23 November 2008


No, not the good kind, blowing stuff up and all that. The Washington Post takes a shot at the Five Myths about US healthcare. It's a nice start, for a traditional media source and a general audience. For health policy wonks and readers of med blogs, probably not too much new there.

I don't have time to fisk it in depth, but a couple of quick observations:

Myth One: America has the best health care in the world.
This is basically a rehash of the OECD data showing the US lagging in outcomes such as life expectancy and infant mortality, while spending 50% more than our nearest comparison. While the OECD numbers have come in for a lot of criticism, and there's a lot more to the outcomes than the quality of the health care system, the authors make one point very well: the cost/expense of medical care does not correlate well with outcomes or quality. This is, in fact, an important point to make. Also, I like the fact that the Post is tackling the zombie myth that the US is the M*A*S*H 4077, the "Best Care Anywhere," since that perception is a significant impediment to reform.

Myth Three: We would save a lot if we could cut the administrative waste of private insurance.
Interesting point to make. While I'm not entirely sure that their point is bullet-proof, the inclusion of this point seems intended to stymie the arguments from the single-payer zealots that we should just get rid of all the insurance companies. Inasmuch as this article represents the zeitgeist of the Villagers in the Beltway at this time, I think it may fairly be inferred that the CW is that a market-based solution is preferable to a single-payer option. Fortunately.

Myth Four: Health-care reform is going to cost a bundle.
I don't have a clever insight to offer here, but I'm still glad that Senator Wyden's plan is still part of the debate.

Myth Five: Americans aren't ready for a major overhaul of the health-care system.
Don't know that this is currently a widely-accepted myth, but it's good to make the point. If it ever will be, the time is now, and the stars may be aligning.


  1. "2. Somebody else is paying for your health insurance.

    Nope. Even when your employer offers coverage, he isn't reaching into his own pocket to cover you and your fellow employees; he's reaching into your pocket, paying you lower wages than he would if he didn't have to pay for your health insurance."

    I must disagree in part. Many employers also reach into your single coworkers' pockets. Most employers (still) pay more toward health care benefits for married employees and/or employees with children. Since an employee's total compensation is wages plus benefits, in many cases a single employee is paid less for doing the same job as a married employee.

    Frankly, that's why the entire "gay rights" issue is a huge bunch of bullshit. The issue isn't that gay people are denied equal rights. The issue is that single people are denied equal rights! Equal compensation for equal work. I'm tired of paying for someone else's kids.

  2. FYI Shadowfax, re #1: We're a bunch of fat slobs who like to kill each other with guns (if you're in a gang mostly), have a bunch of kids with no daddies, and snort cocaine. This has nothing to do with the quality of health care (but it is probably related to our entitlement attitudes since we can get fat and sick and take no responsibility for it ourselves financially), but it greatly skews our life expectancy data. Imagine if we had no/few cath labs and limited cancer care like Great Britain for instance--we'd really be screwed.

    In short, we're doing really well based on who we have to treat. If Americans ate like the Japanese and exercised but had the same health care, we'd probably live forever.

    It's a pet peeve of mine when people say Americans don't have the best health care in the world. We DO, we just have a bunch of fat idiots who don't give a crap about themselves. Fix this and you'll fix health care btw. Sadly, no politician is ever going to do that.

  3. Seriously. Why does King Abdullah bin Abdulaziz come to the Mayo Clinic for his checkup if the US doesn't have the best health care in the World?

  4. K,

    Man, your knee-jerk reflex is 3+. You are right that the OECD data is at best an indirect measure of health care quality. Americans eat more hamburgers, are fatter, and smoke more than some other countries. More saliently, a sixth of all Americans have limited to no access to health care. It's pretty certain, but not yet quantified, that the outcomes are skewed by these factors. So outcomes, in broad strokes, are not the best measure to judge quality.

    Which is what I said. Seriously, read the damn post before reciting your reactionary talking points, please.

    Tom B,

    Gays? What the hell do they have to do with the OP? Anyway, since they are all single, by law in 48 states, they are just as "oppressed" as single people. Course if you get married, you'll reap the benefit of the marriage subsidy. The gays don't have that option, do they? (well, for some employers they may)

    On your other topic, I wonder if you know how many world leaders go to Paris or Berlin or London for their specialty care. I thought not. Anecdote does not equal data.

  5. More saliently, a sixth of all Americans have limited to no access to health care.

    Coming from an ER doc, that's hilarious. Maybe you're the only ER doc that doesn't see uninsured patients for non-urgent complaints, but most others do.

