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The Waiting Game
By Paul Krugman
The New York Times
Monday 16 July 2007
Being without health insurance is no big deal. Just ask President Bush.
"I mean, people have access to health care in America," he said
last
week. "After all, you just go to an emergency room."
This is what you might call callousness with consequences. The White
House has announced that Mr. Bush will veto a bipartisan plan that would
extend health insurance, and with it such essentials as regular checkups
and preventive medical care, to an estimated 4.1 million currently
uninsured children. After all, it's not as if those kids really need
insurance - they can just go to emergency rooms, right?
O.K., it's not news that Mr. Bush has no empathy for people less
fortunate than himself. But his willful ignorance here is part of a
larger picture: by and large, opponents of universal health care paint a
glowing portrait of the American system that bears as little resemblance
to reality as the scare stories they tell about health care in France,
Britain, and Canada.
The claim that the uninsured can get all the care they need in emergency
rooms is just the beginning. Beyond that is the myth that Americans who
are lucky enough to have insurance never face long waits for medical care.
Actually, the persistence of that myth puzzles me. I can understand how
people like Mr. Bush or Fred Thompson, who declared recently that "the
poorest Americans are getting far better service" than Canadians or the
British, can wave away the desperation of uninsured Americans, who are
often poor and voiceless. But how can they get away with pretending that
insured Americans always get prompt care, when most of us can testify
otherwise?
A recent article in Business Week put it bluntly: "In reality, both data
and anecdotes show that the American people are already waiting as long
or longer than patients living with universal health-care systems."
A cross-national survey conducted by the Commonwealth Fund found that
America ranks near the bottom among advanced countries in terms of how
hard it is to get medical attention on short notice (although Canada was
slightly worse), and that America is the worst place in the advanced
world if you need care after hours or on a weekend.
We look better when it comes to seeing a specialist or receiving
elective surgery. But Germany outperforms us even on those measures -
and I suspect that France, which wasn't included in the study, matches
Germany's performance.
Besides, not all medical delays are created equal. In Canada and
Britain, delays are caused by doctors trying to devote limited medical
resources to the most urgent cases. In the United States, they're often
caused by insurance companies trying to save money.
This can lead to ordeals like the one recently described by Mark
Kleiman, a professor at U.C.L.A., who nearly died of cancer because his
insurer kept delaying approval for a necessary biopsy. "It was only
later," writes Mr. Kleiman on his blog, "that I discovered why the
insurance company was stalling; I had an option, which I didn't know I
had, to avoid all the approvals by going to 'Tier II,' which would
have
meant higher co-payments."
He adds, "I don't know how many people my insurance company waited
to
death that year, but I'm certain the number wasn't zero."
To be fair, Mr. Kleiman is only surmising that his insurance company
risked his life in an attempt to get him to pay more of his treatment
costs. But there's no question that some Americans who seemingly have
good insurance nonetheless die because insurers are trying to hold down
their "medical losses" - the industry term for actually having
to pay
for care.
On the other hand, it's true that Americans get hip replacements faster
than Canadians. But there's a funny thing about that example, which is
used constantly as an argument for the superiority of private health
insurance over a government-run system: the large majority of hip
replacements in the United States are paid for by, um, Medicare.
That's right: the hip-replacement gap is actually a comparison of two
government health insurance systems. American Medicare has shorter waits
than Canadian Medicare (yes, that's what they call their system) because
it has more lavish funding - end of story. The alleged virtues of
private insurance have nothing to do with it.
The bottom line is that the opponents of universal health care appear to
have run out of honest arguments. All they have left are fantasies:
horror fiction about health care in other countries, and fairy tales
about health care here in America.
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