the health care debate forces us to weigh health against other national priorities — and, as we have seen, this is something our political system and our kind of regime are exceedingly ill-suited to do. Attempts to confront this problem always seem to turn into efforts to spend yet more on health. The Patient Protection and Affordable Care Act enacted in 2010, colloquially known as Obamacare, was first sold (and perhaps genuinely intended) as a way of “bending the cost curve down,” as President Obama liked to say back then. Even as originally intended, it would have tried to do so in a way that was very unlikely to work, as it would have relied on federal regulation to induce greater efficiency in the health sector. But as it made its way through the political system, the bill became simply a means of expanding public entitlements to health coverage, and so of increasing costs rather than lowering them.
When it comes to dealing with trade-offs, markets work relentlessly and governments fail relentlessly. It is reasonable to suggest that you do not like the way that markets resolve trade-offs. It is less reasonable to suggest that government therefore is the solution.
It is bizarre to suggest that exanding access to health insurance was not an initial or primary component of PPACA. Why not just ask Wikipedia:
http://en.wikipedia.org/wiki/Patient_Protection_and_Affordable_Care_Act#Legislative_history
“Health care reform was a major topic of discussion during the 2008 Democratic presidential primaries. As the race narrowed, attention focused on the plans presented by the two leading candidates, New York Senator Hillary Clinton and the eventual nominee, Illinois Senator Barack Obama. Each candidate proposed a plan to cover the approximately 45 million Americans estimated to be without health insurance at some point during each year.”
Levin is also (perhaps deliberately) confusing the distinction between gross and per-capita health-care costs. Usually, discussion of “bending the health care cost curve” is explicitly or implicitly talking about the per-patient cost of the health-care system. There is no conflict between expanding the system to insure more people while trying to bring down per-patient costs, and in fact they are two great tastes that taste great together, as the expression goes.
I have also yet to see a comprehensive explanation from those who decry government involvement in healthcare for why almost all comparable nations have a) more direct government involvment in health care provision than the United States; b) far lower per-capita health care costs, and c) better health outcomes. Claims that other developed nations are somehow free-riding on the costs of our innovation are also suspect; in fact, many neutral observers and industry participants believe the regulatory climate in Europe is move favorable than that in the United States, despite widespread public insurance provision.
In general, insurance and insurance-like programs and activities tend to be where government provision is most efficient and effective. While this does not mitigate in favor of nationalizing all insurance or insurance-like programs, it does make statements like “when it comes to dealing with trade-offs, markets work relentlessly and governments fail relentlessly” seem rather facile next to the far more complex and difficult realities of problems like health care access and provision.
The usual claim that US healthcare costs more but delivers less comes from statistics by the UN World Health Organization. The WHO health statistics are biased. The WHO itself ranks the US #1 in health care delivery that is important to patients. It issues another ranking of 37th because this quality of care costs more and is not delivered by government in a “fair” way. Critics of US health care always refer to the ranking at 37th. That is a political judgment by the WHO.
There can be a political discussion about the subsidized distribution of healthcare, but advocates of socialization confuse the issue by implying that US health care as delivered is worse than the care delivered by socialized systems. They imply that US health care is both more expensive and worse than in socialized systems. But, US healthcare costs more and is better, so socialization is not an easy choice.
There is some fudging by socialized systems about their level of spending. Many aspects of healthcare (example: fraud detection) is considered a cost of US private healthcare, but is ignored in socialized systems.
The arguments offered against the quality of US health care are based on flawed infant mortality and life expectancy comparisons.
Just two points, with more at the link:
(1) The US follows the WHO definitions exactly for reporting a live birth, “even one breath”. Many countries do not count premature births or babies with severe birth defects. The increased reporting of deaths of these children raises US numbers for infant mortality and decreases average US life expenctancy accordingly.
Also, the US is much more agressive in attempting to save babies at early stages of development, say when the mother has medical emergencies. This increases the number of frail newborns and the infant death rate.
(2) The US has far more death from auto accidents and violent crime, but higher survival for cancer and other chronic diseases. Overall mortality is not a good statistic for comparing health care effectiveness or population health.
US Healthcare is First – Infant Mortality is Low
The key question is whether ACA is sustainable.