April 19, 2006


Caption: Goats listen with amazement to Bush health care plan. Says Venus (right), “This is a joke, right?”

The Bush administration’s explanation of the US health care crisis would be hilarious if they were only joking.

At a time when 46 million Americans lack health coverage, a number that has grown each year since 2000, and many more have negligible or unaffordable coverage, the administration has the guts to suggest that the problem is that too many of us have too much health care and don’t pay enough for it.

Presidential assistant Allan B. Hubbard wrote, apparently with a straight face, in the New York Times that “Health care is expensive because the vast majority of Americans consume it as if it were free. Health insurance policies with low deductibles insulate people from the cost of the medical care they use—so much so that they often do not even ask for prices.”

Most people who live in our solar system see it a little bit differently. If anything, it works the other way. People without health insurance tend to delay care until their condition becomes much more serious—and expensive—to treat.

To use El Cabrero’s beloved state of West Virginia as an example, the state Health Care Authority found in 2004 that hospitals here provided $447 million in uncompensated care, mostly to the uninsured. This merely shifts costs to people who are insured. Families USA estimates that the cost of family coverage in this state is almost $1,800 per year higher due to the cost shift. They estimate that this will increase to over $2,900 by 2010.

For that matter, since health care is kind of important, and since demand is growing and technology is constantly changing, we should expect it to be expensive, cost shifts aside.

But here as elsewhere, the administration lives in a land of (bad) theology rather than reality, the deity in question being the market god. Health Savings Accounts, their silver bullet, would empower “consumers”—whatever happened to sick people?—to shop for health care the way they shop for tomatoes. Too bad health care isn’t a simple commodity.

In fact, health care isn’t exactly the market god’s strong suit. The US pays more in health care as a percentage of GDP than any other developed nation and gets less in return. This is due in part to the fact that most developed countries have public health care systems which can be run much more cheaply than private concerns. This is also true of the publicly administered US Medicare system, which spends just two percent on administration compared with over ten percent in the case of private insurance companies.

As Hendrik Hertzberg puts it in the April 17 New Yorker, “In the United States, we spend fifteen per cent of our gross domestic product on health care, close to six thousand dollars per person. The French and the Canadians spend ten per cent of the G.D.P., about three thousand dollars per head. Yet their ‘health outcomes,’ measured by indices like longevity, are better than ours.”

Rather than deal with the problem head on, the HSAs pushed by Bush administration would make health care like car insurance, with sick people being the equivalent of teenagers with DUI convictions.

Talk about a goat rope. As bad ideas go, this one is almost up there with nuking Iran or starting an unnecessary war in Iraq.

At least they’re consistent.


1 comment:

Khazouh Baszhees said...

Health insurance shouldn't be a problem for you as long as you have goats that can talk. Maybe you should teach them a song: "If you're happy and you know it, and you really want a soda"...