American Health Care Is Worst in Rich World

Empire State Building New York
The Empire State Building in Manhattan, New York behind the light of an emergency vehicle, June 9, 2016 (Unsplash/Dapo Oni)

America has the worst health-care system out of eleven rich nations.

The Commonwealth Fund, a century-old foundation dedicated to improving health care, places the United States behind Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland and the United Kingdom in its latest report. The Netherlands and Norway share first place.

America is the world’s top innovator of new medications and treatments. The best medical schools are in the United States. The country spends relatively more on preventative care than most. But this doesn’t outweigh its poor scores on the Commonwealth Fund’s other criteria: access to care, administrative efficiency, equity and outcomes.

In practical terms, this means especially low-income Americans don’t get the health care they need, either because it’s too expensive, too complex or both. Preventable deaths, including infant and maternal mortality, are higher in the United States than in other wealthy nations. Life expectancy is lower.

The Commonwealth Fund’s findings match those of the Euro Health Consumer Index, OECD, Peterson Center on Healthcare and Kaiser Family Foundation, all of which rank the United States below Australia, Canada and countries in Northern and Western Europe. Read more “American Health Care Is Worst in Rich World”

Dutch Should Keep Health Care System They Have

Leiden Netherlands hospital
Leiden University Medical Center, the Netherlands (LUMC)

Nearly all political parties in the Netherlands call for more government in health care.

The far-left Socialists and Greens would replace private health insurers with public health funds. Labor would keep the insurance companies but take away their power to negotiate prices with health providers. The Christian Democrats and far-right Freedom Party want to end competition between hospitals. Even the center-right VVD believes liberalization has gone too far.

I’m a member of the VVD, but on this point I disagree. (So I’m glad there are few concrete proposals to reverse liberalizations in the VVD’s manifesto.) The Dutch health-care system is one of the best in the world. In a column for Trouw, I challenge the parties that want to uproot it to point to a better example. If there isn’t one, let’s keep the system we have. Read more “Dutch Should Keep Health Care System They Have”

The American Dream Could Use Some European Inspiration

Copenhagen Denmark
Cyclists in Copenhagen, Denmark (iStock/Leo Patrizi)

One can tell two very different stories about the American economy.

In one, growth is robust, unemployment is at its lowest in half a century and the stock market is booming. This is the story President Donald Trump likes to tell.

In the other, two in five Americans would struggle (PDF) to come up with $400 in an emergency. One in three households are classified as “financially fragile“. Annie Lowrey writes in The Atlantic that American families are being “bled dry by landlords, hospital administrators, university bursars and child-care centers.” This is the story Bernie Sanders and the Democrats tell: for millions of Americans on seemingly decent middle incomes, life has become too hard.

Sanders’ solution is to bring “democratic socialism” to America. He cites European countries like Denmark and Sweden as inspiration. They’re not bad places to imitate — but they have actually moved away from socialism and toward a mix of free markets and the welfare state. It is why they rank among the freest and most competitive (PDF) economies in the world.

Americans can learn from the Scandinavian experience, if they get the balance right. Read more “The American Dream Could Use Some European Inspiration”

Britain’s Health Care Debate Is Broken

London, England at night, February 14, 2012
London, England at night, February 14, 2012 (Warren Chrismas)

When it was revealed last week that the British government had not ruled out giving American pharmaceutical companies more generous patent rights under a post-Brexit trade agreement with the United States, the opposition Labour Party was up in arms, accusing the ruling Conservatives of putting the National Health Service (NHS) “up for sale”.

The Conservatives rushed to deny it.

“The NHS is not on the table,” said Health Secretary Matt Hancock. “We are absolutely resolved that there will be no sale of the NHS, no privatization,” said Prime Minister Boris Johnson.

The episode was emblematic of the British health care debate: Labour mischaracterizes any proposed change as a step toward privatization while the Conservatives, rather than make the case for choice and competition, try to convince voters they care about the NHS even more. Read more “Britain’s Health Care Debate Is Broken”

The Best Argument Against Medicare-for-All Is Not Cost

Democratic senator Elizabeth Warren of Massachusetts visits a high school in Des Moines, Iowa, October 21
Democratic senator Elizabeth Warren of Massachusetts visits a high school in Des Moines, Iowa, October 21 (Phil Roeder)

It’s worth asking how expensive nationalizing health insurance in the United States would be. I’ve told you before that cost estimates range from 13 to 21 percent of GDP, a difference of $1.7 trillion, or two-and-a-half times the Pentagon budget.

