I thought that the NY Times was getting better, honestly. After all Gina Kolata, a major offender in the dogs licking sores series of last year, did feature Jack Wennberg this summer. But then recently the Times published an op-ed written by a big Pharma PR flack. At least that was an op-ed, even if it should have been on the op-ed pages of the WSJ. Now, we have “economic view” on health care written by Greg Manikw, the former chief Bush economic adviser who appears to be reinventing himself as a Romney flack. Manikw has some interesting ideas about carbon taxes (which of course never saw the light of day while he had any influence in the Administration), but why does the Times “economic view” on health care means regurgitating a bunch of Manhattan Institute talking points?
For that matter, if he’s an economist, why isn’t Manikw making any attempt at balance? And why is the Times letting him get away with this. As I said, it’s not the WSJ.
OK, so what are the points he makes. Standard Manhattan talking point stuff, so let me add the standard talking point answers.
1) While life expectancy and infant mortality rates are worse here
than in other countries but they are not good measures of a health care
system. Yes and somewhat true, but a) conceded by sensible health
economists, and b) these differences are not due to our different
ethnic makeup. (Yes that stuff about us having more teenage mums is
conservative code for us having too many minorities).
Except, that a big study of white English people and white Americans last year showed that richer white Americans had the health status of poorer English people.
That might somehow have some connection to the fact that we also have
worse coordination of care here than in most countries with universal
coverage. And of course part of the reason we have more low birthweight
babies may be that unlike the Brits, the Japanese and the French, we don’t have a comprehensive system of pre-natal care.
And even if it isn’t reflected in the numbers, shouldn’t it be mentioned as a possible cause. There’s plenty of data about it.
2) The uninsured numbers. What’s the unthinking argument?
- Some people are either offered it at work or are rich and don’t buy insurance—so don’t count them. Except
if they don’t buy it after being offered it at work they are far more
likely to have low incomes. And the rich may not be that rich (high
income families with several people in them) and may not be able to buy
affordable insurance. Or at least so it says in this months Health Affairs.
- Some people ought to be on Medicaid, so don’t count them as they’re “uninsured in name only”. Except of course if they did all try to sign up for Medicaid, the states
would change the limits and dump a bunch of kids out as they did with
S-CHIP in Florida and a bunch of other states in 2003. Perhaps those kids didn’t have names.
- And some of these people are not even citizens, so they don’t even exist. Except
a) a whole bunch of them are legal immigrants (I’ll admit to being
grumpy about this as a former legal immigrant and now citizen) and b)
most immigrants living here are paying taxes and even the illegals are
not much of a burden to the system according to Rand. So why shouldn’t they be paying into the pool?
And even if all Manikw’s points have some validity, why is the
counter argument not mentioned? Let alone someone making the minor
point that if you don’t have insurance for whatever reason and you get
seriously ill, your life is financially devasted. A point made eloquently elsewhere in the NY Times yesterday by Bob Herbert.
3) “Health care costs don’t matter because we’re getting richer and
because we want it that way.” I cannot believe that after the reaming
this argument has taken from sensible people it’s allowed to be
repeated in the NY Times again! No comment other than….aaarrgghhh!!
OK, OK. For the millionth time, this time I’ll quote Tom Leith who made
this argument on THCB in response to the last time the sore licking dog thing happened:
That portion of American health spending that is in excess of
other nations is predominately the result of supply-side market forces
that essentially "up-sell" the consumer. 3-D body scan instead of
X-ray; brand name drug instead of equivalent generic; surgical
procedure over non-surgical treatment with similar long-term outcomes;
disease management instead of health promotion, etc. It is true that
Americans expect heroic measures without an understanding of the costs,
but so much of our expectations are set by providers, particularly
physicians. The "consumer" is spectacularly ill-informed about
best-practices and the industry is far too often unmotivated to find
them because efficiency reduces payments.
So where are the counter-arguments? Apparently the New York Times
either thinks its readers are such geniuses they can validate these
arguments already, or it’s decided to become a mouthpiece for Manhattan
et al. Don’t they already have the WSJ?