Comparing Health Care

We may very well be on the way to some variation of single-payer health care in this country, with the coming Obama administration to push for government mandates to guarantee universal coverage.

One of the leading advocates on the left for universal health is Ezra Klein. He offers some provocative thoughts on all of this in his post, "What is Life Worth?", especially this comparison of health systems in the U.S. and Britain:

People often compare American health care to Canadian health care. It's the wrong comparison. The inverse of the American health care system is the British health care system. Where we are the priciest, they are the cheapest. We refuse to make any explicit decisions, instead denying care based on criteria that makes the denial the fault of the patient rather than the system. You don't have enough money for the treatment. They make all their decisions explicit, relying on criteria that makes the denial the fault of the system's judgments. We don't think that treatment worth the cost. Their system gives patients someone to be angry at. Ours has no connection to value. Their system creates more blame, ours engenders more tragedy.

Beyond the techno-babble of "explicit decisions" and "treatment worth the cost," we have Klein making an essentially normative argument pitting state control versus personal responsibility in health provision.

Which works better? Well, while we're on the British case, recall the big story from last summer on Britain's experience with the nationalization of dental care. Access to good dental health declined in Britain with the advent of a single payer system, as this Telegraph story indicates:

The shake-up of NHS dentistry has been a disaster with standards of care dropping and almost one million fewer people being treated on the health service under the new system, a damning report by MPs has found ....

Instead of improving access to NHS dentistry the reforms have made it worse, the report by the House of Commons Health Select Committee found.

The number of dentists working in the health service has fallen, the number of NHS treatments carried out has dropped and in many areas patients are still experiencing severe difficulties in finding a dentist to treat them.

Worryingly, complex treatments carried out on the NHS have dropped by half while both referrals to hospital and tooth extractions have increased.

This suggests dentists are simply removing teeth rather than taking on complicated treatments because they have become uneconomical to provide ....

The Government hoped the new contracts would give more patients the chance to register with an NHS dentist, encourage more preventive work and reduce the "drill and fill'' culture.

They were also designed to simplify the payments system, so that instead of being paid per treatment, dentists were given a flat annual salary in return for carrying out an agreed amount of work known as units of dental activity (UDAs).

However, the select committee found that as a result of the changes, dentists no longer had any financial incentive to give appropriate treatment.

For folks like Ezra Klein - who have been pushing for a radical expansion of the state sector - well before the economy started cooperated with a collectivist-inspiring crisis of capitalism - the key will be to demonstrate how an expansion of state-control and governmental mandates will not worsen care in the United States.

Rather than build bureaucracy and limit choice among service providers, government should seek to increase competition in insurance markets, and find ways to subsidize, through grants and tax incentives, the affordabiliy of health coverage for lower income and disadvantaged Americans.