Healthcare Hackery

HEALTHCARE HACKERY….Clive Crook takes a sledgehammer to single-payer national healthcare in the Atlantic this month, but here’s all you need to read to know that you can safely ignore his rant. American healthcare has its problems, he says, but:

Wherever you look, you find no plainly superior system. Countless variants ? from the mainly government-run, single-provider, single-payer model at one extreme to America’s semi-private, multi-provider, multi-payer approach at the other ? have been tried. None is widely popular. Canada, did somebody say? You must be joking. Rationing and gaps in coverage, necessary instruments of cost control in that system, are at the limit of what people will accept: they were an issue in the recent election, and helped get the previous government thrown out. Britain’s National Health Service, once the country’s pride, is today renowned for dirty hospitals that make you sicker than you were to begin with.

This is the grubbiest and most venerable trick in the arsenal of the lazy healthcare ideologue: pretend that Canada and Britain are the best benchmarks for comparison and then pick up your ball and go home. But if you’re going to play that game, why not go whole hog and use North Korea and Afghanistan as your reference points instead?

Because, of course, your readers would catch on to that. But the fact is that no one who’s serious about healthcare uses Canada or Britain as anything but cautionary tales. If you want to take a look at national healthcare systems that work, you’d pick, say, Sweden at the most centralized end of the scale, France in the middle, and Germany or the Netherlands at the least centralized end. These healthcare systems all have their good and bad points, but on the whole they’re so much better than America’s on so many different measures that to deny this fact is to drain virtually all meaning from the phrase “plainly superior.” What’s more, every one of them is far more popular among its own populace than America’s system is with ours ? and far less expensive.

These healthcare systems also provide plenty of grist for honest arguments. Some of them require larger copays than others, some provide a bigger role for insurers than others, and some provide greater choice and flexibility than others. Crook is well aware of this.

But blandly suggesting that “the closer you get to the single-payer socialized alternative, the less appealing it looks” ? without even giving your readers a serious, honest look at the single-payer alternative ? is the work of a hack, something that Crook usually isn’t. So what happened this time?

UPDATE: As Matt Yglesias points out, Crook also seriously overstates the problems with the Canadian and British healthcare systems. Decent funding levels would make both of them a lot better. My main goal, however, was to point out the Canada/Britain straw man that’s so common in conversations about global healthcare. There are lots of examples of national healthcare systems that are far superior to either of them, and those are the models we ought to be discussing.