May 9, 2005
By: Kevin Drum
http://www.washingtonmonthly.com/archives/individual/2005_05/006282.php
REPUBLICANS vs. DEMOCRATS ON THE ECONOMY....Did you know that Democratic presidents are better for the economy than Republicans? Sure you did. I pointed this out two years ago, back when my readership numbered in the dozens, and more recently Michael Kinsley ran the numbers in the LA Times and came to the same conclusion.
The results are simple: Democratic presidents have consistently higher economic growth and consistently lower unemployment than Republican presidents. If you add in a time lag, you get the same result. If you eliminate the best and worst presidents, you get the same result. If you take a look at other economic indicators, you get the same result. There's just no way around it: Democratic administrations are better for the economy than Republican administrations.
Skeptics offer two arguments: first, that presidents don't control the economy; second, that there are too few data points to draw any firm conclusions. Neither argument is convincing. It's true that presidents don't control the economy, but they do influence it — as everyone tacitly acknowledges by fighting like crazed banshees over every facet of fiscal policy ever offered up by a president.
The second argument doesn't hold water either. The dataset that delivers these results now covers more than 50 years, 10 administrations, and half a dozen different measures. That's a fair amount of data, and the results are awesomely consistent: Democrats do better no matter what you measure, how you measure it, or how you fiddle with the data.
But it turns out there's more to this. Via Brendan Nyhan, I recently read a paper by Princeton's Larry Bartels that adds some fascinating details to this picture.
--------------------------------------------------------------------------------
The first thing Bartels did was break down economic performance by income class. The unsurprising result is shown in the chart on the right.
Under Democratic presidents, every income class did well but the poorest did best. The bottom 20% had average pretax income growth of 2.63% per year while the top 5% showed pretax income growth of 2.11% per year.
Republicans were polar opposites. Not only was their overall performance worse than Democrats, but it was wildly tilted toward the well off. The bottom 20% saw pretax income growth of only .6% per year while the top 5% enjoyed pretax income growth of 2.09% per year. (What's more, the trendline is pretty clear: if the chart were extended to show the really rich — the top 1% and the top .1% — the Republican growth numbers for them would be higher than the Democratic numbers.)
In other words, Republican presidents produce poor economic performance because they're obsessed with helping the well off. Their focus is on the wealthiest 5%, and the numbers show it. At least 95% of the country does better under Democrats.
--------------------------------------------------------------------------------
But this raises an interesting question: if 95% of the country does better under Democrats, and if economic performance is the most important factor in most presidential elections, then how do Republicans ever get elected? The most common hypothesis — spelled out in detail in last year's What's The Matter With Kansas? — is that cultural issues often override economic considerations. But Bartels proposes a surprising alternative explanation illustrated in the two charts below. The top chart shows income growth during non-election years, and it displays the usual characteristics: under Democrats, income growth is strong overall and the poor do a bit better than the well off. Under Republicans, income growth is weak overall and is tilted heavily in favor of the already prosperous.
But now look at the bottom chart. It shows economic performance during election years and it's a mirror image of the top chart: Republicans produce better overall performance, and they produce especially stupendous performance for the well off. Democrats not only produce poor overall performance, they produce disastrous performance for the well off, who actually have negative income growth.
In other words, voters aren't necessarily ignoring economic issues in favor of cultural issues. Rather, Republicans produce great economic growth for all income classes in election years, and that's all that voters remember. They really are voting their pocketbooks.
Bartels doesn't essay an explanation for this. Do Republican presidents deliberately try to time economic growth spurts — and are Democratic presidents too lame to do the same? Is it just luck? Or is the difference somehow inherent in the different ways that Democrats and Republicans approach the economy (with Democrats typically focusing on employment and Republicans on inflation)? At this point, your guess is as good as anyone's.
Bottom line: if you're well off, vote for Republicans. But if you make less than $150,000 a year, Republicans are your friends only one year in four. Caveat emptor.
