Caring Is Not Enough

That we could extend health care to everybody if only we cared enough is the theme of an op-ed in The Washington Post today by health care consultant Michael Millenson. If only that were true! Unfortunately, the op-ed is intellectually slipshod and not only does it not make that case but, in fact, is self-refuting in the sense that the material provided in the op-ed is either internally contradictory or is sufficient to explain why we don’t do as the author wishes.

So, for example, from near the beginning of the op-ed:

[a music video on Youtube] expresses the frustration felt by those trying to end the United States’s status as the only industrialized nation whose citizens don’t have universal access to health care.

There’s so much wrong with that little snippet that I hardly know where to begin in criticizing it, indeed, I could get past it only with the greatest difficulty. For one thing universal coverage’s most ardent advocates would almost certainly reject the formulation above. Would universal access only to American citizens be acceptable? By defining universal coverage that way the number of the uninsured could be reduced literally at the stroke of a pen. Even a casual glimpse at the states with large numbers of uninsured people tells you that immigrants, particularly immigrants from Mexico are a key part of the problem of the uninsured.

The U. S.’s circumstances are distinctive: we’re the only major industrialized country I can think of that shares a long, largely unsecured land border with a country whose per capita GDP is a quarter its own. Britain and Japan are islands. France, Germany, Belgium, and Spain all have per capita GDP’s within 10% of one another ($33,800, $34,400, $36,500, and $33,700, respectively). There’s not much incentive for illegal immigration among those countries. Mr. Millenson hints at the explanation in his article here:

Only 13 percent of non-Hispanic white Americans is uninsured, compared with 36 percent of Hispanics, 33 percent of Native Americans, 22 percent of blacks and 17 percent of Asians/Pacific Islanders.

There is one country I can think of that has a situation similar to ours: China. It doesn’t have universal health coverage or universal access, either.

There’s another problem with the statement above. Universal coverage and universal access are not synonymous.

I know of no plans currently on the table for providing universal access. If we were to enact such a plan, it would constitute a powerful inducement for the sickest people in the world to get here by whatever means possible to them and claim their share of the universal access pie.

It might just barely actually be within our means to extend basic health care to the entire world. We are, after all, a very rich country. It is not possible, even with the U. S.’s great wealth to extend basic health care to the entire world here. The cost per person is just too high and it would simply be prohibitively expensive—an amount greater than our total GDP.

Mr. Millenson has little use for either political party. Republicans are racists:

The unofficial Republican attitude toward universal health care can be boiled down to the three “nots”: not our voters, not our kind of solution and not our priority. None of the Republican presidential candidates even pretended to present a serious plan for universal coverage, nor did Republican primary voters demand one.

Democrats are insincere phonies:

Meanwhile, Democrats play their own “us vs. them” games. Although high-profile party leaders are loudly calling for universal coverage — recall the Barack Obama-Hillary Clinton slugfest over their respective plans — they reassure the middle class that the cost of compassion will be covered by repealing tax cuts for the wealthy. This “free lunch” approach may tax credulity, but it does avoid the need for discussing other taxes.

Old people via their advocacy groups are selfish hypocrites:

AARP, one of the most powerful consumer groups, is running a high-profile ad campaign advocating a vague health care “reform.” But imagine the revolt if the organization’s leaders had asked its elderly membership to insist that those with no health insurance, including 9 million children, should be guaranteed basic care before Congress spent hundreds of billions of dollars adding a Medicare pharmaceutical benefit.

Meanwhile, he describes the effects of universal access glowingly:

The Commonwealth Fund recently tallied the ways in which universal health care would save hundreds of millions of dollars, most of which were related to lowering the societal costs exacted by the greater burden of illness among the uninsured.

Two can play at that game. For example, imagine how wonderful a perpetual motion machine would be. It could easily be converted into a generator and would produce energy forever at no cost. For that matter how about a universal cure that could be produced easily and inexpensively? That would be sure to keep costs down!

How much would we have to care, who is “we”, and, most importantly, what would we have to do merely to improve access to health care for the people living here now who don’t have adequate access to health care?

•members of the AMA would need to care enough to increase the number of physicians we graduate here annually. Most of the new graduates would have to be in family practice.

•medical educators would need to care enough to produce all of these new doctors without increasing the cost. To do this they’d need to drag medical education into the 21st century.

•physicians would need to care enough to practice where pay rates are lower and they’re far from the social and other amenities that big cities and their surroundings provide.

•legislators would need to care enough to change the work rules so that nurse-practitioners, other health care professionals, and just plain folks could do more legally. Legalizing telemedicine would help, too.

•we’d need to educate a lot more nurses and nurse-practitioners

•we’d need to care enough to close the borders so that the entire system would remain affordable

I’m just scratching the surface here. It would take a heckuva lot of caring.