(I bumped this post, because I ended up attaching a long update. Several new posts I did earlier today follow immediately on the heels of this post.)
I saw Michael Moore with Jay Leno the other day. I was impressed by how very fat he was. He’s not just pleasingly plump, he’s morbidly obese, barely-can-walk fat. Some might think he’s a heart attack waiting to happen. If that were to be the case, he’d be rushed to the hospital in a hi-tech ambulance, be given hi-tech tests, and probably receive hi-tech surgery. All of that made me think about some of the reasons American health care is so expensive, and it’s not just insurance company greed or lawyers.
For starters, American doctors are the best trained in the world. Unlike doctors in most (all?) other countries, who start their medical training right out of high school, American doctors first have to complete their undergraduate education in pre-med courses, where they have to place in the top percentages of their classes to qualify for medical school. Not only does this give them a good practical science education, it means they’re more mature when they finally get to medical school. Medical school, of course, is a four year program. After that, they all have to do a one year internship, which qualifies them to become prison doctors. If they want to go beyond being a prison doctor, they have to continue their training. For the more basic medical practices — internal medicine, pediatrics, etc. — they have to complete a two year residency in their field. However, if they aim higher, after the two year residency, they have to complete either a longer residency (such as surgery), or even go on to a longer fellowship in their chosen medical specialty, such as cardiology or neurosurgery.
In other words, your average American surgeon, after leaving high school, has put in a minimum of twelve years of training. Taking all this into account — their stellar undergraduate grades and their lengthy training — you can’t then pay them Soviet-style wages. We can decide, of course, as a matter of public policy that our doctors are over-trained, and lessen the whole cycle, but we can’t take our current crop of hyper-educated people and reduce them to a secretary’s wages.
The next thing that distinguishes modern American medicine is that it is so high tech. Fifty years ago, for diagnosing patients, your average doctor had a clunky x-ray machine, a few simple blood tests, and his own five senses. If he was able to diagnose something, he had three treatment options: a small arsenal of pills most of which, with the exception of newly discovered antibiotics, were useless; surgery; or doing nothing.
Nowadays, of course, our doctors are science machines. Diagnosis takes place using every type of test and scan scientific ingenuity could create, with the number of tests available growing annually. Treatment involves a panoply of medicines and surgical options unimaginable even thirty years ago. And even putting the fear of lawyers aside, when you have the ability to diagnosis and treat at this level, you’re going to try to do it that way. After all, an EKG is a much better way to find out what’s going on than a stethoscope, and an MRI is better (and safer) than an old-fashioned x-ray. Certainly patients expect that their doctor will use the best equipment, tests and techniques on them. So people who complain about the high cost of medicine, at least when it comes to today’s medical sophistication, are like people who buy a fully equipped SUV and then complain that it’s more expensive than a horse and buggy.
The last thing that distinguishes modern American medicine, not just from treatment in the past, but from treatment elsewhere in the world, is the speed with which treatment is available. I could dig through myriad articles and studies to prove the truth of this statement, but I’m heading out soon, and won’t. I’ll confine myself to citing one article about Canadian medical care (h/t: Earl), and a few anecdotes.
Anecdote 1: When I was living in England, my friend’s mother had a bad hip. She was a candidate for a hip replacement. As you know, in America, that would have happened in days or weeks. My friend’s mother was placed on a list, and spent the last years of her life in a wheelchair, in tremendous pain.
Anecdote 2: Also when I was living in England, I kept hearing people talk about something called BUPA. It sounded like Tupperware, but when I asked, I learned that it was new-fangled medical insurance (this was in the very early 1980s). Inquiry revealed that middle class people who could afford it were buying BUPA and opting out of the national health care system as fast as their wallets would carry them. In other words, given a market choice, they couldn’t escape NHS fast enough.
Anecdote 3: A very wealthy cousin of mine lives in Germany. When she was diagnosed with a major abdominal problem, she was so frightened of the top German doctors who had bungled her care for years, that she hired an ambulance flight to America to have surgery there.
Anecdote 4: Another cousin of mine in Israel was born with congenital eye problems. No one in the regional hospital to which he was assigned was capable of treating them. Nevertheless, the public health care system refused to allow him to obtain treatment in another hospital, which had a staff member who could care for his eyes. His parents ended up spending hundreds of thousands of dollars of their own money to restore and preserve his sight.
I recognize that American health care has problems. Right now, we have a situation where the majority of people get pretty damn good care, either by comparison to historic precedent or care systems in the rest of the world. However, a significant number, but by no means a majority, can afford only basic care, but gets screwed by insurance company for more expensive care. And a clump of people, about 1/12 of the population, has no regular care at all, and gets by on emergency rooms, which is bad for them and expensive for us. Obviously, it’s not perfect.
But is it any more perfect to be in a system where everyone gets mediocre care from poorly trained doctors, using less sophisticated equipment, in systems so overloaded that even life saving treatments are denied? That’s toddler style medical care, with someone out there making the decision that “If I can’t have it, nobody gets it.”
Given the choices, I’d much prefer to fix our system so that it offers the best care for the greatest number of people, rather than jettison it entirely in favor of the socialized medicine that has proven to give the most mediocre care to the greatest number of people.
UPDATE: It’s been a few days since I wrote the above post, and I have a few updates to offer, in no particular order.