Sunday, September 20, 2009
Saturday, September 19, 2009
You can't complain about health care reform if you're not willing to reform your own health
Quote from Bill Maher - New Rule: You can't complain about health care reform if you're not willing to reform your own health. Unlike most liberals, I'm glad all those teabaggers marched on Washington last week. Because judging from the photos, it's the first exercise they've gotten in years. Not counting, of course, all the Rascal scooters there, most of which aren't even for the disabled. They're just Americans who turned 60 and said, "Screw it, I'm done walking." These people are furious at the high cost of health care, so they blame illegals, who don't even get health care. News flash, Glenn Beck fans: the reason health care is so expensive is because you're all so unhealthy.
Yes, it was fun this week to watch the teabaggers complain how the media underestimated the size of their march, "How can you say there were only 60,000 of us? We filled the entire mall!" Yes, because you're fat. One whale fills the tank at Sea World, that doesn't make it a crowd.
President Obama has identified all the problems with the health care system, but there's one tiny issue he refuses to tackle, and that's our actual health.
And since Americans can only be prodded into doing something with money, we need to tax crappy foods that make us sick like we do with cigarettes, and alcohol -- and alcohol actually serves a useful function in society in that it enables unattractive people to get laid, which is more than you can say for Skittles.
I'm not saying tax all soda, but certainly any single serving of soda larger than a baby is not unreasonable. If you don't know whether you burp it or it burps you, that's too big. We need to make taking care of ourselves an issue of patriotism. If you were someone who condemned Bush for not asking Americans to sacrifice for the war on terror, the same must be said for Obama and health care.
President Arugula is not gonna tell Americans they're fat and lazy. No sin tax on food on Obama's watch. And at a time when it's important to set new standards for personal responsibility, he appointed a surgeon general, who is, I'm sorry, kind of fat. Certainly too heavy to be a surgeon general, it's a role model thing. It would be like appointing a Secretary of the Treasury who didn't pay his taxes. He did?
And get this: Surgeon General Benjamin had previously been a nutritional advisor to Burger King. The only advice a "health expert" should give Burger King is to stop selling food. The "nutritional advisor" job was described as, "promoting balanced diets and active lifestyle choices" -- and who better to do that than the folks who hand you meat and corn syrup through a car window? When you have a surgeon general who comes from Burger King, it's a message to lobbyists, and that message is, "Have it your way."
Read more at: http://www.huffingtonpost.com/bill-maher/new-rule-you-cant-complai_b_291852.html
Yes, it was fun this week to watch the teabaggers complain how the media underestimated the size of their march, "How can you say there were only 60,000 of us? We filled the entire mall!" Yes, because you're fat. One whale fills the tank at Sea World, that doesn't make it a crowd.
President Obama has identified all the problems with the health care system, but there's one tiny issue he refuses to tackle, and that's our actual health.
And since Americans can only be prodded into doing something with money, we need to tax crappy foods that make us sick like we do with cigarettes, and alcohol -- and alcohol actually serves a useful function in society in that it enables unattractive people to get laid, which is more than you can say for Skittles.
I'm not saying tax all soda, but certainly any single serving of soda larger than a baby is not unreasonable. If you don't know whether you burp it or it burps you, that's too big. We need to make taking care of ourselves an issue of patriotism. If you were someone who condemned Bush for not asking Americans to sacrifice for the war on terror, the same must be said for Obama and health care.
President Arugula is not gonna tell Americans they're fat and lazy. No sin tax on food on Obama's watch. And at a time when it's important to set new standards for personal responsibility, he appointed a surgeon general, who is, I'm sorry, kind of fat. Certainly too heavy to be a surgeon general, it's a role model thing. It would be like appointing a Secretary of the Treasury who didn't pay his taxes. He did?
And get this: Surgeon General Benjamin had previously been a nutritional advisor to Burger King. The only advice a "health expert" should give Burger King is to stop selling food. The "nutritional advisor" job was described as, "promoting balanced diets and active lifestyle choices" -- and who better to do that than the folks who hand you meat and corn syrup through a car window? When you have a surgeon general who comes from Burger King, it's a message to lobbyists, and that message is, "Have it your way."
Read more at: http://www.huffingtonpost.com/bill-maher/new-rule-you-cant-complai_b_291852.html
Friday, September 18, 2009
Harvard Study: Lack of Insurance Causes 45,000 Deaths Every Year
New York Times:
As the White House and Congress continue debating how best to provide coverage to tens of millions of Americans currently without health insurance, a new study (PDF) is meant to offer a stark reminder of why lawmakers should continue to try. Researchers from Harvard Medical School say the lack of coverage can be tied to about 45,000 deaths a year in the United States — a toll that is greater than the number of people who die each year from kidney disease.
