Sometimes you just wonder how these press release lists get put together. The Pacific Research Institute, which with its fellow traveler organization the Fraser Institute, has been issuing nutty and just plain wrong "research" about Canadian health care for years, decided to start sending me press releases today. They now have their own blog (well it’s not alive yet but a press release is as good as, dontcha think?). The blog will explain why importing drugs from Canada is a bad idea and why paying more for drugs is a good idea.

Well as they’re nice enough to send me the release I went and looked at their annual report, and if you like pictures of Maggie Thatcher you should go look there too. It does worry me a little when Sally Pipes can only find Rick "Man on Dog" Santorum to quote effusive things about her health care work, but I guess you get praise where you can.

However, their press release also says that they solicit corporate contributions from the health care industry. No biggie, as I do that too (although I call it consulting work!), but you might get the impression that the "research" PRI conducts probably fits the views of certain parts of the health care industry very well. So well that I’m a little surprised PRI only manages to get 15% of its $4.1m budget out of the corporate sector–although it gets another $2m odd from "foundations" which may well be corporate-controlled ones too. But they’re not honest enough in the report to say who it is who’s coughing up.

What you really see from reading the report is that PRI has been somewhat effective in turning a small amount of money into either effective policy interventions or totally muddying the policy waters (take your pick). The end result is that whenever Canadian health care comes up, there is a loony cry from the right that manages to obscure a few basic facts, and makes sure that no rational conversation can be had here about real health reform. Even though the genuinely independent Lewin group showed that single payer would save money in California–a report that sank without trace. So to that extent, this little corner of the vast right wing conspiracy (in San Francisco no less!) is doing its job. Pity that PRI’s claim about individual freedom being the be-all and end-all don’t appear to have transmuted over to a stated position on the drug war or medical marijuana.  Perhaps they don’t notice where they are. The Independent Institute, a more intellectually honest libertarian think tank across the Bay has no such qualms.

In an article called  "Solved!" Vic Fuchs (and new-ish partner) Ezekiel Emanuel go into much more detail about their plan for creating a VAT-funded voucher system for health care. I’m moderately in favor of vouchers for health care and education so long as they are indiscriminate between public and private institutions (i..e don’t take money from public schools and give them to private ones). In fact the best of all worlds would have no "public" provision of either education or health care, but a voucher system that was closely controlled to make sure that inequality of geography and class was corrected. In other words you’d get a more valuable voucher if you lived in the ghetto than if you lived in the suburbs, which would encourage health plans and schools to set up there.

Having said that, I don’t think that Fuch’s plan has much chance of success in the medium term because I don’t think that Americans care enough about universal health care. More likely will be some kind of incremental legislation, such as that being discussed in secret by Heritage, Families USA et al. As I’ve railed many times on THCB, if it’s not universal and compulsory, no system will work in either reducing costs or reducing the number of uninsured, because the producers can keep on putting the prices (and services) up and the net result will be more people unable to afford insurance. So an incremental approach will not solve the problem for which a solution is being demanded (which is rising costs for the middle class rather than uninsurance for the lower class).

So in the long run this incrementalism will lead to a single-payer government funded (and possibly provided) system, which will have a defined and fixed budget–and may be administered via a voucher system  But it will take us a long time, or a national crisis to get there.  Who was it who first told me that health care reform only happened in times of national crisis?  Vic Fuchs.

A WEEK AGO, the NY Times ran
a front-page article presenting three case histories of people who sustained
MRI’s.  The article by Janny Scott, “Life at the top in America isn’t just
better, it’s longer,” is part of an ongoing series examining the effects of
social class in the US.  I highly recommend it to all THCB readers as the
real heart and soul of what health care analysis is all about, or at least
should be.It will come as no surprise that Scott finds social class
determines every aspect of each patient’s episode, “from the circumstances of
their heart attacks to the emergency care each received…It shaped their
understanding of their illness, the support they got…[and] their relationships
with their doctors.  It helped define their ability to change their lives
and shaped their odds of getting better.”  In the best traditions of
feature journalism, Scott supplies copious detail to illustrate that the
enormous treatment differences meted out to patients and the commensurate
outcome disparities varied according to social class.Just within the
realm of health care services, the same disparities apply to stroke, cancer,
diabetes, chronic viral infections (HIV, hepatitis C) and a raft of other
episodes and conditions.  Of course, we could examine most of the other
issue areas at the core of contemporary life — education, retirement, child
care, leisure, on and on — and find in these that social class is also at the
root of discrepant life chances and life styles.The Times’s
article also underscores a point that you and I have both made on TCHB several
times, namely that the holy-of-holies under Reagan-Bush-Bush, the omnisciently
unregulated market, is a piss poor way of delivering goods and services that
have such enormous impact upon the length and quality of lives.  Markets
stratify the public into segments, they often require long periods to
self-correct, and they tend to evolve in ways that subvert the very
preconditions for a market.  Some of those market system shortcomings,
within moderate limits, may be acceptable for consumer packaged goods, luxuries
and certain other sectors.  Health care is too important, however, to leave
in the hands of the oligopolists and plutocrats who run markets.