Friday, August 21, 2009

Finally, Some Substance on Health Care

It has taken a while, but we finally have some substantive discussions going on about health care. A real, honest-to-goodness Canadian writes in The Denver Post about the differences between the US and Canadian health care systems (thanks to my Uncle Lenny for forwarding it to me). Bottom line: Canada spends less money for better health. She takes apart all of the myths about the Canadian system. My response is simple: ADT (About Damn Time). Most of the stories and myths about Canadian health care that I've heard are strictly anecdotal, the "I heard about this one guy who came to America because he couldn't get the surgery that he needed in Canada" variety. So it's nice to see some myths debunked.

Of course, many conservatives will dismiss this out of hand, but it will also give liberals more ammunition, make them more confident, and maybe even convince a few independents. Probably the strongest point in the piece is the one about doctors not needing any kind of pre-authorization to practice the medicine that they think is appropriate.

I have a question for conservatives about health care in Canada. Supposedly lots of Canadians are unhappy about health care in Canada, and they are coming to the United States. Where exactly are all these Canadian? Presumably they're coming across the border to Seattle, Detroit, Buffalo, and other border cities. Can we please get some statistics from conservatives proving that Canadians are coming to the US en masse for health care? Because if we can't get those statistics, I'm going to call it a myth.

Next, Patrick Appel, who is performing quite ably in the absence of his boss, Andrew Sullivan, writes a superb post about malpractice insurance and tort reform. This is another bogeyman of the right, largely derived from anecdotal evidence: there are too many frivolous lawsuits from ambulance-chasing lawyers, and the result of all those lawsuits is that malpractice insurance rates are going through the roof, which drives up health care costs. Maybe not so much.
Malpractice payments account for less than 1% of the nation's health care costs each year. Since 1987 medical malpractice insurance costs have risen just 52% despite the fact that medical costs have increased 113%. The size of malpractice damage awards has remained steady since 1991. Adjusted for inflation, the average malpractice payment has actually decreased since then. The number of payments for malpractice judgments of $1 million or more has never exceeded one-half of one percent of the annual total number of malpractice payments dating back to 1991.
The specific subject of the post is tort reform in Texas, which was supposed to solve the problem by limiting the size of malpractice awards. It hasn't, and there hasn't been the promised reduction in health care costs. The basic idea, which we also have in California, is that certain awards for damages in these suits are limited. The idea is that if the insurance company only pays out $250,000, instead of $5 million, malpractice premiums will decline. It hasn't worked out that way. The unintended consequence is that it is now more difficult for some patients to sue, because it's not worth it for the lawyers to sue, since there is a cap on how much money they can make.

I've always thot that the solution to absurdly high malpractice awards is to implement a better solution for disciplining doctors. Appel quotes a reader who wrote in with stats about how many doctors are disciplined. It's not much. Physician, heal thyself.

We owe Sarah Palin and the other wackjobs on the right a big thank you, because their ranting and raving have finally brought these arguments out of the woodwork. Rationality will eventually prevail, but it takes longer to deploy calmly constructed arguments than it does to throw out insane lies and bizarre innuendo. Palin, Glenn Beck, et al. have a slight advantage in this debate in terms of timing, because it takes them no time whatsoever to make something up and throw it out into the public discourse. Liberals, on the other hand, have to take the time to actually think and research and write. Fortunately, liberal arguments end up being much more persuasive, at least to people willing to listen to them.

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