On GM and Jimmy Akin
The United Auto Workers union have exercised their right to strike (a right in full accord with Catholic social teaching) and have begun industrial action against General Motors (GM). I wish them the best. One key point of contention is the spiralling health care costs facing the automobile manufacturer. It claims it simply cannot compete with producers who do not bear responsibility for health care costs. This is a valid point. In nearly all advanced countries, health care is regarded as a government responsibility. But not here.
Of course, the laissez-faire liberals will agree with me so far. But then they would argue that health insurance should be based on actuarial principals, so that each person pays in accord with personal risk, and thereby has an incentive to ration health care. Behind this lies a theory of moral hazard that regards the health care crisis as one of over consumption, not shortage. Of course, I happen to think that a system of social insurance– whereby the young and the healthy subsidize the old and the sick, on the understanding that they themselves will be helped out in due course– is more compatible with the common good than the “each man for himself” mentality that fits with laissez-faire liberalism.
Today is also the day when Catholic apologist Jimmy Akin comes out against “socialist medicine”. I think Mr. Akin should have a word with Fr. Neuhaus, for this is an issue clearly beyond his competency. Here’s his basic argument: if the price is too low, consumption is too high, and there is rationing. This is a simplified version of the moral hazard fallacy. Except that there is very little evidence for this beyond anecdote, as noted by Princeton economist Uwe Reinhart. Health care is not a basic consumer good that responds to price pressures. I do not go to sit in a doctor’s office for the fun of it because it is cheap or free; I go because I am sick. A RAND study in the 1970s showed that higher co-payments did indeed include people to cut back on medical care, but equally on frivolous and not-so-frivolous care. Again, this approach assumes that the problem is that we have too much health care. This is bizarro world!
Akin then resorts to the standard balderdash on rationing. As I noted before, the idea that Americans face shorter waiting times than patients under single payer systems is a fallacy. A problem in making comparisons is that single payer systems typically keep centralized statistics on waiting times, but not so in the US. But the lack of statistics does not mean the lack of a problem. And the evidence all points to the fact that “American people are already waiting as long or longer than patients living with universal health-care systems”. A recent survey by the Commonwealth Fund found that only 47 percent of Americans could get a same or next-day appointment, lower than any other country except Canada. Remember too that health care is rationed extensively by cost in the US. More than half of all sick Americans stayed away from a doctor on cost grounds– needless to say, this is off the charts by comparison with countries offering universal care.
A big part of the problem is the pattern of medical specialization. In Europe, GPs make up half of all physicians, but less than a third in the US. And only 40% of doctors in the US provide after-hours care, as opposed to 75% elsewhere. Where do Americans get their primary care? From emergency rooms. About 26 percent of all Americans visited emergency rooms over the past two years because they could not see their regular doctor. Of course, the US is not all bad: It has relatively short waiting times for non-emergency surgery, including hip replacement or cataract operation (is it any surprise that this forms the basis of the most popular anecdote?)– but even here, it is beaten by Germany.
One final point: I really wish Akin and others would understand the difference between single payer systems (government-run insurance whereby medical practitioners work for themselves) and single provider systems (the government runs the medical system itself, and medical practitioners are on the payroll). The UK is an example of the latter, not the former. Of course, they all look like socialism to those attached to laissez-faire liberalism.
Comments are closed.
Well since they make on average $25-35 dollars an hour for pressing the “on” button for a bunch of robots and sodering a wire every once in a while I don’t feel sorry for them at all. People like skilled workers in the military (electricians, damage control on ships, etc) do a heck of a lot more and they only get 1/5 of the pay UAW people get.
I live in Michigan and I know a lot of people in the auto industry. While self serving executives are partly to blame – most of the blame lands on the UAW for the mess American auto makers are in now.
My wife has an uncle that worked for GM for some 25 years or more.. Started at 18 and retired at 43 or 45 I guess. He has been retired and living off of GM for probably 10 years now. He has been living the good life in the UP, hunting, fishing, riding his motorcycle. He most likely will be supported by GM as a retiree longer than he was as an employee. I wonder how many others are in the same situation.
I would appreciate it if you linked to Akin’s piece.
Michael– sorry, done.
Good point on the distinction between single payer and single provider systems.
There is a slight inaccuracy in your description of the UK as being single provider. The NHS is a single provider at the hospital level, but at the GP (general practitioner/family doctor) level they are all self-employed and usually own their own buildings. Local NHS authorities subcontract services to them on a non-monopoly basis. You can choose your GP and your GP can unchoose you. Most dentists, opticians and pharmacists are also in the same position as GPs.
There are concerns that big companies are trying to take over GP services.
A RAND study in the 1970s showed that higher co-payments did indeed include people to cut back on medical care, but equally on frivolous and not-so-frivolous care. Again, this approach assumes that the problem is that we have too much health care. This is bizarro world!
Not in the minds of some knowledgable people. After all, the RAND experiment actually found that the availability of free medical care encouraged people to use more medical care, but had very little effect on their health (which should be the main issue, shouldn’t it?) As one paper points out:
You (or the source you’re cutting-and-pasting from) don’t mention this finding, which seems rather important. If the “reduction in services” caused by forcing people to pay for medical care has such a small effect on health, then, on the flip side, the marginal consumption of medical care logically cannot always or even on average improve health. (Note the word “marginal” there.)