“If you extend coverage, you can save lives,” said Dr. Steffie Woolhandler, a professor of medicine at Harvard who is one of the study’s authors. The research is being published in the December issue of the American Journal of Public Health and was posted online Thursday.
The Harvard study found that people without health insurance had a 40 percent higher risk of death than those with private health insurance — as a result of being unable to obtain necessary medical care. The risk appears to have increased since 1993, when a similar study found the risk of death was 25 percent greater for the uninsured.
The increase in risk, according to the study, is likely to be a result of at least two factors. One is the greater difficulty the uninsured have today in finding care, as public hospitals have closed or cut back on services. The other is improvements in medical care for insured people with treatable chronic conditions like high blood pressure.
As the White House and Congress continue debating how best to provide coverage to tens of millions of Americans currently without health insurance, a new study (PDF) is meant to offer a stark reminder of why lawmakers should continue to try. Researchers from Harvard Medical School say the lack of coverage can be tied to about 45,000 deaths a year in the United States — a toll that is greater than the number of people who die each year from kidney disease.
“If you extend coverage, you can save lives,” said Dr. Steffie Woolhandler, a professor of medicine at Harvard who is one of the study’s authors. The research is being published in the December issue of the American Journal of Public Health and was posted online Thursday.
The Harvard study found that people without health insurance had a 40 percent higher risk of death than those with private health insurance — as a result of being unable to obtain necessary medical care. The risk appears to have increased since 1993, when a similar study found the risk of death was 25 percent greater for the uninsured.
The increase in risk, according to the study, is likely to be a result of at least two factors. One is the greater difficulty the uninsured have today in finding care, as public hospitals have closed or cut back on services. The other is improvements in medical care for insured people with treatable chronic conditions like high blood pressure.
The Body Count at Home
Published: September 12, 2009
In the debate over health care, here’s an inequity to ponder: Nikki White would have been far better off if only she had been a convicted bank robber.
Skip to next paragraph
Fred R. Conrad/The New York Times
Nicholas D. Kristof
On the Ground
Nicholas Kristof addresses reader feedback and posts short takes from his travels.
Go to Blog » Go to Columnist Page »
Related
Times Topics: Health Care Reform
Courtesy of Nikki White's Family
Nikki White died at the age of 32. She had lupus, a chronic inflammatory disease that was untreated because she could not afford health insurance.
Nikki was a slim and athletic college graduate who had health insurance, had worked in health care and knew the system. But she had systemic lupus erythematosus, a chronic inflammatory disease that was diagnosed when she was 21 and gradually left her too sick to work. And once she lost her job, she lost her health insurance.
In any other rich country, Nikki probably would have been fine, notes T. R. Reid in his important and powerful new book, “The Healing of America.” Some 80 percent of lupus patients in the United States live a normal life span. Under a doctor’s care, lupus should be manageable. Indeed, if Nikki had been a felon, the problem could have been averted, because courts have ruled that prisoners are entitled to medical care.
As Mr. Reid recounts, Nikki tried everything to get medical care, but no insurance company would accept someone with her pre-existing condition. She spent months painfully writing letters to anyone she thought might be able to help. She fought tenaciously for her life.
Finally, Nikki collapsed at her home in Tennessee and was rushed to a hospital emergency room, which was then required to treat her without payment until her condition stabilized. Since money was no longer an issue, the hospital performed 25 emergency surgeries on Nikki, and she spent six months in critical care.
“When Nikki showed up at the emergency room, she received the best of care, and the hospital spent hundreds of thousands of dollars on her,” her step-father, Tony Deal, told me. “But that’s not when she needed the care.”
By then it was too late. In 2006, Nikki White died at age 32. “Nikki didn’t die from lupus,” her doctor, Amylyn Crawford, told Mr. Reid. “Nikki died from complications of the failing American health care system.”
“She fell through the cracks,” Nikki’s mother, Gail Deal, told me grimly. “When you bury a child, it’s the worst thing in the world. You never recover.”
We now have a chance to reform this cruel and capricious system. If we let that chance slip away, there will be another Nikki dying every half-hour.