    Furthermore, most with "no insurance" (not the same as no access) are the relatively healthy 18-24 year old demographic who aren't missing out on many health care needs. Many of the uninsured (20% in my state) DO have access to work-sponsored plans but elect not to take them out, and an additional 50% would qualify for medicaid or a low-premium health plan subsidized by the state. Also, many don't use free/subsidized low-cost clinics that charge nominal fees because they don't know where they are or aren't willing to pay $20 when it's "free" in the ER or whatever. Again, only very few have truly NO ACCESS.

    No access by choice or by ignorance is not a moral problem in need of the magic touch of politicians as you imply imho. When you subtract violent deaths and accidents, the US life expectancy is actually first among the 14 richest nations in the world, even with our uninsured.

    Again, the problem in our society isn't so much health care, it's poor attitudes, too many calories, lack of sense of personal responsibility, and violence in certain cultural groups especially (ie poor gangbangers). We should be focusing on this stuff and not rehashing data that doesn't accurately reflect the quality of our health system.

  6. Gays have exactly the same right to get married that I do. In other words, they have the right to marry a member of the opposite sex if they want the benefits of marriage. That's my point. There should be no state or employer sponsored incentives to get married. Gays should be free to marry if they want to, and I should be free to not marry, and benefits should have nothing to do with it. If employers must continue to be the primary providers of health care insurance (which I think is a problem), then every employee should be given the same number of "points" to shop for the plan that suits his or her situation the best. If you want to cover a spouse, a child, or a "special friend" then you pay more. But your employer pays the same. That would be fair, and that would make #2 a myth.

  7. Mrs Brownlee is a provocative journalist. Her book "Overtreated", as well as the referenced article, tend to over-simplify a complex topic in order to either make a point or generate discussion.

    I'm surprised SF did not comment on one of Mrs Brownlee's more incendiary statements- "We can improve the quality of care and cut costs without rationing." I was not sure if this was one of the myths, or if she actually believed this. To support her claim, she mentioned a few HMOs as "doing a better job for less". No one likes to mention the rationing word, but HMOs use rationing as a blunt, yet effective instrument to save dollars.

    The reality is healthcare is long overdue for a major reform. Hopefully with someone of Mr Daschle's experience and stature heading the HHS, we will see a commission appointed that will outline the multifaceted and complex reforms needed.

  8. Tom,

    "Negroes have exactly the same right to get married that I do. In other words, they have the right to marry a member of the same race if they want the benefits of marriage."

    I would like to say up front that I am not calling you a racist. However this logic is exactly that which was used to defend the anti-miscegenation laws in the 1950's.

    As to the more salient point, the author is in fact correct on point #2. For example, at our enlightened small business, health insurance is paid for 100% by the employer (me). However, the same amount is then deducted from pre-tax pay in its entirely. This is exactly intended to negate the differential utilization of benefits that singles and families bring to the company.

    Now the "myth" here is that some of my employees think they are getting health care for free, since they never pay a dime out of pocket for it, but in fact they are each fully accountable for the cost. This is what the author meant by that myth -- not cross-subsidizing from one class of employees to another, but the misconception that "it doesn't matter if premiums go up because it's not costing *me* anything."

  9. As usual, a great post to (obviously) stir up some conversation, though I must object to one minor point... The infamous M*A*S*H unit with our friends Trapper, BJ, and Hawkeye was the 4077th!

  10. Dammit, you're right. How could I have made that mistake?

    I'm gettin' old.

  11. This may be belaboring the point, but for #2, the tax structure and Medicare do seem to be someone else paying for health insurance. Employer-sponsored health insurance arose out of companies competing for workers during the wage-controls of WWII, and at that time, it was the company paying, since they couldn’t give you an increased wage instead. But even today, the tax-exemption for health care benefits does make it favorable, and worth more than if you had to go by it individually on the open market. And most Medicare beneficiaries receive more in benefits than they paid into Medicare. And some of its financing problems seem to stem from this as Baby Boomers are expecting the next generation to pay for it, but Gen X/Y is a smaller group.

    I read your summary of Sen. Wyden’s Healthy Americans Act, but I didn’t notice anything about dental or optical care. If medical insurance is separated from insurance, what about dental and optical benefits? I’m sure there is probably a provision somewhere, but I wondered if you knew.

  12. I don't have a problem with gay marriage. I have a problem with government and employer based incentives to get married. I can see where my comments were incendiary (gay rights is a huge bunch of bullshit). What I should have said is the issue is secondary to the primary problem of discrimination against non-married people. Solving the problem for gay married people does not take the primary injustice away.

  13. The point many miss about myth 1 is that they define healthcare too narrowly, like just a hospital procedure. The OECD and UN/WHO definitions of healthcare encompass primary care, health promotion and public health, which is why it's relevant to include infant mortality, obesity and other factors with a strong societal influence. A healthcare system is much more than fixing a broken leg.


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