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'45 Million
Americans' -- Who Are Those Guys? Part 2 Larry Elder Thursday, June 25, 2009 Last week's article
on why 45 million Americans go without health care insurance touched a nerve
and generated many questions and assertions: "You and
your pesky statistics! Forty-five million Americans without health care is
huge. And you wrote that 89 percent of the 85 percent of people with health
insurance are satisfied. That means 25 percent of all Americans are
unsatisfied!" Elder: Those
"pesky" statistics become especially pesky when misstated. I wrote
that 45 million Americans have no health insurance, leaving 85 percent
with health insurance -- but not without health care. ERs must
treat the uninsured, including illegal residents. Meanwhile, 89 percent of
Americans -- with or without insurance -- are satisfied with the quality of
their own health care. An 89 percent
satisfaction rate sounds pretty darn high. Are people, for example, 89
percent satisfied with their jobs? Their marriages? Their financial
situations? Their experiences at concerts or ballgames or restaurants or
hotels or with airline travel? An 89 percent satisfaction rate is pretty
impressive for most things we pay for. And as for the
remaining 11 percent -- to what degree and for what reason are they
"dissatisfied"? Had bad experiences? Don't like having copays?
Would prefer a complete choice of doctors but are restricted by their plans?
Had to wait for appointments or sit too long in waiting rooms? (Canadians are
used to eight-month-or-more waits and long lines. Americans, I assure you,
are not.) A lot of people simply complain -- about most everything. For example, 10
years ago I had laser eye surgery. I filled out a questionnaire designed to
determine how fastidious I am. Why? The doctor told me the surgery would not
get me 20/20 vision. Was I OK, the doctor asked, with a less than 20/20 result?
I was. He said some prospective patients, however, are dissatisfied with such
a result. Given their -- in his view -- unrealistic expectations, the doctor
wouldn't treat them. "Doesn't
universal coverage work in Canada?" Elder: Not exactly.
Large numbers of Canadians came (and still come) to America to avoid waiting
for MRIs or to get time-sensitive treatment that couldn't wait. Canada is
moving toward more privatization -- which was previously illegal in Canada
but is now permitted as a result of a successful lawsuit. Imagine having to
sue to spend your own money in a voluntary transaction between two parties!
According to a 2007 survey by the Canadian Fraser Institute, the median wait
time in Canada between visiting a general practitioner and receiving
treatment was more than 18 weeks -- and up to 38 weeks for procedures such as
orthopedic surgery. "What's
wrong with a government-provided alternative plan to keep the insurance
companies honest and more competitive?" Elder: Here's a
recent example of what happens when government sets up
"alternative" plans to cover the uninsured at (supposedly) lower
costs. Hawaii offered universal child health care -- for seven months. Then
it dropped the plan. Why? People (and employers) with private plans dumped
them to ride the "cheaper" government train. One of Hawaii's health
care administrators lamented, "I don't believe that was the intent of
the program." And Hawaii is a small state, without nearly the number of
"health insurance needy" as we have on the mainland. "Come on!
Obviously the American health care system IS broken! That's why our life
expectancy is so much lower and our infant mortality rate is so much higher
than in other countries." Elder: Ezekiel
Emanuel, a medical adviser to the President (and brother of Rahm, the chief
of staff), once told me, "Life expectancy is one of the dumbest ways to
measure the quality of a nation's health care." Quality of medical care
does not -- by itself -- determine life expectancy. For example, deaths from
accidents and murders are much higher in America than in other developed
countries. Texas A&M health economist Robert Ohsfeldt and health
economics consultant John Schneider calculated that if accidental deaths and
homicides during the '80s and '90s were removed from the calculations, life
expectancy in America would have ranked at the top of all developed
countries. What about personal behavior? Obesity leads to serious health
problems, including heart disease. One-third of Americans are obese -- almost
50 percent more than the British and Australians, over 100 percent more than
the Canadians and Germans, about 250 percent more than the French and 1,000
percent more than the Japanese. As for infant
mortality, a 2007 study by economists June and David O'Neill found that low
birth weight drastically increases an infant's chance of dying. They compared
U.S. infant mortality (6.8 per 1,000 births) with Canada's (5.3). Teen
mothers are far more likely to have low-weight babies, and America's teen motherhood
rate is three times higher than Canada's. They determined that if Canada had
America's low-weight birth distribution, Canada's infant mortality rate would
rise from 5.3 to 7.06. If America had Canada's low-weight birth distribution,
our infant mortality rate would fall from 6.8 to 5.4. So don't blame
the "broken health care system" for lower life expectancies.
American health care actually helps us cope with the consequences of
unhealthy lifestyles, keeping our ranking from being even lower. Return to: Articles
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