That’s how often someone dies in America because of a lack of insurance, according to a study by a branch of the National Academy of Sciences. Over a year, that amounts to 18,000 American deaths.
After Al Qaeda killed nearly 3,000 Americans, eight years ago on Friday, we went to war and spent hundreds of billions of dollars ensuring that this would not happen again. Yet every two months, that many people die because of our failure to provide universal insurance — and yet many members of Congress want us to do nothing?
Mr. Reid’s book is a rich tour of health care around the world. Because he has a bum shoulder, he asked doctors in many countries to examine it and make recommendations. His American orthopedist recommended a titanium shoulder replacement that would cost tens of thousands of dollars and might or might not help. Specialists in other countries warned that a sore shoulder didn’t justify the risks of such major surgery, although some said it would be available free if Mr. Reid insisted. Instead, they offered physical therapy, acupuncture and other cheap and noninvasive alternatives, some of which worked pretty well.
That’s a window into the flaws in our health care system: we offer titanium shoulder replacements for those who don’t really need them, but we let 32-year-old women die if they lose their health insurance. No wonder we spend so much on medical care, and yet have some health care statistics that are worse than Slovenia’s.
My suggestion for anyone in Nikki’s situation: commit a crime and get locked up. In Washington State, a 20-year-old inmate named Melissa Matthews chose to turn down parole and stay in prison because that was the only way she could get treatment for her cervical cancer. “If I’m out, I’m going to die from this cancer,” she told a television station.
Mr. and Mrs. Deal say they are speaking out because Nikki wouldn’t want anyone to endure what she did. “Nikki was a college-educated, middle-class woman, and if it could happen to her, it can happen to anyone,” Mr. Deal said. “This should not be happening in our country.”
Struggling to get out the words, Mrs. Deal added: “The loss of a child is the greatest hurt anyone will ever suffer. Because of the circumstances she endured with the health care system, I lost my daughter.”
Complex arguments are being batted around in this health care debate, but the central issue isn’t technical but moral. The first question is simply this: Do we wish to be the only rich nation in the world that lets a 32-year-old woman die because she can’t get health insurance? Is that really us?
In the debate over health care, here’s an inequity to ponder: Nikki White would have been far better off if only she had been a convicted bank robber.
Skip to next paragraph
Fred R. Conrad/The New York Times
Nicholas D. Kristof
On the Ground
Nicholas Kristof addresses reader feedback and posts short takes from his travels.
Go to Blog » Go to Columnist Page »
Related
Times Topics: Health Care Reform
Courtesy of Nikki White's Family
Nikki White died at the age of 32. She had lupus, a chronic inflammatory disease that was untreated because she could not afford health insurance.
Nikki was a slim and athletic college graduate who had health insurance, had worked in health care and knew the system. But she had systemic lupus erythematosus, a chronic inflammatory disease that was diagnosed when she was 21 and gradually left her too sick to work. And once she lost her job, she lost her health insurance.
In any other rich country, Nikki probably would have been fine, notes T. R. Reid in his important and powerful new book, “The Healing of America.” Some 80 percent of lupus patients in the United States live a normal life span. Under a doctor’s care, lupus should be manageable. Indeed, if Nikki had been a felon, the problem could have been averted, because courts have ruled that prisoners are entitled to medical care.
As Mr. Reid recounts, Nikki tried everything to get medical care, but no insurance company would accept someone with her pre-existing condition. She spent months painfully writing letters to anyone she thought might be able to help. She fought tenaciously for her life.
Finally, Nikki collapsed at her home in Tennessee and was rushed to a hospital emergency room, which was then required to treat her without payment until her condition stabilized. Since money was no longer an issue, the hospital performed 25 emergency surgeries on Nikki, and she spent six months in critical care.
“When Nikki showed up at the emergency room, she received the best of care, and the hospital spent hundreds of thousands of dollars on her,” her step-father, Tony Deal, told me. “But that’s not when she needed the care.”
By then it was too late. In 2006, Nikki White died at age 32. “Nikki didn’t die from lupus,” her doctor, Amylyn Crawford, told Mr. Reid. “Nikki died from complications of the failing American health care system.”
“She fell through the cracks,” Nikki’s mother, Gail Deal, told me grimly. “When you bury a child, it’s the worst thing in the world. You never recover.”
