A Sheepish Convert to 'Socialized Medicine'

Matt Welch is the editor of Reason magazine, whose motto is 'free minds and free markets'. Reason represents the libertarian trend in American political thought, which has no real counterpart in European polities. Think of it as the FDP on steroids: American libertarians generally call for a radical reduction in the size of the federal government, a 15% flat tax, and believe free markets can supply most public goods (highways, education, mail delivery) better than government bureaucracies. Libertarians come in lots of flavors -- some of them pretty preposterous. Others, like Welch, are pretty sharp. For his crowd, Welch's recent article, 'Why I Prefer French Health Care', will be a shocker:

For a dozen years now I’ve led a dual life, spending more than 90 percent of my time and money in the U.S. while receiving 90 percent of my health care in my wife’s native France. On a personal level the comparison is no contest: I’ll take the French experience any day. ObamaCare opponents often warn that a new system will lead to long waiting times, mountains of paperwork, and less choice among doctors. Yet on all three of those counts the French system is significantly better, not worse, than what the U.S. has now.

Need a prescription for muscle relaxers, an anti-fungal cream, or a steroid inhaler for temporary lung trouble? In the U.S. you have to fight to get on the appointment schedule of a doctor within your health insurance network (I’ll conservatively put the average wait time at five days), then have him or her scrawl something unintelligible on a slip of paper, which you take to a drugstore to exchange for your medicine. You might pay the doc $40, but then his office sends you a separate bill for the visit, and for an examination, and those bills also go to your insurance company, which sends you an adjustment sheet weeks after the doctor’s office has sent its third payment notice. By the time it’s all sorted out, you’ve probably paid a few hundred dollars to three different entities, without having a clue about how or why any of the prices were set.

In France, by contrast, you walk to the corner pharmacist, get either a prescription or over-the-counter medication right away, shell out a dozen or so euros, and you’re done. If you need a doctor, it’s not hard to get an appointment within a day or three, you make payments for everything (including X-rays) on the spot, and the amounts are routinely less than the co-payments for U.S. doctor visits. I’ve had back X-rays, detailed ear examinations, even minor oral surgery, and never have I paid more than maybe €300 for any one procedure.

...

What’s more, none of these anecdotes scratches the surface of France’s chief advantage, and the main reason socialized medicine remains a perennial temptation in this country: In France, you are covered, period. It doesn’t depend on your job, it doesn’t depend on a health maintenance organization, and it doesn’t depend on whether you filled out the paperwork right. Those who (like me) oppose ObamaCare, need to understand (also like me, unfortunately) what it’s like to be serially rejected by insurance companies even though you’re perfectly healthy. It’s an enraging, anxiety-inducing, indelible experience, one that both softens the intellectual ground for increased government intervention and produces active resentment toward anyone who argues that the U.S. has “the best health care in the world.”

What we see here is the difference between someone who's read about European health care systems, and someone who's actually experienced them. The American media are filled with agit-prop scare stories about long waits and missing MRI machines. Welch is an example of someone who came to France expecting one experience, then finding out that reality was something quite different. The better-functioning European healthcare systems (Germany, France, Sweden) aren't bureaucratic monstrosities, and are in fact quite transparent and accessible. Most of the advantages Welch cites for French health care apply equally in Germany. With minor exceptions, everyone gets coverage, you can see a doctor within days, filling prescriptions is simple, and medical procedures cost about 1/3 of what they would in the States.

But here's the kicker: Welch says he doesn't support the current bill working its way through the U.S. Congress (which he calls Obamacare). Hard to blame him for this, there are many reasons to fear this unwieldy legislative kludge. The more straightforward solution would be a simple single-payer system like the one France has. The one Welch says he "prefers." Yet Welch himself says: "It’s not that I think it’s either feasible or advisable for the United States to adopt a single-payer, government-dominated system." Err, why not? one might ask. Instead, Welch advocates "more capitalism at home" as the solution to America's healthcare dilemma, although (1) he doesn't explain exactly what that means; and (2) he doesn't explain why going in the direction of more government involvement, which has achieved the results he praises in France, would somehow backfire in the U.S.

I mean, come on, Matt baby. We're Americans. We sent people to the friggin' moon. Yet we can't beat the French at their own game? The French?

Comments

[malpais beach costa rica]

Seriously. There are loooooooong threads started by men who haven't gotten laid in a long time asking for "help" to rekindle their sex lives. Any attempts to actually provide them with help will result in a lecture about how their wife wouldn't accept oral or any kind of sexual touch. They are only looking to bitch and commiserate with other men who aren't getting any.

[Lauren]

Now, it is the Law of the Land! We will see in a few years from now how expensive this health care bill will be and it will cover all those millions without causing the consequences many fear. I think there is too much politics involved in this bill and not enough problem solving solutions that will eventually bring the results needed to fix this enormous problem.

[Turbulence]

I realize Americans are much more anti-statist than Europeans, but in this area, their libertarianism simply seems crazy and not at all evidence-based (I say this as someone who could probably be described as leftish/progressive libertarian, if there is such a thing).

Americans can be remarkably statist...just try suggesting that the home-mortgage interest deduction is bad policy and you'll find many of the most anti-statist Americans spittle flecked with rage. For that matter, most of the anti-statist Americans protesting healthcare reform most strenuously now had nothing to say in the recent past when the government announced that it could legally grab American citizens off the street and send them to prison indefinitely without ever having to justify their arrest in court (to say nothing of torturing them in prison).

I have the impression all political groups realize healthcare is a huge mess right now.

