Neuron Culture

It’s been 26 years since health-care reform failed. Does the debate reflect anything that’s happened since?

From The Columbia Journalism Review:

“The idea that we’ve made a great breakthrough just isn’t so,” says Jonathan Oberlander, a health-policy expert at the University of North Carolina. “Most of the plans today are direct descendants of what was proposed for the ’93-’94 debate. The debate reminds me of one of my favorite movies, Groundhog Day.

With few exceptions, like the fine series last summer by NPR that explained how a number of other countries handle health care, the press has done little to challenge this reality or help to broaden the health-care debate. Rather, it has mostly passed along the pronouncements of politicians and the major stakeholders who have the most to lose from wholesale reform. By not challenging the status quo, the press has so far foreclosed a vibrant discussion of the full range of options, and also has not dug deeply into the few that are being discussed, thereby leaving citizens largely uninformed about an issue that will affect us all.

[and]

Absent from the debate are not only single-payer systems like the ones in England and Canada, but other systems with multiple payers, like ones in Germany and Japan–or, for that matter, any discussion of why a system that relies on competition among private insurers in The Netherlands hasn’t resulted in lower prices for consumers, as advocates claimed. What’s common to all these systems is that everyone is entitled to health care and pays taxes to support the system, and medical costs are controlled by limits on spending. The specter of a system that takes a significant bite out of stakeholder profits in the U.S. is the real reason the debate is so restricted.

Opponents of a public health-insurance plan pose two main objections: that it will create an ‘unlevel playing field’ that will harm the private market for insurance (an odd objection, since that playing field already tilts quite sharply away from patients’ pockets and health and toward the wallets of the health-insurance industry); and that government involvement will raise costs. 
These objections seem to hold sway to the degree we limit our discussion to what already exists in the U.S. As with squabbles about the problems with our educational (non)system, the picture gets clearer if we step back and test this argument against the larger world.
In an article in Forbes, Bruce Bartlett brings some clarity by doing just that:

We spend $7,290 per person on average versus $2,964 among all OECD countries. Norway, the nation with the second most expensive health system on a per capita basis, spends $4,763. (Currency conversions based on purchasing power parity.)
Of course, Americans know that they pay a lot for health; the rising cost of health insurance for employers is the main reason why wages have been stagnant for years. [NB from DD: Actually, many Americans manage to ignore this, because they don’t feel the connection; they know their wages aren’t going up, but because they never see the money that the employers pay for premiums, they don’t really feel the loss. Put it in their hands and take it out again — the experience I have as a freelancer — and you damn well feel it.] But they also fear that any further expansion of government involvement in the health care system will only make it more expensive. This is a key objection to the health care reform bill now working its way through Congress.
The international data, however, show no evidence that increasing government’s share of health care expenditures raises health spending as a share of GDP. The top five countries with the highest government share of total health outlays spend almost exactly the same percentage of GDP on health as the lowest five countries excluding the U.S.: 8.2% of GDP on average for the former versus 8.3% of GDP for the latter. (I left out the U.S. because it skews the data; the bottom five countries including the U.S. spend 9.7% of GDP on health on average.)