How can you over-exaggerate something?
And for that matter, do you really think the legal profession is on the ropes? To summarize my thoughts
1. It's pretty evidence we already don't have enough doctors. I don't think it's controversial to say that reducing their compensation while still it's extraordinarily costly to be a doctor will reduce the number of people who want to be doctors relative to other things.
2. I don't think the seriousness of our governmental finance issues can be exaggerated. Nobody projects that we have a reasonable way to pay for the current system. We will have to cut benefits we're projected to give people and/or raise taxes. Probably both, and not in some moderate "tax only a couple zillionaires' sort of way. So as a first proposition, I'm inclined to figure that out before I add more obligations to the mix. Consider it proof of concept. If one thinks the government can come in and (
successfully) take over the entire health insurance industry, demonstrate how it can be successful in the parts it already offers.
3. I agree 100% on NPs. Unfortunately, the fact they are not in as widespread use as they should be is largely a result of regulations imposed that prevent them from legally doing many of the things doctors do. I'd like to see the government be able to resolve problems its created like this before I cede more control and decision-making power to them.
Oh no, those are not opinions, those are verifiable facts. The US health care system provides better treatment to people who, on average, are in worse shape. In treating
heart attacks and
cancers, the results are across the board better. Taken from that last paper, here are 5 year survival rates for folks treated for various cancers in the US and various European countries:
Code:
Cancer US Europe
Prostate 99 76
Skin 92 86
Breast 90 79
Uterus 82 78
Colon 66 56
Lymphoma 62 55
Stomach 25 25
Lung 16 11
That article also shows death among the elderly from more common things like pneumonia and flu are lower than average in the US when adjusted to consider differences in population characteristics.
Overall mortality rates in the US are lower for basically behavioral reasons, not the quality of the health care we receive. Another study I recently read indicated, for example, that the average
American who reaches age 65 can expect to live nearly half a year longer than the average Dutchman who reaches 65. Which is probably more amazing because the state of your average 65 year old American's body is typically worse than the Dutchman's
This fact sort of leads into the behavioral concerns McArdle rants about and Klein tries to dismiss, but it's pretty evident from looking at the data that the biggest issue causing Americans to appear to have worse health care than Europeans is the fact that we lead less healthy and more dangerous lives.
I don't expect, by the way, that Klein had a straight face when he was making that argument.
Among other things that quote from him is patently absurd. He surely knows, for example, that Medicare only started including prescription drug coverage about 3 years ago (that was the Medicare part D bill). So when he argues that Medicare is somehow funding the development of new and better drugs, he's not even in the right ballpark (and missing out on the 37 years where people were paying for it themselves).
Beyond that, Medicare is relatively famous for insisting that folks use outdated but proven means of doing things, because doing anything else, literally, takes an act of congress. For example, my grandmother had Alzheimer's for the last several years of her life, and because of the various drugs she was given, had to have her blood sugar checked a couple times a day. Now, if you know about this stuff, you might know that there now exist means of testing this without the old-fashioned finger prick tests. You just use a little machine that instantly and painlessly measures it. However, for several years, these were not approved for use by Medicare, and thus the Nursing home wouldn't get one and use it. Even worse, they would not be reimbursed for the time the testing took if they didn't use the Medicare approved method of poking my grandmother's finger every day. And oh yeah, it would expose them to a lawsuit (which is something the current health care "reform" proposals do nothing about. Hence, even when my granddad offered to buy the machine and give it to the nursing home at no cost, they refused on both of those grounds.
And, of course, there's the elephant in the room that we mentioned before: Medicare is uber-expensive despite the sort of insane decision-making it leads to, and is thus not employable to the entire population in the same way it has been (unsustainably) employed to those 65 and over.
