America’s Defining Choice

As Borja has noted, I have recently been quiet on the health care front. In part this is due to suffering from kidney stones this past month and consequently focusing more on Spain’s health care system than the joke of a debate going on back in the States. Needless to say (as I have already written countless times before), I am in favor of a public option – not that I would necessarily contract the public option myself, but a public option would without a doubt drive down costs and make the private alternatives – as is the case in Spain – more affordable and accessible.

For non-Americans the entire notion that somehow Americans could be against universal, affordable health care is mind-boggling. Yet, it is true. Many Americans have this perverse – albeit factually inaccurate – idea that any government sponsored program amounts to communism. Americans tend to ignore the fact that many activities so representative of Americana, that set us apart from the rest of the world, are in fact government-run or publicly sponsored.

A few months ago I had conversations with various friends who had grown up in the United States but were now raising children in Europe, some were Americans others were Spanish. They all mentioned access to public sports as what their children would most miss out on by growing up outside of the U.S. That’s right, good old fashioned American little league baseball, recreational soccer, and the local basketball courts are all public.

Does that mean that our kids are commies because they take the yellow bus to their public elementary school? Are our local high school cheerleaders socialists because their uniforms are paid for by the tax payer? When they put lights up at the public high school’s football stadium are we turning into Communist China?

Ironically, many conservatives argue that the solution is to be found in … you guessed it, government regulation (what they euphemistically call “Tort Reform”). Let’s leave this topic for a separate post, but suffice it to say that the costs associated with malpractice lawsuits only represent about two percent of the total cost of health care and have been stable since the 1980s.

Besides the silly ideological battle from the right, the pharmaceutical and health insurance lobbies have the guys on the left in their pockets, insuring that there will be no real or meaningful reform. This translates once again into the difference between Obama’s bold words and his subsequent blandness. The result will most likely be a public mandate and not a public option. In other words, health care will be like auto-insurance; everyone will be required to buy insurance from … you guessed it, the big winners, the insurance companies.

For the time being, though, I will defer to New York Times columnist Nicolas D. Kristof’s two recent articles on the subject. The first one debunks that myth, popular in the U.S., that we have the best health care system in the world:

The United States ranks 31st in life expectancy (tied with Kuwait and Chile), according to the latest World Health Organization figures. We rank 37th in infant mortality (partly because of many premature births) and 34th in maternal mortality. A child in the United States is two-and-a-half times as likely to die by age 5 as in Singapore or Sweden, and an American woman is 11 times as likely to die in childbirth as a woman in Ireland.

. . . Opponents of reform assert that the wretched statistics in the United States are simply a consequence of unhealthy lifestyles and a diverse population with pockets of poverty. It’s true that America suffers more from obesity than other countries. But McKinsey found that over all, the disease burden in Europe is higher than in the United States, probably because Americans smoke less and because the American population is younger.

Moreover, there is one American health statistic that is strikingly above average: life expectancy for Americans who have already reached the age of 65. At that point, they can expect to live longer than the average in industrialized countries. That’s because Americans above age 65 actually have universal health care coverage: Medicare. Suddenly, a diverse population with pockets of poverty is no longer such a drawback.

The second addresses whether it is better to be spending on health care or Afghanistan:

President Obama and Congress will soon make defining choices about health care and troops for Afghanistan.

These two choices have something in common — each has a bill of around $100 billion per year. So one question is whether we’re better off spending that money blowing up things in Helmand Province or building up things in America.

With a war that has almost no effect whatsoever on keeping us safe at home, I would rather have a normal first world health care system.