Wednesday, February 06, 2008

Is health care going to be THE issue? 

At least in one race, it appears so.
Al Franken, the comedian-turned-U.S. Senate candidate, thinks the current state of health care in Minnesota � and the United States as a whole � is anything but funny.

�Every other industrialized country in the world has universal health care � we�re the only industrialized country that doesn�t � and I think it�s no coincidence that we spend twice as much per person as any other industrialized country on health care,� Franken said during a visit to the Detroit Lakes Newspapers offices on Friday. �And yet we don�t have as good outcomes as they do.

�We�re last in the industrialized world in preventive care. We have 47 million people who are uninsured, with tens of millions more who are underinsured because they can�t afford full coverage � and they live in fear that they will go bankrupt if they have a medical crisis. Medical crises are the No. 1 cause of bankruptcy in this country.

�Fifty percent of the bankruptcies in this country are caused by medical crises. They don�t have that in other industrialized countries.�

Franken also notes that the current health care system has �tremendous waste,� with 34 percent of health care dollars being spent on administrative fees.

�No other country spends more than 21 percent (on administrative fees),� he said. �We have people going to work every day for insurance companies trying to figure out how to deny you care.

�I hear story after story of incredible waste in our system because we aren�t universal.�

Where do we start with this hooey? Let's look at a couple of leading examples, say, Sweden:
Health Minister G�ran H�gglund has criticized the lack of progress made toward shortening wait times in Sweden�s health system.

He made the comments in an opinion article published in Dagens Nyheter in which he stated that the 250 million kronor spent by the government on lowering wait times has apparently had a little effect.

The criticism comes in response to a report by the National Board of Health and Welfare (Socialstyrelsen) showing that nearly 45 percent of patients have longer wait times than are supposedly guaranteed by the healthcare system.
In J�mtland county, for example, four out of ten patients couldn�t even get through to their local clinic by telephone on the day they become ill.

H�gglund asserted that people are generally satisfied with the care provided�when they receive it.

�But the wait to receive attention�be it a telephone call to a local clinic or a first visit to a physician�is simply too long,� he said.
Hat tip Mark Perry, who wonders what would happen to Domino's or Northwest Airlines if four out of ten of their customers couldn't get their calls answered.

Next door in Norway, hospitals are suffering a budget crisis. This is worth reading in its entirety, but I will italicize the paragraph that should be used as a clue-bat to the back of Al Franken's noggin:
With waiting lists long, and patients still often lying in corridors, many Norwegians can't understand why medical care is under so much pressure in one of the world's wealthiest countries.

The board of Ullev�l University Hospital in Oslo, one of the country's biggest public health institutions, announced earlier this week that it needed to cut its budget by NOK 406 million (about USD 81 million). Medical personnel were quick to claim that patient care would be affected.

The cuts come after another year of reports that patients often have to wait months for operations, that clinics face shutdown or maternity patients are sent home within hours of birth. The physical plant at Ullev�l, like at many other Norwegian hospitals, can use some refurbishing, if for no other reason than to make the hospital a more cheerful, inviting place.

State officials, including Health Minister Sylvia Brustad of the Labour Party, argue that the hospitals are receiving more state funding than ever before, and that more patients are being cared for than ever. Nevertheless, cuts are warned and both hospital administrators and union leaders claim they're dealing with yet another health care "crisis."

Newspaper Aftenposten has gathered figures showing that Norwegian hospitals today have NOK 86 billion available, up from NOK 56 billion in 2002. Even though budgets have increased every year, the hospitals are using more money than they're getting. That's led to an accumulated budget deficit of around NOK 9 billion.

The number of doctors tied to Norwegian hospitals rose from 6,700 in 1995 to 10,854 in 2006, up 62 percent. The number of nurses and psychologists on staff has also increased, while administrative personnel has increased the least. The total number of hospital workers in Norway jumped from 67,098 in 1995 to 94,923 in 2006, with payroll costs jumping 70 percent.

Professor Terje Hagen of a health management and economic institute at the University of Oslo claims there is no crisis within Norwegian health care. "The hospitals have had tighter financial constraints in recent years, but they're still using more resources than planned," Hagen told Aftenposten.

Hagen says health care personnel aren't working as many hours as they did before, and notes there's more of them. Professor Ivar S�nb� Kristiansen puts the financial problems firmly on the rise in personnel and the resulting payroll hikes. He also rejects talk of a crisis.

"As I see it, neither hospital personnel nor politicians manage to say 'no' (to health care services that result in higher costs)," Kristiansen said. "When the possibilities for what can be done just get bigger and bigger, and no one sets priorities, budgets will burst.

"It's virtually immoral to talk about a crisis, when we are among the countries using the most money on hospitals in the world."
The budget that bursts is not the hospital's, in universal care. It's yours.

Now of course, Franken's supporters will argue that he doesn't really want single-payer, even though his health-care page says "A single-payer system would be the most effective in terms of reducing administrative costs, and I would be thrilled to support such a system." He just wants it for kids under 18 (that's the Obama plan, too.) But even his plan for adults -- every state mandated to come up with its own plan -- creates a problem that Glen Whitman identified a few months ago:
To enact any mandate, legislators and bureaucrats must specify a minimum benefits package that an insurance policy must cover. Yet this package can't be defined in an apolitical way. Each medical specialty, from oncology to acupuncture, will push for its services to be included. Ditto other interest groups. In government, bloat is the rule, not the exception.

Even now, every state has a list of benefits that any health-insurance policy must cover--from contraception to psychotherapy to chiropractic to hair transplants. All states together have created nearly 1,900 mandated benefits. Of course, more generous benefits make insurance more expensive. A 2007 study estimates existing mandates boost premiums by more than 20%.

If interest groups have found it worthwhile to lobby 50 state legislatures for laws affecting only voluntarily purchased insurance policies, they will surely redouble their efforts to affect the contents of a federally mandated insurance plan. Consequently, even more people will find themselves unable to afford insurance. Others will buy insurance, but only via public subsidies. Isn't that just what the doctor didn't order?
Who is going to write the mandate that says hair transplants are out? That physical therapy for a chronically arthritic shoulder is limited to only ten times a year, or that condoms are in but that new fancy IUD is out?

And what happens if you mandate that everyone buy their own health insurance, and they don't? As Whitman points out, in the 47 states with mandatory auto insurance, 12% of autos are uninsured -- a higher percentage than persons without health insurance in Minnesota. And in a third of the cases nationwide, the uninsured had household income over $50,000. (Source.)

(BTW, Arnold Kling recommends this excellent article, but it's a 7 MB pdf, so beware.)

The question comes down, as Grace-Marie Turner says, to whether you let individuals control their own care, or you let government. Sweden and Norway use government, and Al Franken thinks that's a good idea. Luckily for those Republicans suffering palpitations on their choice of presidential nominee, all of the remaining GOP candidates are not for the Scandinavian model of health care. John McCain says "To use their money effectively, Americans need more choices."

Here, by the way, is Norm Coleman's health care page. I don't see any mention of Sweden.

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