Paul Krugman has a great column out about the international health care context, called The Medical Money Pit. There’s nothing new or original that THCB readers or Health Affairs readers won’t already know. We spend more and basically get less, but we lead the league in surgeons driving Porsches. But it’s very good that someone is raising this issue outside of pure policy wonk circles. Even Krugman seems stunned that our government spends so much more per head than other governments which cover all their people, and all we get for it is Medicare for seniors and crappy coverage for the very poor. And by the way those numbers don’t count the role of the Feds and states as employers paying for health care coverage for 10 million government workers–if you add that in, the government share of spending is higher (although that math doesn’t really matter as we don’t cover any more people because of which column you put the spending in).
What Krugman doesn’t say is that, in general, government spending in those other countries guarantees a basic level of care for everyone, and that the rich (even in the UK, but not in Canada) can trade up with their own money for a nicer class of waiting room or to jump the line. And they do, and there’s not only nothing wrong with that. It doesn’t destroy the basic fabric of the social system. And if we had universal health care here, it would be true here too, and there would be nothing for those in the upper social tiers here to be afraid about. But you won’t find that rumor getting out when this gets discussed politically.