Remember that while democracy requires capitalism, the reverse isn't true. Capitalism isn't about free trade (which has nothing to do with the movement of capital overseas). Capitalism isn't about competition (witness the vigor with which growing corporations swallow competitors and cross into new industries, and how entrepreneurs position themselves to be bought out by large corporations). Privatization isn't about additional opportunities for you and me - it's about additional opportunities for large companies poised to bid big for new markets. And none of the above is about healthy government or healthy citizens. The neocons would have you believe that all of the above are natural fallout from "freedom," but the evidence says different.
Most Americans probably don't know that we have substantially lower life-expectancy and higher infant-mortality figures than other advanced countries. It would be wrong to jump to the conclusion that this poor performance is entirely the result of a defective health care system; social factors, notably America's high poverty rate, surely play a role. Still, it seems puzzling that we spend so much, with so little return.
An important part of the answer is that much of our health care spending is devoted to passing the buck: trying to get someone else to pay the bills.In 2002, the latest year for which comparable data are available, the United States spent $5,267 on health care for each man, woman and child in the population. Of this, $2,364, or 45 percent, was government spending, mainly on Medicare and Medicaid. Canada spent $2,931 per person, of which $2,048 came from the government. France spent $2,736 per person, of which $2,080 was government spending.
According to the World Health Organization, in the United States, administrative expenses eat up about 15 percent of the money paid in premiums to private health insurance companies, but only 4 percent of the budgets of public insurance programs, mainly Medicare and Medicaid. The numbers for both public and private insurance are similar in other countries - but because we rely much more heavily than anyone else on private insurance, our total administrative costs are much higher.
... private insurers generally don't compete by delivering care at lower cost. Instead, they "compete on the basis of risk selection" - that is, by turning away people who are likely to have high medical bills and by refusing or delaying any payment they can. Yet the cost of providing medical care to those denied private insurance doesn't go away.
First, in the U.S. system, medical costs act as a tax on employment. For example, General Motors is losing money on every car it makes because of the burden of health care costs. As a result, it may be forced to lay off thousands of workers, or may even go out of business. Yet the insurance premiums saved by firing workers are no savings at all to society as a whole: Somebody still ends up paying the bills.
Second, Americans without insurance eventually receive medical care - but the operative word is "eventually." According to Kaiser Family Foundation data, the uninsured are about three times as likely as the insured to postpone seeking care, fail to get needed care, leave prescriptions unfilled or skip recommended treatment. And many end up disabled - or die - because of these delays.
And by "evidence," I mean something more than a friend of a friend who had a neighbor who had to wait for a medical procedure in Canada, or dittoheads calling in to Rush to say how a second cousin of a co-worker lost a toe there. Such things happen here too, though more frequently to those with inadequate health care - probably no one reading this on his or her computer.