Thanks for the comments, John.
Just quick, rather off the cuff responses.
Krugman's argument is at the macro level, that we spend more and, in the aggregate, get less. The more seems obvious; the less is higher infant mortality rates and lower life expectancy. Here's the relevant quote.
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.
The attraction of single payer systems to me is that they are more likely to address the health of everyone (even folk who lack employment) rather than simply folk who can afford to pay; and they embody a central social policy tenet for me which is concern for the full national family and spreading the risk.
I think the main issue people with positions like mine must face is the one you bring up, medical innovation, particularly drug innovation. We can argue that policy can't do everything. Innovation is a good thing but if policy choices must be made, it's more important to provide adequate services for everyone than to innovate for a minority. The rejoinder to that is the obvious one: the medical innovation of the present becomes the commonplace of the future. So policy, in my view, should never make that stark a choice.
The other response is that it is, in fact, not that stark a choice, that the drug companies wish to make it that and have done a stunning job of installing that notion in the political culture. But that it is not a truth; just a politically created and manipulated view.
My own guess is that there is a policy answer somewhere which combines these two goods sufficiently well to get a political majority. It won't happen now, not within the confines of the present political culture. But every worm turns. |