We now have a chance to reform this cruel and capricious system. If we let that chance slip away, there will be another Nikki dying every half-hour.
That’s how often someone dies in America because of a lack of insurance, according to a study by a branch of the National Academy of Sciences. Over a year, that amounts to 18,000 American deaths.
After Al Qaeda killed nearly 3,000 Americans, eight years ago on Friday, we went to war and spent hundreds of billions of dollars ensuring that this would not happen again. Yet every two months, that many people die because of our failure to provide universal insurance — and yet many members of Congress want us to do nothing?
Mr. Reid’s book is a rich tour of health care around the world. Because he has a bum shoulder, he asked doctors in many countries to examine it and make recommendations. His American orthopedist recommended a titanium shoulder replacement that would cost tens of thousands of dollars and might or might not help. Specialists in other countries warned that a sore shoulder didn’t justify the risks of such major surgery, although some said it would be available free if Mr. Reid insisted. Instead, they offered physical therapy, acupuncture and other cheap and noninvasive alternatives, some of which worked pretty well.
That’s a window into the flaws in our health care system: we offer titanium shoulder replacements for those who don’t really need them, but we let 32-year-old women die if they lose their health insurance. No wonder we spend so much on medical care, and yet have some health care statistics that are worse than Slovenia’s.
My suggestion for anyone in Nikki’s situation: commit a crime and get locked up. In Washington State, a 20-year-old inmate named Melissa Matthews chose to turn down parole and stay in prison because that was the only way she could get treatment for her cervical cancer. “If I’m out, I’m going to die from this cancer,” she told a television station.
Mr. and Mrs. Deal say they are speaking out because Nikki wouldn’t want anyone to endure what she did. “Nikki was a college-educated, middle-class woman, and if it could happen to her, it can happen to anyone,” Mr. Deal said. “This should not be happening in our country.”
Struggling to get out the words, Mrs. Deal added: “The loss of a child is the greatest hurt anyone will ever suffer. Because of the circumstances she endured with the health care system, I lost my daughter.”
Complex arguments are being batted around in this health care debate, but the central issue isn’t technical but moral. The first question is simply this: Do we wish to be the only rich nation in the world that lets a 32-year-old woman die because she can’t get health insurance? Is that really us?
Thursday, September 17, 2009
Right Wing Fringe Lunatics
Rachel Maddow talks to Frank Schaeffer about why a good deal of conservatives when polled said they weren't sure if President Obama was the anti-Christ.
Maddow: I do not know what possessed this polling firm to ask whether or not that people think the President is the anti-Christ, but they did. Does the response rate among conservatives surprise you? More than one in three saying yes or they don’t know.
Schaeffer: Well I was a child when President Kennedy was assassinated and my mother thought that because he died of a head wound foretold in scriptures of the anti-Christ he would be resurrected as the anti-Christ. She thought this might be a possibility. So those of us who come from the evangelical subculture have been weaned with our mother’s milk on a changing case list of villains. It might be Kennedy to one generation, Obama to the next.
But the larger point this brings up is that the mainstream not just media but culture doesn’t sufficiently take stock of the fact that within our culture we have a subculture which is literally a fifth column of insanity that is bred from birth, through home school, Christian school, evangelical college, whatever to reject facts as a matter of faith.
And so this substitute for authentic historic Christianity, and I may add as a little caveat here, I’m a church-going Christian, really brings up the question. Can Christianity be rescued from Christians? And that’s an open question. And when you see a bunch of people going around thinking that our President if the anti-Christ you have to draw one of two conclusions.
Either these are racists looking for any excuse to level the next accusation or they’re beyond crazy. And I think beyond crazy is a better explanation and that evangelical subculture has rotted the brain of the United States of America. We have a big slice of our population waiting for Jesus to come back. They look forward to Armageddon. Good news is bad news to them. We talk about the Left Behind series of books that I talk about in my book Crazy for God.
What we’re really talking about is a group of people are resentful because they know they’ve been left behind by modernity, by science, by education, by art, by literature—the rest of us are getting on with our lives. These people are standing on a hill top waiting for the end and this is a dangerous group of people to have as neighbors. And they’re our national neighbors. And this is the source of all these insanities that we see leveled at the President. One way or the other they go back to this little evangelical subculture.
