The health care reality conservatives ignore

http://www.cnn.com/2013/11/29/opinion/waldman-obamacare/index.html?hpt=hp_bn7

By Paul Waldman
Fri November 29, 2013

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But the momentary political situation aside, conservatives still face a fundamental problem when they confront America's health care system. Their ideology dictates only one solution to all health care problems, and that solution -- less government, more free market -- is exactly what gave us our dysfunctional health care system in the first place.

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Let's step back a moment to consider why we needed the Affordable Care Act and what it says about the health care market. The basic conservative position is that the more you let market forces operate, the better the outcome will be. "More markets" is the answer to everything: Let people buy insurance across state lines. Make it virtually impossible to sue for medical malpractice. Create more health savings accounts.

But where do you think the problems of America's health care system came from? It wasn't government that gave us nearly 50 million uninsured Americans and denials for pre-existing conditions. It wasn't government that gave us the yearly and lifetime caps on insurance coverage that have sent so many people into bankruptcy when they've faced a serious illness or accident. It wasn't government that gave us "rescissions," where your insurance company cancels your policy if you get sick.

It wasn't government that gave us a system in which the gap between what we spend and what we get is so enormous.

It was the free market.

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Every one of our peer nations has a system with more government control than ours, ranging from almost completely socialized systems like Great Britain's to ones like those in Switzerland and the Netherlands, which resemble Obamacare but with tighter regulation.

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On almost any criterion you can come up with, the government-controlled systems work better. They cover everyone, while spending far less than we do. Their health outcomes are as good or better than ours. A recent Bloomberg News analysis rated America's as the world's 46th most efficient health system, right above Serbia and right below Iran. Among the developed countries in the Organisation for Economic Cooperation and Development, the U.S. ranks first (by a mile) in health spending per capita, but 26th in life expectancy.

There are some, however, who love the American health care system. American doctors make far higher salaries than their counterparts in other countries. American insurance companies do very well. As a recent New York Times investigation revealed, makers of devices like artificial hips mark up their prices double, triple, or even more when they sell to American hospitals as they do when they sell the same devices to European hospitals. The same is true of a hundred other devices and procedures. Why? Because in Europe, Japan, and other places with highly regulated health care, government rules keep the costs low.

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The Commonwealth Fund recently released a study of health systems in 10 developed countries around the world which included a survey of satisfaction. America's health system was the least popular, with only 25% of Americans saying it works well and the other 75% saying it should be fundamentally changed or completely rebuilt.

The most popular was the most socialized, Great Britain's, with 63% saying it works well.

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In all their glee about the troubled rollout of the Affordable Care Act, most Republicans are barely bothering to offer an alternative, other than a return to the way things used to be. It isn't surprising, because to be brutally frank, they never much cared about the spectacular human suffering created by free-market health care.

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