RATIONING OUR COMPREHENSION! Our spirits soared when Leonhardt said he’d tackle that “rationing rhetoric:” // link // print // previous // next //

Let’s take a look at the record: How much do developed nations spend, per person, on health care? Yesterday, at the New Republic web site, Jonathan Chait linked to this post at the Kaiser Foundation. It presents spending figures for various countries, for 2003. (For Chait’s post, just click this.)

Here are the per capita spending totals presented by the Kaiser Foundation. According to Chait, all these countries, except the US, have universal coverage. To be clear: This chart records US spending per person—not per person with health insurance. For obvious reasons, we’ll put the US at the top of the list. Does the term “American exceptionalism” pop into anyone’s mind?

Total health expenditures per capita, 2003

United States $5711
Australia $2886
Austria $2958
Belgium $3044
Canada $2998
Denmark $2743
Finland $2104
France $3048
Germany $2983
Iceland $3159
Ireland $2466
Italy $2314
Japan $2249
Luxembourg $4611
Netherlands $2909
Norway $3769
Sweden $2745
Switzerland $3847
United Kingdom $2317

Assuming those figures are basically accurate, something is rotten in the state of Luxembourg. But even the little grand duchy falls well behind the United States when it comes to per capita spending. France, Germany, Italy, Britain? They’re shown spending roughly half as much as the US—and they already have the full health coverage the US currently seeks.

(The WHO has stopped ranking the world’s health systems—too hard. When it last did so, in the year 2000, the systems of all the countries we’ve named were ranked ahead of ours.)

Today, we’ll largely repeat what we’ve already said, while looking ahead to tomorrow. These figures describe a truly remarkable state of affairs—a state of affairs which is almost never discussed within our major media. In fact, it’s a comical state of affairs—except that a deeply serious aspect of life is involved here.

Which leads again to the obvious question: Why is this remarkable situation so rarely discussed?

Why does the United States spend so much more for health care? Over the years, we think we’ve seen varying explanations, in the random tidbits of attention the question occasions. At one time, it seems that we would typically hear about the remarkable costs of paperwork, due to the blizzard of varying insurance forms created by our non-system system. In recent months, we seem to be hearing more about doctors performing unnecessary procedures. (As in one of these letters in last Wednesday’s New York Times.)

But we’ll ask you again: Have you ever seen a serious attempt in our major newspapers to tease out the answer to that question? A series of front-page reports in the Times, exploring various possible factors? Most issues are poorly discussed in the press, but we can’t think of another issue where the overall discussion has been so comically awful. Where the Big Major Basic Facts are so ruthlessly hidden. Where it’s so normal to see Major Pols spreading so much blatant disinformation—without little attempt by big news orgs to correct or challenge their statements. (We think of Rudy Giuliani, spewing spin in 2007 during the GOP primaries.)

Result? The debate now unfolding! Using those 2003 figures, we spend $5700 per person—while Finland spends only $2100. But in our current debate, we’re trying to figure how much more we’ll have to spend to get what Finland has!

Only a kooky, non-rational culture could tolerate such a discussion.

Yesterday, we looked on as the ladies Dormady discussed health care with John King (see THE DAILY HOWLER, 6/17/09). It was “a fun discussion,” King enthused at the end, “and great oatmeal with raisins at Junior's Diner.” (For the full transcript, click here.) Just a guess: The ladies Dormady, like most voters, have no idea how truly kooky the state of our health care spending is. You simply can’t run a sane discussion when such basic information has been airbrushed for so many years.

How the heck does Finland do it? We don’t have the slightest idea. But there may be a very good reason for that. You see, we read American newspapers. We spend a great deal of our time observing the American press.

Rationing our comprehension: Yesterday, we cited David Leonhardt’s “Economic Scene” column, from the New York Times. Specifically, we posted a paragraph, late in his piece, where he wrote this: “Over all, the survival rates for many diseases in this country are no better than they are in countries that spend far less on health care.”

Rereading Leonhardt’s column this morning, we see that he mentioned this general problem in more detail, midway through his piece:

LEONHARDT (6/17/09): Milton Friedman’s beloved line is a good way to frame the issue: There is no such thing as a free lunch. The choice isn’t between rationing and not rationing. It’s between rationing well and rationing badly. Given that the United States devotes far more of its economy to health care than other rich countries, and gets worse results by many measures, it’s hard to argue that we are now rationing very rationally.

“Devotes far more of its economy?” That strikes us as a pointlessly wonkish way to put it, but it does approach our curious problem: We spend much more on health care than other countries—and we get worse overall results. Regarding those bad results, this graphic accompanied Leonhardt’s piece, and gave a few apparent examples.

At any rate, we were struck by Leonhardt’s column because of its overall focus. He attempted to tackle a familiar bit of spin—a bit of rhetoric that’s frequently used to undermine calls for health care reform. This rhetoric was used against Clinton in 1993; it’s being bruited around today.

Huzzah! Leonhardt said he was going to tackle familiar talk about health care “rationing.” His column appeared beneath this headline: “Health Care Rationing Rhetoric Overlooks Reality.”

We were intrigued by the way he began. Few columnists approach our public debates in this right-on manner:

LEONHARDT (6/17/09): Rationing.

More to the point: Rationing!

As in: Wait, are you talking about rationing medical care? Access to medical care is a fundamental right. And rationing sounds like something out of the Soviet Union. Or at least Canada.

The r-word has become a rejoinder to anyone who says that this country must reduce its runaway health spending, especially anyone who favors cutting back on treatments that don’t have scientific evidence behind them. You can expect to hear a lot more about rationing as health care becomes the dominant issue in Washington this summer.

Today, I want to try to explain why the case against rationing isn’t really a substantive argument. It’s a clever set of buzzwords that tries to hide the fact that societies must make choices.

All through our sprawling warren of study carrels, the analysts perked up! Over and over, our public debates are driven and shaped by “clever sets of buzzwords”—by poll-tested pieces of “rhetoric,” carefully formulated spin. These frameworks often cloud the public’s understanding; often, they’ve been designed to do just that. They deliberately ration our comprehension. But they rule our public debates.

It’s rare when a major columnist says he wants to tackle a piece of familiar, misleading rhetoric. But alas! We’re often struck by the way major scribes seem to miss the point of these potent formulations.

What are voters supposed to think when they hear talk about possible “rationing?” The ladies Dormady seemed to know. By way of contrast, we thought Leonhardt largely missed the point in a largely wandering column.

Read his piece. See what you think. We think he wanders around quite a bit. We’ll discuss it tomorrow.