Wednesday, August 26, 2009

All Kidding Aside II --- More on Health Care Rationing

Lawrence Lindsey of the American Enterprise Institute has a realistic and even-handed discussion of health care rationing in the United States and under the NHS in the United Kingdom in the U.K. Times. One of his most interesting points is that "inequality" of health care access (defined as the gap between the care received by the wealthy as compared to the care received by the typical citizen) might be greater in either the U.S. or the U.K., depending on how we might want to measure it.

The article is in no way a ringing endorsement of the current U.S. system. Lindsey notes that the U.S. does spend much more per person on health than the U.K.. Lindsey gives a full discussion of how the current U.S. system already has large government components. Nor is it a one-sided indictment of the NHS. Lindsey points out that the history of health care was different in the U.K. than in the U.S., and notes that all of the major political parties in Britain agree that the NHS has succeeded in the job it was given following World War II. But, he provides some of the answer to the question of what we get in America for this difference in systems and expenditures. One thing we get is much higher cancer survival rates. Any male reading this post should draw a circle around the fact that, according to Lindsey (and I have seen these numbers cited elsewhere, but I do not have the original sources), "a man with prostate cancer is six times as likely to die within five years in Britain as in America." As an economist who will be lecturing this afternoon on "don't confuse correlation with causality" I'm wondering what other factors besides the health care system could explain such a large gap.

One problem we have in this type of discussion is disentangling many different societal and economic changes that happened at about the same time. What it is that doctors could actually do for major illnesses changed dramatically both after the introduction of the NHS in Britain and the introduction of Medicaid and Medicare in the United States. Is the higher survival rate from prostate cancer in the U.S. due to or in spite of or irrelevant to government programs such as Medicare (federal) and Medicaid (shared between the federal and state governments). I don't know the answer to that question.

I think that these kind of discussions highlight why Christians must be "wise as serpents" in considering the facts and debating important public policy issues such as health insurance reform. The world simply does not fall into a Proverb, Prophecy, or teaching of Jesus that "Woe be to those who oppose single-payer health insurance" --- nor does it script for us "Blessed are those who rely solely on profit-maximizing insurance companies."

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