Krugman: A Private Obsession

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" Zepp " <zepp

Thu, 28 Apr 2005 20:40:42 -0700

 

 

[Zepps_News] Krugman: A Private Obsession

 

 

 

 

<http://www.nytimes.com/2005/04/29/opinion/29krugman.html?hp>

 

 

Private Obsession

By PAUL KRUGMAN

 

Published: April 29, 2005

 

 

American health care is unique among advanced countries in its heavy

reliance on the private sector. It's also uniquely inefficient. We spend

far more per person on health care than any other country, yet many

Americans lack health insurance and don't receive essential care.

 

This week yet another report emphasized just how bad a job the American

system does at providing basic health care. A study by the Robert Wood

Johnson Foundation estimates that 20 million working Americans are

uninsured; in Texas, which has the worst record, more than 30 percent of

the adults under 65 have no insurance.

 

And lack of insurance leads to inadequate medical attention. Over a

12-month period, 41 percent of the uninsured were unable to see a doctor

when needed because of cost; 56 percent had no personal doctor or health

care provider.

 

Our system is desperately in need of reform. Yet it will be very hard to

get useful reform, for two reasons: vested interests and ideology.

 

I'll have a lot more to say about vested interests and health care in

future columns, but let me emphasize one key point: a lot of big

companies are essentially in the business of wasting health care

resources.

 

The most striking inefficiency of our health system is our huge medical

bureaucracy, which is mainly occupied in trying to get someone else to

pay the bills. A good guess is that two million to three million

Americans are employed by insurers and health care providers not to

deliver health care, but to pass the buck to other people.

 

Yet any effort to reduce this waste would hurt powerful, well-organized

interests, which have already demonstrated their power to block reform.

Remember the " Harry and Louise " ads that doomed the Clinton health plan?

The actors may have seemed like regular folks, but the ads were paid for

by the Health Insurance Association of America, an industry lobbying

group that liked the health care system just the way it was.

 

But vested interests aren't the only obstacle to fixing our health care

system. We also have a big problem with ideology.

 

You see, America is ruled by conservatives, and they have a private

obsession: they believe that more privatization, not less, is always the

answer. And their faith persists even when the evidence clearly points

to a private sector gone bad.

 

I could cite many examples of this obsession at work. But a particularly

good illustration of ideology-induced obliviousness is the 2004 Economic

Report of the President, which devotes a whole chapter to health care

that can be read as a sort of conservative manifesto on the subject.

 

The main message of that report is that U.S. health care is doing just

fine. Never mind the huge expense, the low life expectancy, the high

infant mortality; it's a market-based system, so it must be good.

 

The report even takes a Panglossian view of uninsured Americans - one

that is completely at odds with the grim statistics I cited above -

suggesting that " many of them may remain uninsured as a matter of

choice, " perhaps because " they are young and healthy and do not see the

need for insurance. "

 

The president's economists had only one criticism of the system:

insurance is too comprehensive, which encourages people to consume too

much health care. As they see it, insurance covers too large a

percentage of medical costs. The answer to this problem is the creation

of, you guessed it, private accounts, which have now superseded tax cuts

as the answer to all problems.

 

Indeed, a new paper by Martin Feldstein of Harvard, which clearly

reflects the administration's views, suggests that Social Security

privatization and health savings accounts - tax shelters designed to

encourage people to pay medical costs out of their own pockets - are

only the beginning. " Investment-based personal accounts, " he says, are

the way to go for unemployment insurance and Medicare, too.

 

O.K., let's not turn this into a Bush-bashing session. President Bush

didn't cause the crisis in American health care. His health care

policies have made things only a little bit worse.

 

The point, instead, is that even though all the evidence suggests that

we would be much better off under a system of universal coverage, any

such move will be fiercely opposed, on principle, by conservatives who

want us to move in the opposite direction.

 

And reform will also be opposed by powerful vested interests - my next

subject in this series.

 

E-mail: krugman

--

 

Election 2004

The Triumph of the Swill

 

" The National Government will regard it as its first and foremost

duty to revive in the nation the spirit of unity and cooperation.

It will preserve and defend those basic principles on which our

nation has been built. It regards Christianity as the foundation

of our national morality, and the family as the basis of national

life. "

Adolph Hitler, My New World Order,

Proclamation to the German Nation

at Berlin, February 1, 1933

 

 

Not dead, in jail, or a slave? Thank a liberal!

Pay your taxes so the rich don't have to.

 

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