Maddow: I do not know what possessed this polling firm to ask whether or not that people think the President is the anti-Christ, but they did. Does the response rate among conservatives surprise you? More than one in three saying yes or they don’t know.
Schaeffer: Well I was a child when President Kennedy was assassinated and my mother thought that because he died of a head wound foretold in scriptures of the anti-Christ he would be resurrected as the anti-Christ. She thought this might be a possibility. So those of us who come from the evangelical subculture have been weaned with our mother’s milk on a changing case list of villains. It might be Kennedy to one generation, Obama to the next.
But the larger point this brings up is that the mainstream not just media but culture doesn’t sufficiently take stock of the fact that within our culture we have a subculture which is literally a fifth column of insanity that is bred from birth, through home school, Christian school, evangelical college, whatever to reject facts as a matter of faith.
And so this substitute for authentic historic Christianity, and I may add as a little caveat here, I’m a church-going Christian, really brings up the question. Can Christianity be rescued from Christians? And that’s an open question. And when you see a bunch of people going around thinking that our President if the anti-Christ you have to draw one of two conclusions.
Either these are racists looking for any excuse to level the next accusation or they’re beyond crazy. And I think beyond crazy is a better explanation and that evangelical subculture has rotted the brain of the United States of America. We have a big slice of our population waiting for Jesus to come back. They look forward to Armageddon. Good news is bad news to them. We talk about the Left Behind series of books that I talk about in my book Crazy for God.
What we’re really talking about is a group of people are resentful because they know they’ve been left behind by modernity, by science, by education, by art, by literature—the rest of us are getting on with our lives. These people are standing on a hill top waiting for the end and this is a dangerous group of people to have as neighbors. And they’re our national neighbors. And this is the source of all these insanities that we see leveled at the President. One way or the other they go back to this little evangelical subculture.
Wednesday, September 16, 2009
Why so much Obama Opposition?
From my perception I have never seen the degree of vitriol and resistance to a Democratic president of the US , even going back to Truman. I am curious why this negativity is happening to such a great degree to Obama, compared to other past presidents.
I am doing my own survey. In your estimation and from your vantage point, what number [1 through 5, where 5 is the strongest] would you attribute to the following Obama resistance factors?
Please take a moment of your time to respond. Thank you for your time.
____Democrat
____Moderate Liberal
____Black Man
____Too Intellectual
____ The “Socialism” bad word
____General fear of change due to the strained economy
____He has a legislative branch where the majority party generally agrees with his policies
____Distant, not folksy enough
_____Other Factors such as_________________________________________________________________________________
I am doing my own survey. In your estimation and from your vantage point, what number [1 through 5, where 5 is the strongest] would you attribute to the following Obama resistance factors?
Please take a moment of your time to respond. Thank you for your time.
____Democrat
____Moderate Liberal
____Black Man
____Too Intellectual
____ The “Socialism” bad word
____General fear of change due to the strained economy
____He has a legislative branch where the majority party generally agrees with his policies
____Distant, not folksy enough
_____Other Factors such as_________________________________________________________________________________
A Canadian doctor diagnoses U.S. healthcare
A Canadian doctor diagnoses U.S. healthcare The caricature of 'socialized medicine' is used by corporate interests to confuse Americans and maintain their bottom lines instead of patients' health. By Michael M. Rachlis August 3, 2009 » Discuss Article (360 Comments) Universal health insurance is on the American policy agenda for the fifth time since World War II. In the 1960s, the U.S. chose public coverage for only the elderly and the very poor, while Canada opted for a universal program for hospitals and physicians' services. As a policy analyst, I know there are lessons to be learned from studying the effect of different approaches in similar jurisdictions. But, as a Canadian with lots of American friends and relatives, I am saddened that Americans seem incapable of learning them. Our countries are joined at the hip. We peacefully share a continent, a British heritage of representative government and now ownership of GM. And, until 50 years ago, we had similar health systems, healthcare costs and vital statistics. What's so great about private health... ADS BY GOOGLE U.S.' and Canada's different health insurance decisions make up the world's largest health policy experiment. And the results? On coverage, all Canadians have insurance for hospital and physician services. There