So the book club at TPM is drawing to a close. Here’s my first piece trying to explain that social insurance whether voucher/competition-based or fee-schedule-based is pretty similar compared to what we have now. In fact it’s a Distinction without a Difference. But that just seemed to confuse everyone, so I tried again with a larger explanation with a longer title called Social insurance is the key–but it can handle competition, just not the type you’re used to!

Uwe skewers the HSA as a regressive tax shelter that impacts only the poor over at Health Affairs Blog. This time the cracks are at Bloomberg readers rather than certain crank health policy shops in Dallas, TX but it’s still a beautiful read.

Here’s his New Republic piece called Health Care Like The Europeans Do It republished on CBS news. Personally I think that he gives the American system too easy a ride, even though Ezra beats up the Cato boys on this too. When I looked at this issue of performance on particular disease categories a while back I found this quote.

Contrary to popular belief, the health care here isn’t always the best. Many other industrialized countries provide health care that is just as good and sometimes better. For instance, 30-day acute myocardial infarction case-fatality rates are below 7% in Denmark, Iceland, and Switzerland, compared with almost 15% in the United States. Incidence of major amputations among diabetic patients in Finland, Australia, and Canada is less than 10 per 10,000 compared with 56 per 10,000 in the United States. And Australia, Canada, England, and New Zealand all have a better 5-year kidney transplantation survival rate than the United States.

You’ll never hear that in a Cato/Manhattan/PRI/AEI press release—and it defies belief that they want to go down that path.

But the overall point is that health and medical services are only distantly related, and talking about outcomes in the context of different health systems is stupid. But there are two outcomes that it is not stupid to talk about, and those are the two on which America leads the world. High costs across the system, and poor (and middle income) people losing all their wealth due to medical care costs.

After spending his whole piece beating back the silliness about individual disease outcomes, Jon does get to the real point:

Not even conservatives dispute the one clear advantage other countries have over us: You don’t see their citizens choosing between prescriptions and groceries, or declaring bankruptcy, because of medical bills.

And that is the point. Universal health care insurance is not about health, it’s about wealth. As in not losing it when your sick because you didn’t have good health insurance. Because as I’ve said before on THCB good insurance is mostly a function of good employment, which is mostly a function of good education, which is mostly a function of how you choose your parents.

As John Edwards put it when he announced his health care plan, "It doesn’t have to be that way."

OK. The bickering about Jon Cohn’s new book Sick has started over at TPMCafe Book Club. Lots of interesting stuff including one from moi.