Stuart,
Now you are shifting the debate a little, arguing that spending on health care does not really lead to better outcomes after all. I guess it would fit with the Republican view that over consumption of health care is the real problem!
There are a number of ways to address this issue. First, the US in general is atrocious when it comes to primary care, to preventive care, to follow-up care. So, sure, if you don’t treat people when they are children, don’t be surprised if you have to spend great amounts later on in life. That, plus the subsidy to the insurance companies, is why health care costs are so much higher in the US, despite spending twice as much per capita.
But I have a more precise criticism of your issue. If you are going to wave economics in my face, I suggest you do a little better than the Cato institute. The problem with most of these studies is that they suffer from endogeneity bias, the perenial issue in econometrics. In this context, greater treatment could be chosen by regions where health is worse. A cool new paper tries to control for this effect (“Returns to Local Area Health Care Spending: Using Health Shocks to Patients Far From Home,” Joseph Doyle (MIT), NBER Working Paper 13301, August, 2007: http://www.nber.org/papers/w13301.pdf). He looks at the experience of patients in health care systems not designed for them — those who get treatment when they are traveling. This is a pretty good natural experiment to control for endogeneity bias. Doyle finds that “visitors who become ill in high-spending areas have significantly lower mortality rates compared to similar visitors in low-spending areas”. In other words, spending on health care matters for outcomes.
Hmmm! A look at the tax return for Catholic Answers for the year ended 6/30/06 indicates that Akin pulled down over [redacted] for that period.
Am thinking he has no problem with affordable health insurance! Tough luck to those who cannot afford insurance or whose employers don’t offer it.
I don’t see where Akin offers any solution. Did I miss anything?
Let ‘em eat cake, I guess.
Admin note: If it is a matter of public record and people are interested, they can certainly look it up. Publishing it as a matter of argumentation puts us in the unfortunate position of having to verify the number or if the number is erroneous having potential liability. I do not have enough interest to verify the number. ~M.Z.
Now you are shifting the debate a little, arguing that spending on health care does not really lead to better outcomes after all.
How is it “shifting the debate”? You stated that a certain proposition was “bizarro world,” and I was answering that claim with your own citation of the RAND study (which you seemed not to understand).
I guess it would fit with the Republican view that over consumption of health care is the real problem!
I’m not saying that’s the “real” problem, just that it’s a problem to be considered. It’s not a “Republican” view either. Anyone who has ever heard of the word “iatrogenic” has to admit that healthcare isn’t a pure good. Same for anyone who is familiar with the literature on the many billions spent every year on unnecessary procedures done in America (add that to your list of why healthcare is more expensive here than in Europe).
If you are going to wave economics in my face, I suggest you do a little better than the Cato institute.
I suggest you avoid ad hominem arguments. Robin Hanson is an extremely smart and well-read individual; he’s making a serious argument, backed up by lots of citations; and Cato included responses to his essay from professors at Harvard and Stanford, plus the RAND Chair of Health Economics. They may disagree with Hanson, but they certainly take his arguments seriously. It doesn’t affect the validity of his point that some random anonymous blogger sneers at the word “Cato.”
That, plus the subsidy to the insurance companies, is why health care costs are so much higher in the US, despite spending twice as much per capita.
As I already pointed out in a Commonweal thread (you had no answer to this point there either), you’re completely ignoring the fact that the U.S. government ALREADY spends more on health care than the French government. If you were right, then the U.S. government’s health care spending would already cover the entire U.S. population — right now, and for the same dollar cost. Therefore, some huge factor must be occurring OTHER than the costs that you identify here (see what I say above for one clue).
The Doyle paper is clever and interesting. It doesn’t show what you seem to think, however; that is, it doesn’t show that the U.S. population would be better off if we spent “more” on health care. All he shows is that among Florida counties, those counties that spent more on health care had better outcomes. Well, that’s no surprise — high-spending counties tend to be those that pay doctors more, and therefore draw the best doctors. This in no way proves that overall outcomes would improve if overall spending went up. (In my personal experience with the health care system, there’s a wide variety in doctor quality depending on the location. The place where you get treated can be the difference between getting an expert doctor who immediately has a diagnosis vs. having doctors who flail about for weeks and run up tens of thousands of dollars in unnecessary tests without coming to a diagnosis.)
Well well, so we have the highly-paid Jimmy Aikin preaching on the evils of ‘Socialized Medicine’. Isn’t that a surprise! From what I’ve seen and heard of the ‘Catholic’ media, 99% of them share Aikin’s opinion and will be hard at work until the next election framing their OPINION to resemble Church dogma. ‘Socialized Medicine’ will be the topic of vigorous debate between Catholics from the insurance industry vs Catholics from the rightwing think tanks. The fur will really be flying. And of course there will be the usual cadre of rightwing priests and bishops–the darlings of ‘Catholic’ media–trotted out to proclaim ‘Socialized Medicine’ would undoubtedly lead to more ABORTIONS! Then some upstanding Catholic wack will make the rounds plugging his new book which proclaims that ‘Socialized Medicine’ would put the US at greater risk for another terrorist attack. Amazing–who’da thunk! Of course, this alarming news will be followed by multiple cable TV gigs by Blustery Bill Donohue echoing the sentiment: Socialized Medicine = Armageddon. Some elderly Catholics might even be frightened into opting out of Medicare rather than risk eternal damnation by continuing to be served by ‘Socialized Medicine’ – not a bad idea since it would save $$$ and possibly generate another tax cut.