are no deductibles or co-pays. Most provinces also provide coverage for programs for home care, long-term care, pharmaceuticals and durable medical equipment, although there are co-pays. On the U.S. side, 46 million people have no insurance, millions are underinsured and healthcare bills bankrupt more than 1 million Americans every year. Lesson No. 1: A single-payer system would eliminate most U.S. coverage problems. On costs, Canada spends 10% of its economy on healthcare; the U.S. spends 16%. The extra 6% of GDP amounts to more than $800 billion per year. The spending gap between the two nations is almost entirely because of higher overhead. Canadians don't need thousands of actuaries to set premiums or thousands of lawyers to deny care. Even the U.S. Medicare program has 80% to 90% lower administrative costs than private Medicare Advantage policies. And providers and suppliers can't charge as much when they have to deal with a single payer. Lessons No. 2 and 3: Single-payer systems reduce duplicative administrative costs and can negotiate lower prices. Because most of the difference in spending is for non-patient care, Canadians actually get more of most services. We see the doctor more often and take more drugs. We even have more lung transplant surgery. We do get less heart surgery, but not so much less that we are any more likely to die of heart attacks. And we now live nearly three years longer, and our infant mortality is 20% lower. Lesson No. 4: Single-payer plans can deliver the goods because their funding goes to services, not overhead. The Canadian system does have its problems, and these also provide important lessons. Notwithstanding a few well-publicized and misleading cases, Canadians needing urgent care get immediate treatment. But we do wait too long for much elective care, including appointments with family doctors and specialists and selected surgical procedures. We also do a poor job managing chronic disease. However, according to the New York-based Commonwealth Fund, both the American and the Canadian systems fare badly in these areas. In fact, an April U.S. Government Accountability Office report noted that U.S. emergency room wait times have increased, and patients who should be seen immediately are now waiting an average of 28 minutes. The GAO has also raised concerns about two- to four-month waiting times for mammograms. On closer examination, most of these problems have little to do with public insurance or even overall resources. Despite the delays, the GAO said there is enough mammogram capacity. These problems are largely caused by our shared politico-cultural barriers to quality of care. In 19th century North America, doctors waged a campaign against quacks and snake-oil salesmen and attained a legislative monopoly on medical practice. In return, they promised to set and enforce standards of practice. By and large, it didn't happen. And perverse incentives like fee-for-service make things even worse. Using techniques like those championed by the Boston-based Institute for Healthcare Improvement, providers can eliminate most delays. In Hamilton, Ontario, 17 psychiatrists have linked up with 100 family doctors and 80 social workers to offer some of the world's best access to mental health services. And in Toronto, simple process improvements mean you can now get your hip assessed in one week and get a new one, if you need it, within a month. Lesson No. 5: Canadian healthcare delivery problems have nothing to do with our single-payer system and can be fixed by re-engineering for quality. U.S. health policy would be miles ahead if policymakers could learn these lessons. But they seem less interested in Canada's, or any other nation's, experience than ever. Why? American democracy runs on money. Pharmaceutical and insurance companies have the fuel. Analysts see hundreds of billions of premiums wasted on overhead that could fund care for the uninsured. But industry executives and shareholders see bonuses and dividends.
Compounding the confusion is traditional American ignorance of what happens north of the border, which makes it easy to mislead people. Boilerplate anti-government rhetoric does the same. The U.S. media, legislators and even presidents have claimed that our "socialized" system doesn't let us choose our own doctors. In fact, Canadians have free choice of physicians. It's Americans these days who are restricted to "in-plan" doctors. Unfortunately, many Americans won't get to hear the straight goods because vested interests are promoting a caricature of the Canadian experience. Michael M. Rachlis is a physician, health policy analyst and author in Toronto.
Compounding the confusion is traditional American ignorance of what happens north of the border, which makes it easy to mislead people. Boilerplate anti-government rhetoric does the same. The U.S. media, legislators and even presidents have claimed that our "socialized" system doesn't let us choose our own doctors. In fact, Canadians have free choice of physicians. It's Americans these days who are restricted to "in-plan" doctors. Unfortunately, many Americans won't get to hear the straight goods because vested interests are promoting a caricature of the Canadian experience. Michael M. Rachlis is a physician, health policy analyst and author in Toronto.
Subscribe to:
Posts (Atom)