Saturday, February 12, 2005

That darned Westover

Posted by Craig Westover | 6:54 PM |  

After reading the letters section that will appear in Sunday's Pioneer Press “Local Letters” section, I’m hoping that indeed, there is no such thing as bad publicity, as long as they spell the name right.

Under the headline “That darned Westover,” a trio of letter writers takes off after my column on ex-Canadian physician Lee Kurisko and criticism of the Canadian health care system, balanced by a trio of letters supporting my stance against smoking bans. Well two letters in support and a third that I’m not sure about. It’s not so much that the writer is against smoking bans, she just wants a non-reproductive section.

But, back to the criticism.

The first letter is from Rhoda R. Gilman, a past chairwoman of the Minnesota Universal Health Care Coalition, who says of my column on Dr. Kurisko --
His [mine] critique presents no facts or figures but relies on observations by one medical specialist who has moved his practice to this country. It ends with a rigning quotation from Ayn Rand, the prophet of Libertarians. Ask the average Canadian and you get quite a different story.
Well let’s work backwards and ask average Canadians. I didn’t ask, but they were quick to write and tell me. You can read what they have to say in the comments here and in the post here. Not exactly singing the praises of socialized medicine.

No facts and figures? Probably just not the ones she wanted to see (which I’ll handle below), but for the record, here’s confirmation from the Canadian Medical Association of Dr. Kuisko’s statements about the physician shortage in Canada.

Just a brief note about the “fact” that Ayn Rand is a “Libertarian” prophet. Although her work has attracted millions of people to libertarian (small “l’”) principles, she herself took metaphysical, epistemological and ethical exception to libertarianism (for Profile of Learning fans, that’s philosophy). A trivial point to be sure, but not when raised by a person as an ad hominem argument. The quote by the way -- “The common good was the claim and justification of every tyranny ever established over men,” stands on its own.

Ms. Gilman the cites a report by the Harvard Medical School that --
“reveals that half of the personal bankruptcies in this country result from overwhelming medical costs . . . Among middle-class people whose health coverage proved inadequate.”
Pretty scary, eh? Until one looks at the Reuter’s account of the study.
Half of all U.S. bankruptcies are caused by soaring medical bills and most people sent into debt by illness are middle-class workers with health insurance, researchers said on Wednesday.

The study, published in the journal Health Affairs, estimated that medical bankruptcies affect about 2 million Americans every year, if both debtors and their dependents, including about 700,000 children, are counted.
What is that telling us? That medical bankruptcies affect 2 million Americans if each case includes all family members. That’s 2 million people out of a population of over 250 million people or 8/10s of one percent of the population (2 million divided by 250 million times 100 for those who believe math is about feelings). Tragic for these families -- certainly -- but if we must have government-sponsored compassion, let’s at least focus it on this 8/10s of one percent that need help, not institute a health care system that is rotten for everyone in the name of a pseudo-equality.

And let’s also remember that bankruptcy in this country is not putting someone on the street in tattered rags to live in a cardboard box. Bankruptcy is essentially a “do-over,” allowing people to get out from under insurmountable debts and start over. The same article notes that it’s people with assets to protect that file bankruptcy.

[Just as an aside, close on the heels of medical bankruptcies are bankruptcies caused by divorce. I wonder if Ms. Gilman supports the president’s proposals supporting marriage?)

Finally she cites that Canadians care for people at half the per capita cost of the United States. Fact is, the cost is only slightly less and look what you get for your money by reading the CMA report and Dr. Kurisko’s comments on contrived physican shortages and his difficulty obtaining equipment.

Enough with Ms. Gilman. On to Randall Holbrook. He cites better infant and maternal morality rates in Canada and higher life expectancy in Canada as arguments that their health care system is better.

Here is a case of aggregate statistics that don’t present an accurate picture of the sub groups that make up the statistics. Health care is but a small influence on mortality and life expectancy statistics. More influential are social conditions. Cluster a diverse population in large cities, and you’re going to see a negative difference in mortality and life expectancy rates compared to a largely rural country. You can get the same disparity in statistics by comparing different states within the United States. You also get the same disparities comparing areas within Canada.

Statistics that really tell the health care story are those that reveal how long one has to wait for care, how far one has to travel for a procedure, what care is actually available and the like -- the things that matter to 99 percent of the people who interact with the system everyday. In these categories, Canada loses badly.

And then there’s Robert Dannaeker, who pulls out the old equalitarian argument -- “adequate health care for all or better health care for the privileged?”

He infers that my argument is that “American health providers function to serve the highest bidder -- not the masses in their entirety.” He calls that “unconscionable in the wealthiest nation in the world.” He calls it “classism.”

What to say? The problem is when speaking to people like Mr. Danneker any argument that references free market economics is taken as a win/lose situation. People like Mr. Danneker see a static pie and if one person gets a big piece that means less for everyone else. That attitude is expressed by his opening characterization of health care as either “adequate health care for all” or “better health are for the privileged.”

[Funny hat tip to Peg at What If for the “people like Mr. Danneker” link.]

Some people will always have more than others, and they pay for it. But it is competition for the “it” that drives down prices and expands markets for everyone. Take that out of the equation, and you get . . . well, Canada, where the “privileged” come to the United States for treatment rather than wait for “free” Canadian benefits. I couldn’t confirm this statistic, but Dr. Kurisko indicated that the entire medical R&D budget for Canada is about what is spent on medical research at Texas A&M University. I wouldn't doubt it.

Is there a disparity in medical care in the United States? Yes, but there’s also better than adequate care for nearly all the population. Are health care costs out of control? If not, they’re getting there, but that’s because there are few market forces working to keep them down. Do some people have less than adequate health care? Yes, but let’s not destroy the whole system when we could attack the acute problem.

These three letters are not about health care. They are about political ideology. The Ayn Rand quote makes a fitting conclusion --
“The common good was the claim and justification of every tyranny ever established over men.”