The "Fantasy" of Decent Health Care

Robert Samuelson has an astonishingly obtuse column today in the Washington Post. First, he alleges -- without offering any evidence or justification -- that the phrase "fix the health care system" is "completely meaningless" and that critics of our health care system just focus on a few specific flaws. Then he characterizes Bush's yet-unannounced health care plan as mere "tinkering" that won't address the fundamental drivers of increased costs in health care. I'll agree with him that if Bush's plan consists of mere tax deductions and "health savings accounts," as is being reported, it won't solve the fundamental flaws in our system. Then he zooms in, using anecdotal backup, on what he evidently considers the real driver of astronomical health care costs. See, when Samuelson goes to his nice small private family practice, he observes lots of apparently extraneous staff. Doctors hire too many secretaries and nurses and accountants! That's why we spend 16% of our GDP on health care, compared to 6-8% in Europe! Finally, in an argument that sounds downright condescending, he tells Americans that decent and affordable health care is a "fantasy," and -- like a weary parent schooling his kids -- we should all just wake up to the reality that our health care system is the best of all possible worlds. Silly Americans: we expect too much.

I suppose Samuelson's resigned tone of inevitability, so to speak, would be easier to accept if our health care system weren't distinctly costly, inefficient, and inaccessible. Not only do we spend twice as much as most other developed countries relative to the size of our economy, our aggregate health indicators (life expectancy, infant mortality, etc.) are among the worst in the industrialized world. On top of it all, the system leaves close to 50 million Americans uninsured and millions more with high-deductible coverage on narrow terms. No benevolent social planner, given a blank slate, would design the crazy-quilt patchwork of public and private insurance we have now.

That we could do better is anything but a "fantasy," unless, like Samuelson, you are ideologically blinded or completely unwilling to look outside our borders for ideas. Personally, after living in the UK for two years, I think the horror stories we hear about "socialized medicine" are overblown -- their system is the quintessential government-monopolized health care bureaucracy, yet it actually keeps health care costs pretty low relative to already efficient European countries, it offers 100% coverage and is easy to subscribe to (I got into the NHS system just a few weeks after arriving, and kept my coverage for a full two years even though I never paid a cent in British taxes), and the waiting list is not much more severe than you get in our own crowded hospitals and doctors' offices.

And we could actually do much better than the NHS; take, for example, the French health care system, which spends a little more (about 9% of GDP), but as one would expect from the French offers almost all the luxuries one could ask for: every French resident has coverage, there is absolutely free choice of doctors and hospitals, guaranteed access to specialists of your choice without a "gatekeeper" HMO, full drug coverage, even spa therapy. The government and private insurers foot on average 85% of the bill; the poor and the catastrophically sick pay nothing. It's enough even to make a conservative jealous.

But wait: I thought Samuelson said this was all a fantasy?