This is certainly not true. Many people do realize it is a mess, but many do not. Also, many people who believe it is a mess do so for absurd reasons that compel them to reject healthcare reform. For example, they might believe that all problems in American healthcare stem from illegal aliens using up healthcare for free. There is a tremendous amount of ignorance regarding the most basic facts of the health care system in the US. In particular, most of the costs of insurance are borne by employers, so most employees have no idea what their premiums are or how fast they're rising. The small group and individual insurance markets are a complete disaster with much high premiums than the large-group market, but most employees don't participate in that market and have no clue how bad it is. Finally, older people get access to a government health insurance system, so they have absolutely no clue what it is like to get coverage on the market.

You'd think that would make it very easy to change it, somehow. If it would still be a mess after that - so what, nothing gained, but nothing lost either. I just don't get it. Or is this just a proxy war, and the debate is actually about something else?

Fundamentally, the conservative party in America believes it will benefit electorally if it can prevent the liberal party from successfully passing health care reform. They are almost certainly correct. And due to rather foolish institutional design, they have tremendous power far out of proportion with the number of votes their received.

[Turbulence]

Why not doing small steps - for example first prohibit, that insurers reject customers.

The current legislation consists of three components (1) restrictions on insurer's ability to reject applicants, (2) an individual insurance mandate, and (3) subsidies. If you passed (1) by itself, the private insurance market in the US would disintegrate in an adverse selection death spiral in short order. That is, moderately healthy people would stop buying insurance. After all, why pay for insurance when you can just wait until you get sick and then get an insurance policy? That means that insurance companies' risk pools would become dominated by those already sick, i.e., the most expensive to insure. This would force insurance companies to raise their premiums which would in turn compel healthy people to drop their coverage. Hence the death spiral.

Adding in the mandate fixes this problem but the mandate cannot be passed without subsidies. After all, it is political suicide to demand that people pay for something they cannot afford, and it might face legal challenges as well.

These three components are like the three legs of a stool; you cannot remove any of them without making the stool useless.

Works just fine in Switzerland.

As far as I know that's not true. Switzerland has an existing policy set that works well. But Switzerland did not transition from an American style health care system to one in which insurer rejection was banned. Transitions matter, not just end states.

[Kurt]

It doesn't sound like he's a convert. It sounds like he prefers France's system to what we currently have in the US, but would generally prefer a real free market setup to either.

I think you'll find many libertarians who feel the same way, provided they're really aware of the differences in the various systems. You'll also find many who are reasonably ignorant of what's out there and what we have here. "Ignorant" trumps most political systems, unfortunately.

The thing about France's system is that it's significantly better than what we have now, but still untenable in the long run. *Everyone's* health care spending is increasing faster than their GDP. No one has a sustainable, long term system. Everyone is going to have to figure out how to control cost increases. There are many of us who believe that the only way to truly control costs is to let the market work its magic.

[Scott Frey]

The AMA monopolizes/controls what specialties and professions have the power to diagnose in this country, which is its own form of centralized power. Wilk v. American Medical Association is just one example off the top of my head. "Socializing medicine" just turns the current crap that you dislike into a different, and I would argue much worse pile of crap.

[Herbert Lorenz]

As an austrian living in the US i'm puzzled by this post. I've actually experienced the month long wait times. After moving here i could get appointments with the same kind of specialists that were more competent and better equipped within 2 days! in terms of pure service quality the US system was a giant improvement, at least for me. this is just anecdotal evidence as well, but seeing that i have no agenda in this, i thought it's a valid datapoint.

[M. Möhling]

> a EU-Brussels healthcare system. And I fear that would
> really be a night mare

Night mare? Charmingly equestrian; riding the patient in accordance with 15,432-paged EUSSR regulation, so to speak. Earnestly, you're spot on. Scot W. Stevenson dealt with that aspect back in 2006:

Wer sich wundert, warum viele US-Bürger einer landesweiten allgemeinen Krankenversicherung skeptisch gegenüberstehen, soll sich überlegen, wie es wäre, wenn die EU alle nationalen Versicherungen durch eine zentrale, von Brüssel gelenkte würde ersetzen wollen.

An obvious issue that gets short shrift, if any, over here. I wonder why that is. More myths dispelled for the so inclined reader:

• krankenversicherungen-und-blutende-amerikaner-vor-der-notaufnahme
• das-veto-gegen-die-krankenversicherung-schip

[Michael]

I think its pretty interesting, that in the USA both supporters and opponents of ObamaCare (or PelosiCare or whatever) almost always cite the British or Canadian health care systems, which both are really in very bad shape. Maybe this has something to do with the language?

Another thing I don't get is why there is a need for such a massive new bill. Washington politics is much more messy than politics in European states - each representative has to somehow get something for his constituency and his donators into each bill. I think its highly questionable if there is any possibility to get a "clean" healthcare bill.

Why not doing small steps - for example first prohibit, that insurers reject customers. Works just fine in Switzerland.

Also I think one should always keep in mind, that an US healthcare system would not be like the French or German healthcare system but like a EU-Brussels healthcare system. And I fear that would really be a night mare.

[cohu]

I was hoping you'd have an explanation for the incoherent views of many Americans re: healthcare. Instead you seem to be just as puzzled as I am!

I've had the suspicion that Americans tend to think everyone is, prima facie, in charge of their own health, whereas Europeans are more fatalistic and tend to accept everyone will be dependent on others at some point, and conclude there needs to be a system to help them out when they get sick themselves. Or are there any other explanations for the US healthcare dilemma?

I realize Americans are much more anti-statist than Europeans, but in this area, their libertarianism simply seems crazy and not at all evidence-based (I say this as someone who could probably be described as leftish/progressive libertarian, if there is such a thing).
I have the impression all political groups realize healthcare is a huge mess right now. You'd think that would make it very easy to change it, somehow. If it would still be a mess after that - so what, nothing gained, but nothing lost either. I just don't get it. Or is this just a proxy war, and the debate is actually about something else?