Senator Elizabeth Warren puts her plan at the low end of spectrum, about $2 trillion per year (which would still mean a 50-percent increase in federal spending). Even journalists broadly sympathetic to Medicare-for-all doubt that’s realistic.

I doubt it’s going to convince anyone. Medicare-for-all’s proponents are unlikely to change their minds even if they find out the cost isn’t manageable. Americans who oppose nationalizing health insurance are unlikely to come around even if it is.

The questions most Americans will be asking are:

Who Pays for Medicare-for-All?

Elizabeth Warren
Democratic senator Elizabeth Warren attends a meeting in Worcester, October 22, 2017 (Wikimedia Commons)

Replacing private health insurance with a single-payer, government-run system is hugely unpopular in the United States, but that hasn’t convinced two of the Democrats’ three top-polling presidential candidates — Bernie Sanders and Elizabeth Warren — to back away from it.

In the most recent televised debate, Warren, who is polling neck and neck with former vice president Joe Biden, couldn’t say how much “Medicare-for-all” would cost or who would pay for it. She has since promised to release a detailed plan.

Sanders, to his credit, admitted it would require tax increases. But by how much, and for whom, he didn’t say.

He can’t. Nationalizing health insurance for 327 million Americans is such a huge and complex undertaking that nobody knows how much it would cost.

Which calls into question the wisdom of doing it at all. Read more “Who Pays for Medicare-for-All?”

Democrats Back Away from Abolishing Private Health Insurance

Democratic senator Kamala Harris of California listens to voters during a town hall meeting in Los Angeles, April 21, 2017
Democratic senator Kamala Harris of California listens to voters during a town hall meeting in Los Angeles, April 21, 2017 (Office of Senator Kamala Harris)

Good news: Democratic presidential candidates are coming to their senses on health care.

Senators Cory Booker, Kirstin Gillibrand and Kamala Harris have all backed away from abolishing private health insurance in favor of Medicare-for-all.

Even Senator Elizabeth Warren has given herself wiggle room, saying “there are a lot of different pathways” to achieving universal coverage.

The exception is Bernie Sanders, the author of Medicare-for-all and a self-declared democratic socialist. Read more “Democrats Back Away from Abolishing Private Health Insurance”

Democrats Are Not Talking to Swing Voters

New York mayor Bill de Blasio, Ohio congressman Tim Ryan, former housing secretary Julián Castro, New Jersey senator Cory Booker and Massachusetts senator Elizabeth Warren participate in a Democratic presidential debate in Miami, Florida, June 26
New York mayor Bill de Blasio, Ohio congressman Tim Ryan, former housing secretary Julián Castro, New Jersey senator Cory Booker and Massachusetts senator Elizabeth Warren participate in a Democratic presidential debate in Miami, Florida, June 26 (Getty Images/Joe Raedle)

Imagine you’re an American swing voter and you listened Tuesday and Wednesday night to the twenty Democrats vying for their party’s presidential nomination. What did you hear?

  • Three of the four highest-polling candidates want to abolish private health insurance and replace it with a single government program.
  • Virtually all candidates would decriminalize illegal entry into the United States and all of them praised immigration.
  • Many would give free health care to undocumented immigrants.
  • Some, like Bernie Sanders, would even give them a free college education.

This is not a winning program. Read more “Democrats Are Not Talking to Swing Voters”

Abolishing Private Health Insurance Is Bad Policy for Democrats

Democratic senator Kamala Harris of California listens to voters during a town hall meeting in Los Angeles, April 21, 2017
Democratic senator Kamala Harris of California listens to voters during a town hall meeting in Los Angeles, April 21, 2017 (Office of Senator Kamala Harris)

Four of the Democrats running for their party’s presidential nomination committed to replacing private health insurance with a government-run system in debates this week: Senators Kamala Harris of California, Bernie Sanders of Vermont and Elizabeth Warren of Massachusetts as well as Mayor Bill de Blasio of New York.

Harris later maintained she had misheard the question and supports Medicare-for-all with supplemental private insurance.

She, as well as Sanders and Warren, stand a real chance of becoming the nominee (de Blasio is a long shot), so it’s worth pointing out why abolishing private health insurance is such bad policy for Democrats. Read more “Abolishing Private Health Insurance Is Bad Policy for Democrats”