I'm usually loathe to rip into a top-notch economist like Brad DeLong, especially when he titles his post "An Unrealistic, Impracticle, Utopian Plan for Dealing with the Health Care Opportunity." But several things bothered me about that post.
What I've never understood about the entire healthcare debate is the need to invent completely new plans. My take on this is ultimately pragmatic: find a system that provides universal coverage and good healthcare and institute it. Much of Europe--including the dreaded French--have very good healthcare. Translate the damn documentation, slap a big ol' U.S. of A. flag on it, and you have some healthcare*. If other countries can do that, it's not impossible, or even impractical.
Then DeLong, realizing that his program won't be passed, veers in the other direction by supporting the Democratic candidates' programs because they would be better than what currently exists (which is probably correct). But, at this stage, I still don't understand why Democratic candidates feel the need to develop complex plans (any plan would be complex) that wouldn't be as good as some of the EU plans. There's no international copyright on government programs, and if you're going to go through all of the legislative trouble anyway, why not use a better plan?
Finally, in the more immediate future (not the one where we all have cloned organs waiting for us), if you want to make a tremendous impact on morbidity, mortality, and economic burden, lower the two million hospital-acquired infections that occur annually in the U.S. Some preliminary data from a colleague suggests that hospital-acquired infections--just what you catch in the hospital--runs to roughly $60 billion annually. And that's probably a low-ball figure. Need I mention the 90,000 who die annually from these infections? Before we get all het up about novel medical technology, let's try practicing good nineteenth century medicine.
There endeth the rant.
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great post. I've been wondering the same thing for awhile.
also, what's the asterisk next to "healthcare"? some qualifying footnote, I assume; but it's not posted, is it?
Actually, there was a big effort to prevent infections called 100K Lives that went on in many hospitals (including ours). There's regularly reminders and training to take care of the basic hygene stuff. We actually rolled out "Wash your hands" screensavers to a bunch of devices just for that reason. Funny that smart, well-educated people need such basic reminders. I suspect the insane pace of healthcare rewards people who cut corners on such things.
I agree with everything mike says, except we don't have to go as far as the EU - Canada has a healthcare plan that I've head people claim is better than many of the EU plans. Also, all the doccumentation for it is available in English.
Also, as far as perfect plans vs. any plan that is better than what we have now go: the Democrats have been tripping over this point for decades. As I understand it, we nearly had a national health care plan under Nixon: Nixon was willing to sign a health care plan into law, but the Democrats wanted a "better" plan than what Nixon was willing to go for.
Right now, we spend more and have worse health care statisctics than any other non post-communist industrialized nation. Sure, every plan has flaws, and other countries have worse stats than we do. But those with as bad or worse stats can only afford a used Yugo of a health care system. We are paying Mercedes Benz prices for a Yugo.
First, from what I've read, the top plans are France and then Germany.
However, according to studies Canadian healthcare does better than US in most areas, with the US better in only a couple areas.
Then there's two bottom line issues:
1) all those single payer plans cost less than 10% to adminster; ours costs over 30%. We start off by throwing away over 20% of our healthcare dollars (and we don't even cover everyone).
2) our healthcare costs us around twice per capita as that of Canada, the UK, France, or Germany. Any problems that a system like Canada's has could be easily be fixed by doubling spending.
Why are we paying for a Mercedes and accepting a Yugo?