Health Care

When it comes to health care I have no ideological axes to grind. I don't care whether it's fully private, fully government-funded or a mix of the two. All I care is that it works. Kids should get inoculations. Expectant mothers should get prenatal care. Older folks should get regular checkups. When people are sick or injured they should be able to go to the doctor. When someone has a serious condition that requires surgery or expensive treatment in order to get well, they should be able to get what they need without facing bankruptcy. The noise put out by people with ideological preconceptions to defend or financial interests to serve does not interest me. Good medical care does.

That is why we should cut through the fog and take a stark look at health care in America. If our system worked well for all our people I would be more than satisfied. But it does not. The figures are quite clear on this. 17% of the American Gross Domestic Product is now spent on health care. The average for OECD countries is 9%. (Thirty countries belong to the Organization for Economic Cooperation and Development, a group that started with the U.S., Canada and European countries receiving Marshall Plan aid and now extends to much of the rest of Europe plus others such as Japan, Korea, Australia, Mexico and Turkey.)

16% of our people are completely without health coverage. No one in any other OECD nation is. Average life expectancy in our country is 75 for men and 80 for women. The OECD averages are 78 and 83. The infant mortality rate in the U.S. is the highest and the maternal mortality rate is the third highest. We have the second lowest hospital beds per capita and the fifth lowest number of physicians per capita. These results are not acceptable.

There are many people in the United States who like mindlessly to chant, "USA! USA!" and, "We're number one! We're number one!" They feel it is reflexively patriotic to so believe. They do not like to hear news that contradicts their ignorance.

There are others who believe that an unfettered "free market" is always the best solution to every problem. When evidence demonstrates otherwise on a particular issue they are quick to offer a myriad of excuses. They do not like to hear facts that do not fit their ideological preconceptions.

There are others yet who feel their profits depend on maintaining arrangements as they are, and many others they pay to advertise, advocate, and legislate to protect these arrangements. They like to pretend, and may in some cases even believe, that their personal interests and the national interest are one and the same. They do not like to hear anything that questions this.

The bottom line is that we are paying much more and getting much less for our health care dollar than comparable countries. The Canadian, French, British, German, Japanese, Italian and many other plans work better than ours at far less cost. If we spent what they do per capita we would have an additional $100 billion to devote to other things. And these costs have been going up by 12% a year. The economy cannot sustain a bubble like that any more than it could sustain housing prices annually going up at that rate. This is not about politics or ideology. It is about practicality.

John McCain wants to take away the business deduction for providing insurance. So one would expect companies to stop offering it for their employees. Instead, people will get a $2,500 individual or a $5,000 family tax credit for buying their own health insurance. The average family health insurance plan costs $12,000. The kinds of plans people could buy for $5000 have huge gaps in coverage. If they want a good comprehensive plan they will have to pay $7,000 out of pocket, $7,000 that already-strapped families are not paying now. And what of those who cannot afford any plan? And how is this to be paid for? McCain's idea is worthless.

Hillary Clinton and Barack Obama want to rescind the Bush tax cuts for people making over $250,000 and use that to fund their health insurance plans. Employers would be encouraged to provide coverage for their employees as many do now. Otherwise, people could go into a medicare-type plan or they could opt for better, paying the difference on a sliding scale. Clinton would require people to join or buy. Obama would make the system available to all but would require people to purchase, if necessary, only for their children.

The Clinton and Obama plans are considerably better than McCain's, though even they probably overstate the amount that can be funded from the tax restoration and that will be saved from various cost-control measures their plans will try to require of the private insurers and health care providers. They represent a halfway approach that tries to reform the present system rather than go to a truly national system such as the other countries have. They would be an improvement over the way things are done now, but will not fully rectify the problems. But they may be all that is politically possible given the resistance of the entrenched interests and the weight of people's preconceptions. More's the pity.