First, a commenter took issue with my claim that about 1/12 (or about 8%) of the population is uninsured. I stand by that number. In an article today about health care (to which I’ll return), the number of uninsured is given as 26 million. According to the useful CIA World Fact book, America’s current population is slightly more than 301 million. My math is primitive, but I’m pretty sure that works out to — 8%.
Second, I spent some time this weekend talking to yet another person who has lived with socialized medicine and he, too, said that this is not the way to go. Better to fix America’s system than to destroy it and remake it in the socialized mold, he said.
Third, the article to which I refer above, in comparing America’s health care to that in other countries, missed a few things, most of which have already been covered in comments. For example, the article raves about French-style health care, which ranks #1 in the world. However, it may rank #1, not because it is true socialized medicine, but because it is much closer to the American model (which gets to my and my friend’s point about fixing the American model, not destroying it):
In Sicko, Moore lumps France in with the socialized systems of Britain, Canada, and Cuba. In fact, the French system is similar enough to the US model that reforms based on France’s experience might work in America. The French can choose their doctors and see any specialist they want. Doctors in France, many of whom are self-employed, are free to prescribe any care they deem medically necessary. “The French approach suggests it is possible to solve the problem of financing universal coverage…[without] reorganizing the entire system,” says Victor G. Rodwin, professor of health policy and management at New York University.
The article also comments, intelligently, on the fact that America’s resources are directed more at treating the sick than on maintaining health. I agree. But one doesn’t need to socialize medicine to fix that problem. Just off the top of my head, insurance could give wellness incentives. As an example, I have very good teeth and good dental health habits. Part of that goes back to the dental insurance policy my dad got through his job in the 1960s. The deal with the policy was that, if you had your teeth cleaned and checked twice a year, the policy would pay for all major dental care. However, if you did not take the time and discomfort to have your teeth checked regularly, your coverage would be drastically reduced. This type of carrot and stick worked well, and it was pure private sector.
The article is honest enough to admit that, while the other countries have strong aspects to their health care systems, still have significant problems, including the fact that many have to grapple more and more with a problem that has long bedeviled America’s health care system — increasing numbers of immigrants who use lots of health care while paying nothing into the system overall.
The article also glosses over the fact, mentioned in comments, that America subsidizes a lot of European health care, by footing all the costs for drug R&D so that socialized medicine countries can then demand discount prices, and by relieving many of this countries of the obligation to use their tax money to fund a meaningful military. England, which has a meaningful military, has a less than stellar health care system, and is increasingly forced to rely on cheap doctors from other countries, some of whom, as Mark Steyn says, are literally bombs waiting to go off:
Does government health care inevitably lead to homicidal doctors who can’t wait to leap into a flaming SUV and drive it through the check-in counter? No. But government health care does lead to a dependence on medical staff imported from other countries.
Some 40 percent of Britain’s practicing doctors were trained overseas – and that percentage will increase, as older native doctors retire, and younger immigrant doctors take their place. According to the BBC, “Over two-thirds of doctors registering to practice in the UK in 2003 were from overseas – the vast majority from non-European countries.” Five of the eight arrested are Arab Muslims, the other three Indian Muslims. Bilal Abdulla, the Wahhabi driver of the incendiary Jeep and a doctor at the Royal Alexandra Hospital near Glasgow, is one of over 2,000 Iraqi doctors working in Britain.
Many of these imported medical staff have never practiced in their own countries. As soon as they complete their training, they move to a Western world hungry for doctors to prop up their understaffed health systems: Dr. Abdulla got his medical qualification in Baghdad in 2004 and was practicing in Britain by 2006. His co-plotter, Mohammed Asha, a neurosurgeon, graduated in Jordan in 2004 and came to England the same year.
When the president talks about needing immigrants to do “the jobs Americans won’t do,” most of us assume he means seasonal fruit pickers and the maid who turns down your hotel bed and leaves the little chocolate on it. But in the United Kingdom the jobs Britons won’t do has somehow come to encompass the medical profession.
Aneurin Bevan, the socialist who created the National Health Service after World War II, was once asked to explain how he’d talked the country’s doctors into agreeing to become state employees: “I stuffed their mouths with gold,” he crowed. Sixty years later, no amount of gold can persuade Britons to spend their working lives in the country’s dirty, decrepit hospitals (they spend enough of their nonworking lives there, waiting to be seen, waiting for beds, waiting for operations). According to a report in the British Medical Journal, white males comprise 43.5 percent of the population but now account for less than a quarter of students at UK medical schools. In other words, being a doctor is no longer an attractive middle-class career proposition. That’s quite a monument to six decades of Michael Moore-style socialist health care.
This point, of course, circles back around to my original point, which is that American doctors are amongst are smartest citizens and are the best trained doctors in the world.
UPDATE II: Don Quixote told me that, per United States Census Bureau information, revised 2005 figures show that, in that year, 44.8 million people had no health insurance, as opposed to the 26 million figure in the article from which I quoted. This does raise the number of uninsured from the 8% number on which I relied to almost 15%. It does not, however, alter my substantive discussion of the issue.
UPDATE III: Larry Elder, who has actually studied the numbers, hews to my side on the “numbers of uninsured” argument, pointing out that the numbers vary based on the time of day you’re examining them and the population you include.