Health Care

David Lazarus of the San Francisco Chronicle used this quote in today's column:

"Why have all other countries figured out a way to do this?" Grumbach asked. "Why are we the only ones that are so uncivilized?"

"Grumbach" is Dr. Kevin Grumbach, head of UCSF's Department of Family and Community Medicine; and he was discussing, as was Lazarus, the fact that the U.S. spends twice the amount on health care that other industrialized democracies spend (the ones which guarantee health care, like Canada and Britain), yet we don't live as long as their citizens, and more of our babies die. (That's English for "life expectancy in the United States was lower than in each of these other countries and infant mortality was higher.")

I'm afraid I know the answer to that question, and it isn't pretty; it reflects some of the nastier side of the American public. Why do we spend so much and get so little?

Well, for one thing, we're cheap bastards. We don't want to pay for the common good. We have one of the lowest tax burdens in the industrialized world, and we're terrified that we might have to pay more of "our" money to "the government" for a program that would provide benefits to someone else. This is the state of mind that objects to paying into Social Security because the objector could do better investing the money himself, and to supporting the public schools because the objector has no kids.

We seem to have forgotten that we are the government: of the people, by the people, for the people. Health care isn't the only example of this: the state of California hasn't spent a nickel more on infrastructure maintenance than it absolutely had to for 40 years, because it would have had to raise taxes. But health care is the one that's affecting the most people.

Numero Two-o (as dear Molly used to say): We blame the victim. If you don't have health care it's your own fault. Going way back to the Puritans who founded the Massachusetts Bay Colony, who believed that personal prosperity was a sign of God's grace, there's a sneaky feeling, not often voiced out loud, that if you aren't personally prosperous enough to afford health care, then God must be punishing you in some way; you must be less deserving than others, because if you were truly deserving, God would have given you health care (or whatever other benefit you need but don't have). This is another variant of the (also usually unstated) American belief that if you are poor, it's because you're lazy and shiftless. In fact, most of the poor in this country are working 2 and even 3 jobs just to pay the rent and (we hope) put food on the table.

Third, we were hypnotized years ago by the American Medical Association's shrieks about "socialized medicine," back when "socialist" was just a sidestep away from "Communist." Perish the thought that you shouldn't be able to pick your own doctor. The issue here isn't who picks your doctor; it's who pays your doctor, and how much, and for what. The stupidest thing we ever did was to allow health insurance companies, and health providers, to be for-profit; because when you get a bottom line in there, someone will make the unilateral decision that Treatment X is Too Expensive, and then someone else will die to increase the quarterly numbers.

Fourth, we don't believe the government could do it efficiently. This isn't a completely off-the-wall concern. MediCare is run by the government and provides health care to everyone over 65. MediCare isn't, God knows, perfect; consider the MediCare drug program, for government-run insanity squared. But if your alternative to government-paid-for health care was no health care at all, and for over 40 million Americans that's exactly the case, what would you choose??

The generally quoted administrative overhead number for Medicare is 3%; for private health insurance, 15% - plus or minus 10%. I'm not kidding. Google "medicare overhead" and you'll see a wide range of overhead numbers quoted both for MediCare (anywhere between 1% and 4%) and for private insurance: as low as 8%, as high as 30%. (And that's just in the blog titles!) I think the truth is, nobody really knows. This is a very murky and complex area.

OK, maybe I'm being a typical American and blaming the victim. We don't have universal health care because we're nasty people. It isn't that simple. But one thing is clear: what we have now isn't working, and we need to fix it, and we may need more than one try to get the solution right. Another thing that seems clear to me: the existing health insurance industry has a huge vested interest in keeping things as they are now, and is spending money like a drunken sailor, on advertising and government lobbying, to make sure they stay that way.

Can we please stop arguing about socialized medicine and do something useful? People are dying here.