The tv was playing at our house last night while I was competing against wife and 4-year-old in a game of Candy Land. It happened that we were tuned to ABC, where the Republican presidential candidates were debating, but I was into the game, monitoring the movements of the 4-year-old in order to have a chance of winning myself. Then the subject of health care came up in the debate, and I heard, through the fog of the Candy Land competition, one candidate after another declare that the American health care system is the best in the world. My attention turned to the tv, and I began responding robotically to cries of "Your turn!" at fifteen second intervals. The fog of Candy Land merged with the fog enshrouding the candidates as they declaimed, with delusional urbanity, on the American health care system, "the greatest on earth."
Here is a link to the transcript of the debate. The health care discussion begins on page 10 of 25. I have consulted it now, after a night's sleep, just to verify that I heard what I thought I heard. Yes, it started like this:
Charlie Gibson (the moderator): We're the only industrialized nation in the world that doesn't insure all of our citizens. If we can afford a trillion-dollar war in Iraq, why can't we afford medical insurance for everybody?
Giuliani: The reality is that, with all of its infirmities and difficulties, we have the best health care system in the world. And it may be because we have a system that still is, if not holy, at least in large part still private. To go in the direction that the Democrats want to go--much more government care, much more government medicine, socialized medicine--is going to mean a deteriorated state of medicine in this country. I mean, I said jokingly in one debate, if we go in the direction of socialized medicine, where will Canadians come for health care? [Laughter.} And the reality--and the reality is--
Gibson: But do you all--do you all agree that we have the best health care system in the world?
[Different candidates say "Sure" and "Yes" simultaneously.]
McCain: Now--tell me, when people get sick where they come to get health care. I--
Thompson: We certainly have the best health care.
The reality--Giuliani's favorite word during his response--is that "the best health care system in the world" is, compared to those existing in countries with which we have the closest historical and cultural ties, very much more expensive, very much less comprehensive, and achieves inferior outcomes. Malcolm Gladwell has said it well:
Americans spend $5,267 per capita on health care every year, almost two and a half times the industrialized worlds's median of $2,193; the extra spending comes to hundreds of billions of dollars a year. What does that extra spending buy us? Americans have fewer doctors per capita than most Western countries. We go to the doctor less than people in other Western countries. We get admitted to the hospital less frequently than people in other Western countries. We are less satisfied with our health care than our counterparts in other countries. American life expectancy is lower than the Western average. Childhood immunization rates in the United States are lower than average. Infant mortality rates are in the nineteenth percentile of industrialized nations. Doctors here perform more high-end medical procedures, such as coronary angioplasties, than in other countries, but most of the wealthier Western countries have more CT scanners than the United States does, and Switzerland, Japan, Austria, and Finland all have more MRI machines per capita. Nor is our system more efficient. The United States spends more than a thousand dollars per capita per year--or close to four hundred billion dollars--on health-care-related paperwork and administration, whereas Canada, for example, spends only about three hundred dollars per capita. And, of course, every other country in the industrialized world insures all its citizens; despite those extra hundreds of billions of dollars we spend each year, we leave forty-five million people without any insurance.
Bush has been president for seven years. For most of that time, Republicans have held a majority of seats in both the Senate and the House. We now can understand why nothing has been done in those years about the broken health care system. It isn't really broken. It is the greatest system in the world. Meanwhile, since 2000 the number of Americans without health insurance has increased by around 7 million, to 47 million, or 16% of our population.
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