Health care expenditures, financing, insurance, and biomedical research

Health Care Finance

Greenwald engages in a discussion comparing the U.S. health care system to, well, other health care systems. An interesting methodological fault is that Greenwald cherry-picks his examples. In one paragraph, he compares the U.S. with Canada, in other the UK, and in another Spain. The problem, methodologically, is that he can cherry-pick data from whatever country best suits his argument. What this means, in terms of interpretation, is that Greenwald's findings need to be taken with a grain of salt. As an example, Greenwald notes higher wait times in three countries for urgent coronary artery bypass. Nobody likes high wait times, but Greenwald's U.S. figure doesn't factor in the uninsured, whose wait time is infinity. They just die. The issue many have with the U.S. system is not that performance is poor; it is that performance is only good when you can afford it.

This cuts to the heart of the difference between the U.S. And other industrialized countries. The trade-off between quality of care and universal care exists in any nation. The trade-off that other countries have made is that they have chosen universal care, even when there are times when service standards are lower. In the U.S., there has never been a strong collective motivation to make that trade-off. There are reasons for this, and they are more social that medical. While some have argued that lobbyists are the issue, I disagree with that assessment, because most other nations adopted universal health care long before lobbyists took over the U.S. government. The lack of universal health care in the U.S., therefore, is more related to social factors. The erosion of the manufacturing base has in turn eroded the sort of jobs where working class Americans can get health insurance; replace such jobs with part-time retail and the number of insured will decrease. Further, at-risk groups such as the poor, African-Americans, Native Americans and the disabled are disproportionally uninsured (Link & Phelan, 1996). There is a certain lack of concern with the well-being of these groups that has resulted in a lack of desire to provide insurance for them. It's kind of the elephant in the room -- while Canada and Europe were developing universal health care, a lot of parts of the United States were having trouble wrapping their head around desegregation in schools. We should not be so naive as to think this mentality does not play a role in public opposition to universal health care. As well, health care costs were manageable and for most, the system has worked reasonably well. This means there was no impetus for change -- only recently with the explosion of health care costs has there been concern about paying for health insurance even from the middle class.

Costs