Health care policy should be debated through micro-facts. Let’s consider a few:
1. American health care outcomes look much better once we adjust for race and other demographic factors, including violence and car crashes. Some groups — such as Asian-American women — have remarkably good health care outcomes.
2. Some of the health care savings of other systems occur through price effects (e.g., doctors are paid an average of $60,000 in France) and do not involve real resource savings.
3. American’s high expenditures, however wasteful they may be, nonetheless drive much of the world’s medical innovation. Medical innovation is also a public good to some extent and no the pharmaceutical companies are not simply parasites on the NIH and universities.
4. America has a different structure of interest groups. and therefore a single payer system in the United States would not operate as does a single payer system in other countries. It would more likely favor the interests of doctors and insurance companies, for a start.
5. If we take the international health results/expenditures data at face value (and we shouldn’t), they imply that greater access to medical care does not itself improve health outcomes. So we should be careful in how we use and cite such results.
6. Health care outcomes improve with income even under single-payer systems. Our best estimates suggest that this gradient is no steeper in the United States than it is in Canada.
7. Having health insurance does improve your health care outcomes, but not to an amazing degree. The largest benefits are arguably the alleviation of financial risk, and no I am not meaning to slight that factor.
8. Pharmaceuticals, unlike many forms of health care, have large and noticeably positive effects on individual health.
9. The major Democratic health care plans on the table all, one way or another, admit they will spend more money on health care. The fact that other countries spend less therefore does not help predict the change in spending that would result from these plans.
(Sorry for the lack of links, I am on the road, google back to previous MR posts for documentations.)
Now here is how to debate health care policy. Ask a defender of single payer systems (or other possible reforms) how many of these points he or she accepts. Settle on that list, noting that residual disagreements may well remain. Then debate what the list means for what America should do about health care policy today.
Here’s how not to debate health care policy. When you hear one point on that list, bring up in response that other countries spend less and produce better health care outcomes and that therefore we should copy the systems of those countries.
But libertarians, I am not letting you off the hook either: Isn’t there some form of further government intervention into health care that could help somebody? And if your basic model is that governments steal as much money as they can, and then waste it all, shouldn’t we then jump at the chance to institute health care subsidies of this at least partially helpful nature? The alternative is simply that the money gets wasted some other and worse way.