There he goes again. Last Monday Paul Krugman made another ill-fated venture into health care. Like his other columns, it is a bevy of distortions and disinformation.
Krugman begins his column with a tired lefty trope:
So the time will soon be ripe for another try at universal coverage. Public opinion is already favorable: a 2003 Pew poll found that 72 percent of Americans favored government-guaranteed health insurance for all.
But special interests will, once again, stand in the way.
The People vs. the Special Interests! If originality were water, you could die of thirst reading his column. Actually, it was 67% who supported government-guaranteed health insurance in the Pew survey, but we all know about Krugman's carelessness with numbers. But it matters little, since such polls are meaningless. Government-run health insurance is one of those issues that the public supports heavily in polls and opposes just as heavily at the ballot box. In 1994 Californians voted 73-27% against Proposition 186 that would have provided universal coverage in the Golden State. In the state of Oregon -- not exactly red county central -- voters rejected a similar measure even more handily, 79-21%, during the 2002 election. Krugman may think the time is ripe for universal coverage, but the voters have other ideas.
Next, Krugman displays his typical respect for those who disagree with him:
Let's ignore those who believe that private medical accounts -- basically tax shelters for the healthy and wealthy -- can solve our health care problems through the magic of the marketplace.
Yes, let's dismiss it because it isn't true that health savings accounts (HSAs) are only for the healthy and wealthy. A recent report by America's Health Insurance Plans showed that 37% of those purchasing HSAs had previously been uninsured. A study by Assurant Health from last year showed that 19% of HSA purchasers had family incomes of less than $40,000, while an eHealthInsurance study found that nearly the same percentage had less than $35,000 in income. That same eHealthInsurance report found that just under 50% of HSA purchasers were over 40, while the Assurant study found that 70% were over 40. Given that older people tend to be sicker than the young, this strongly suggests HSAs are not just for the healthy.
Krugman also has an odd choice for a pitchman for his dream of socialized medicine:
A system in which the government provides universal health insurance is often referred to as "single payer," but I like Ted Kennedy's slogan "Medicare for all." It reminds voters that America already has a highly successful, popular single-payer program, albeit only for the elderly.
Well, if Ted Kennedy says so, I feel confident, don't you? In seriousness, it's not so clear how successful Medicare is. Although the number of Medicare patients having trouble finding a physician has stabilized some in recent years, surveys conducted by the Center for Health System Change showed that the number of Medicare patients who had trouble getting treatment increased heavily from late 1997 to 2001. The primary reason is that fewer doctors were treating new Medicare patients during that same period.
The Association of American Physicians and Surgeons (AAPS) regularly conducts a less rigorous survey on the same topic, but it is telling nonetheless. In its most recent survey AAPS found that 23% of doctors had stopped participating in Medicare, while another 33% had stopped taking new Medicare patients. The reasons doctors cited for either discontinuing or restricting their participation in Medicare are hardly surprising to anyone who studies bureaucracy: billing and regulatory requirements, hassles and/or threats from Medicare carriers/government, and fear of prosecution or civil action.
Finally, Krugman trots out the usual nonsense about government-run health care being cheaper than private care:
The great advantage of universal, government-provided health insurance is lower costs. Canada's government-run insurance system has much less bureaucracy and much lower administrative costs than our largely private system. Medicare has much lower administrative costs than private insurance. The reason is that single-payer systems don't devote large resources to screening out high-risk clients or charging them higher fees. The savings from a single-payer system would probably exceed $200 billion a year, far more than the cost of covering all of those now uninsured.
As I've noted before, the reason Medicare has lower administrative costs is that it is able to require the private sector to bear the cost of complying with Medicare regulations. Indeed, according to the AAPS survey, doctors "estimate that they and their staff spend 22% of their time on compliance with Medicare regulations, and that it costs, on average, $22 to process a Medicare claim, compared to $14 for a private claim."
Furthermore, money is not the only kind of "cost." Another kind is the pain and suffering due to long waits for treatment. The Fraser Institute releases an annual report on wait times in Canada. From 1993 to 2004, the median wait between seeing a general practitioner and receiving treatment increased 92%, from 9.3 weeks to 17.9. From general surgery to internal medicine to radiation oncology, wait times increased in every category except elective heart surgery. One has to wonder whether the "costs" saved by Canada's health care system aren't offset by lost productivity among workers waiting for treatment.
But none of that matters to those intent on bringing a universal-coverage nirvana to the U.S. Fortunately, with voters having rejected it at the ballot box and the GOP in charge in Washington, the time is anything but ripe for government-run health care. Krugman is deluding himself if he believes otherwise.
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