November 10, 2007
The Best Health Care System in the World

At least we’re still ahead of Liberia.

The United States ranks near the bottom for infant survival rates among modernized nations. A Save the Children report last year placed the United States ahead of only Latvia, and tied with Hungary, Malta, Poland and Slovakia.

The same report noted the United States had more neonatologists and newborn intensive care beds per person than Australia, Canada and the United Kingdom — but still had a higher rate of infant mortality than any of those nations.

To no one’s surprise, babies born to black mothers die two and a half times as frequently as those born to white mothers, a stark indication of the continuing influence of racism, and probably even more of disparities in income.

Krugman says:

…finding out that you’re covered by Medicaid when you show up at an emergency room isn’t at all the same thing as receiving regular medical care.

Beyond that, a large fraction of the population — about one in four nonelderly Americans, according to a Consumer Reports survey — is underinsured, with “coverage so meager they often postponed medical care because of costs.”

So, yes, lack of insurance is a very big problem, a problem that reaches deep into the middle class.

Here’s the part I keep missing, somehow. Why are people so excited about insurance? I can’t remember the last time I needed health insurance. What I need is health care, and I don’t want any damn insurance company making money off that need. In fact I think they should have to pay me for putting up with their existence.

Public subsidy, private profit, that’s the American system. Or put another way, we’re all about socialism, but it only applies to the costs. Those we’re happy to socialize. The benefits must be privatized, or we’d have the unhappy situation of, say, Cuba, where any random person off the street could get health care.

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Posted by Chuck Dupree at November 10, 2007 06:54 PM
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People are excited about health insurance because those who have only cash pay double or triple the fee the health provider has negotiated with the health insurer.

I first bought health insurance after reading a who pays how much chart on the wall of an x-ray joint.

Posted by: Joyful Alternative on November 10, 2007 9:21 PM

I don't get the connection to insurance, though. Naturally people are trying to keep health costs down, but the price reductions come, as you rightly point out, from the power of group negotiation. That could be done way more powerfully, and according to the available data about 9% cheaper, by the government. Efficiency and profit are opposites, it seems to me.

As John Edwards says, in the discussion of how to provide health care for everyone like all other industrialized countries do, the drug companies and the insurance companies should not have a seat at the table. We'll tell them what they will do, if anything, once we decide on our plan.

Posted by: Chuck Dupree on November 10, 2007 9:38 PM

Of course the government could provide the same or better price negotiation. But I'm not old enough for Medicare yet and am not poor enough for Medicaid, so until we actually have single-payer universal health insurance----

Posted by: Joyful Alternative on November 11, 2007 1:00 AM

Sure, for an individual, having insurance is better than having nothing. But I'm wondering why Krugman is saying that the problem is the lack of insurance. That's not the problem; the problem is the lack of health care. Insurance is one way of supplying that lack, but a very inefficient one.

Posted by: Chuck Dupree on November 11, 2007 2:33 AM
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