February 27, 2006

More Healthcare Posts from Drum

Filed under: Random Stuff — Bob Gifford @ 8:49 pm

Kevin Drum at Political Animal has a couple posts on healthcare. First, he points to the blog of Malcolm Gladwell of Blink and Tipping Point fame. Six years ago Gladwell argued against the Canadian single-payer system, but he has now completely reversed his position:

Why have I changed my mind? Some of my reasons are in the piece on moral hazard I wrote for the New Yorker last summer.

The bigger reason is simply that I woke up one day and realized what much smarter people than me (Adam Gopnik) realized a long time ago, which is that the idea of employer-based health care is just plain stupid–and only our familiarity with it and sheer inertia prevent us from rising up in rebellion. I always try to think of a suitable analogy and fail. The closest I can come is to imagine if we had employer-based subways in New York. You could ride the subway if you had a job. But if you lost your job, you would either have to walk or pay a prohibitively expensive subway surcharge. Of course, if you lost your job you would need the subway more than ever, because you couldn’t afford taxis and you would need to travel around looking for work. Right? In any case, what logical connection is there between employment and transporation? If you can answer that question, you can solve the riddle of the U.S. health care system. And maybe I’ll change my mind back.

I hadn’t seen his New Yorker article, so I was grateful for the pointer. An excerpt:

Gina, a hairdresser in Idaho, whose husband worked as a freight manager at a chain store, had “a peculiar mannerism of keeping her mouth closed even when speaking.” It turned out that she hadn’t been able to afford dental care for three years, and one of her front teeth was rotting. Daniel, a construction worker, pulled out his bad teeth with pliers. Then, there was Loretta, who worked nights at a university research center in Mississippi, and was missing most of her teeth. “They’ll break off after a while, and then you just grab a hold of them, and they work their way out,” she explained to Sered and Fernandopulle. “It hurts so bad, because the tooth aches. Then it’s a relief just to get it out of there. The hole closes up itself anyway. So it’s so much better.”

People without health insurance have bad teeth because, if you’re paying for everything out of your own pocket, going to the dentist for a checkup seems like a luxury. It isn’t, of course. […] “Almost every time we asked interviewees what their first priority would be if the president established universal health coverage tomorrow,” Sered and Fernandopulle write, “the immediate answer was ‘my teeth.’ ”

Those of us with good insurance and good jobs take so much for granted. This is a great article that I’ll be quoting from again in a future post.

Next, Drum posts about the sudden end of the malpractice insurance crisis:

The fine folks at Americans for Insurance Reform have tabulated recent increases in malpractice premiums and found that after the big upsurge of a few years ago, rates aren’t going up anymore:

Contrary to the medical and insurance lobbies’ message — that medical malpractice lawsuits and claims were to blame for the increase in insurance rates — the fact is that in 2001, commercial property insurance rates jumped across the board. In other words, rate hikes for doctors were only a small part of a much larger insurance problem that affected homeowners, motorists and all kinds of policyholders.

It turns out that the recent insurance hikes were caused by insurance industry business cycle, and not by higher malpractice damage awards. Tort reform, one of Bush’s proposals to improve access to healthcare, is a solution to a problem that doesn’t exist.

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