The United Auto Workers union have exercised their right to strike (a right in full accord with Catholic social teaching) and have begun industrial action against General Motors (GM). I wish them the best. One key point of contention is the spiralling health care costs facing the automobile manufacturer. It claims it simply cannot compete with producers who do not bear responsibility for health care costs. This is a valid point. In nearly all advanced countries, health care is regarded as a government responsibility. But not here.
Of course, the laissez-faire liberals will agree with me so far. But then they would argue that health insurance should be based on actuarial principals, so that each person pays in accord with personal risk, and thereby has an incentive to ration health care. Behind this lies a theory of moral hazard that regards the health care crisis as one of over consumption, not shortage. Of course, I happen to think that a system of social insurance– whereby the young and the healthy subsidize the old and the sick, on the understanding that they themselves will be helped out in due course– is more compatible with the common good than the “each man for himself” mentality that fits with laissez-faire liberalism.
Today is also the day when Catholic apologist Jimmy Akin comes out against “socialist medicine”. I think Mr. Akin should have a word with Fr. Neuhaus, for this is an issue clearly beyond his competency. Here’s his basic argument: if the price is too low, consumption is too high, and there is rationing. This is a simplified version of the moral hazard fallacy. Except that there is very little evidence for this beyond anecdote, as noted by Princeton economist Uwe Reinhart. Health care is not a basic consumer good that responds to price pressures. I do not go to sit in a doctor’s office for the fun of it because it is cheap or free; I go because I am sick. A RAND study in the 1970s showed that higher co-payments did indeed include people to cut back on medical care, but equally on frivolous and not-so-frivolous care. Again, this approach assumes that the problem is that we have too much health care. This is bizarro world!
Akin then resorts to the standard balderdash on rationing. As I noted before, the idea that Americans face shorter waiting times than patients under single payer systems is a fallacy. A problem in making comparisons is that single payer systems typically keep centralized statistics on waiting times, but not so in the US. But the lack of statistics does not mean the lack of a problem. And the evidence all points to the fact that “American people are already waiting as long or longer than patients living with universal health-care systems”. A recent survey by the Commonwealth Fund found that only 47 percent of Americans could get a same or next-day appointment, lower than any other country except Canada. Remember too that health care is rationed extensively by cost in the US. More than half of all sick Americans stayed away from a doctor on cost grounds– needless to say, this is off the charts by comparison with countries offering universal care.
A big part of the problem is the pattern of medical specialization. In Europe, GPs make up half of all physicians, but less than a third in the US. And only 40% of doctors in the US provide after-hours care, as opposed to 75% elsewhere. Where do Americans get their primary care? From emergency rooms. About 26 percent of all Americans visited emergency rooms over the past two years because they could not see their regular doctor. Of course, the US is not all bad: It has relatively short waiting times for non-emergency surgery, including hip replacement or cataract operation (is it any surprise that this forms the basis of the most popular anecdote?)– but even here, it is beaten by Germany.
One final point: I really wish Akin and others would understand the difference between single payer systems (government-run insurance whereby medical practitioners work for themselves) and single provider systems (the government runs the medical system itself, and medical practitioners are on the payroll). The UK is an example of the latter, not the former. Of course, they all look like socialism to those attached to laissez-faire liberalism.
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