent on defending an obviously bad deal. I don't know if it's a reflexive, for-what-the-left-is-against kind of thing, or whether they're worried about the specter of a single-payer system very few people support, but it leaves them clinging to scraps of evidence, and ignoring vast swaths of the story.

Indeed, raw survival numbers of specific diseases by themselves tell us very, very little about the efficacy of the health care system, with the operative word being system. Conservatives cherry pick bits of data that are illustrative of absolutely nothing and construct elaborate arguments to defend a health care system that is significantly more costly than any other system in the world, has worse medical outcomes than any other western democratic nation and that leaves almost 50 million people without coverage at all.

It's economically indefensible, medically inferior and morally repugnant and yet every day conservatives wage battle to protect this system.

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