Any Hope for a Health Care Debate Based on Facts?
posted by Frank Pasquale
Usually critics of democratic processes emphasize the populace’s political ignorance, and despair of bringing them “up to speed” on complex technical issues. But what happens when even accomplished & fair-minded policy analysts permit hoary old assumptions to substitute for facts? Consider the following points made by Austan Goolsbee in a review of Sicko:
In Sicko, Moore tries to skirt the issue of rationing by going to a Canadian emergency room and finding that people have only had to wait there for 20 minutes. But that’s not the relevant comparison, of course. The emergency room is less crowded in places where everyone has health care. The question is what happens for the vast majority of expensive procedures that you don’t go to the emergency room for. And for those, patients in single-payer countries tend to wait much longer than in the U.S. and can easily be told that they can’t have a particular treatment at all.
I don’t know exactly what “expensive procedures” Goolsbee is talking about, but recent studies by the Commonwealth Fund should lead him to reconsider any general assumptions about comparative wait times. As Catherine Arnst at Businessweek notes, “waiting times in the U.S. are often as bad or worse as those in other industrialized nations—despite the fact that the U.S. spends considerably more per capita on health care than any other country.” According to a 2005 survey, “Of the countries surveyed, 81% of patients in New Zealand got a same or next-day appointment for a nonroutine visit, 71% in Britain, 69% in Germany, 66% in Australia, 47% in the U.S., and 36% in Canada.”
Goolsbee may well have fundamentally misunderstood the relationship between ER and other care. Arnst claims “Those lengthy wait times in the U.S. explain why 26% of Americans reported going to an emergency room for a condition that could have been treated by a regular doctor if available, higher than every other country surveyed.” These waits probably hurt worker productivity as well, as some forward-thinking businesses recognize. Sometimes American-style cost-based rationing can be penny wise and pound foolish.
My first recommendation for Goolsbee would be to take a look at this essay by Tim Jost. Then he might avoid making the mistake that David Leonhardt notes in another Slate ecolumnist, Steve Landsburg:
[A] problem plagues many of the new economic imperialists: . . . they don’t get out enough. They are asking good questions about epidemiology and psychology, but they are not spending much time with epidemiologists and psychologists, let alone with the people who are the subjects of their academic research. As a result, they arrive at conclusions that can be clever but lack wisdom, as the economist David Colander points out in his recent book, “The Making of an Economist, Redux.”
And by the way, there’s little in Goolsbee’s essay that I disagree with! He has a lot of great warnings for Moore-style revolutionaries. I just think that the policy, just like law, falters when basic facts get shoved aside. . . even in service of the bien-pensant concessions of the soi-disant statesman.
PS: Yes, I realize that the wait time is worse in Canada. As I’ve said before, France or Germany is probably the better model for U.S. reform.
July 7, 2007 at 2:03 pm
Posted in: Health Law
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Responses (6)
Daniel Goldberg - July 7, 2007 at 2:51 pm
Actually. as to ERs, the best evidence suggests that wait times in Canadian ERs — as opposed to primary care — is as bad, if not worse than in the U.S. This evidence belies the notion that ERs are overcrowded in the U.S. because so many lack access to care. If that were the primary causal factor, one would think that ER wait times would be significantly lower in countries where all have access to primary care. I have a post on this here.
Frank - July 7, 2007 at 3:06 pm
Thanks, Daniel. That’s a very interesting post, and the links in it are definitely edifying.
Perhaps one rule of thumb for the health debate should be: anyone writing online about it should link to the underlying sources and studies they’re basing their commentary on. I look forward to seeing exactly what “expensive procedures” Goolsbee has empirical evidence about re wait times and denials. I like CMWF-style scorecards because they tend to a) commensurate many different measures of quality/access/cost containment and b) allow the reader to break-out exactly how each measure is done.
And I look forward to reading your piece on the justification of a universal health care system.
Frank - July 7, 2007 at 4:15 pm
PS: This book on the French system looks particularly interesting; I eagerly anticipate its publication:
http://jan.ucc.nau.edu/pvd/
here’s the author’s primer on French health care:
http://jan.ucc.nau.edu/pvd/Primer.htm
Andrea - July 7, 2007 at 5:22 pm
Instead of linking to Goolsbee’s essay, you linked to his Wiki profile…what’s the review on which this post is based, so we can read it too?
Margaret - July 7, 2007 at 5:27 pm
I’ll tell you what’s penny wise and pound foolish: covering erectile dysfunction treatments but not covering birth control pills!
Frank - July 7, 2007 at 6:01 pm
sorry, Andrea, it’s
http://slate.com/id/2169454/
i’ll put that in.
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