I am currently serving as a TA for two courses, a basic undergrad health economics class given through the economics department and a health policy class for MPH students via the School of Public Health. At the beginning of the semester, the professors in each class put forth the following question: "How many of you think that the American health care system gives good value for the dollar?" Surprisingly, about 1/3 of the undergrads answered "yes." Not surprisingly, the public health-ers unanimously answered "no."
I think there are two things to take from this. First, there is a great deal of self-selection on the margin of political leanings in public health. Most MPH students tend to identify with democrats/liberals (or, in one of my more cynical moments, "pink-os"), which probably is what induces them to pursue a service-oriented field like public health in the first place. (I'm not sure if the causality works the other way: does learning about public health shift people's voting preferences to the left?).
Second, and most germane to this post, is that, despite what Michael Moore says, not everyone thinks the U.S. health care system is a complete disaster. Slowly but surely, some recent press and research work suggests that the American system isn't really as bad as it seems when making general comparisons with systems in other OECD countries.
For some insight into this, check out recent New York Times article by Greg Mankiw. It is actually the post that I wanted to write and had already written part of before finding out I was scooped. Given that I was about the say the same thing, I think his commentary is very sensible. Here are the major points (I'm not going to give too much away, so as not to destroy any incentives to read the real thing):
1) Cross-country differences in infant mortality rates and life expectancies are mismeasured and overstated when judging different health systems.
2) The 47 million uninsured statistic that everyone quotes masks a lot of things that actually aren't very worrisome, at all.
3) Rising health care costs may be a sign of progress rather than impending doom. At the very least, putting a value judgment on that 16% of GDP tidbit is misguided.
These points don't just stem from conservative, free-market dogmas. Rather, they should be taken seriously for their attention to measurement issues and economic principles. It isn't the first time that alternate, less pernicious interpretations can be given to stylized facts that initially seem quite alarming. Check out an earlier post for another example of this, which also happens to be drawn from the health care arena.
The obvious bottom line: we need to learn from both sides of the health care debate in order to make reasonable policies.
1 comment:
Hmmm...not so sold on statement 2. I'll grant the "illegals" and the healthy Medicaid-eligible. I'd like to know how many millions remain; he merely puts them at a "few percent" of the 300 million total (of whom how many are insured through the VA and Medicare and Medicaid, and thus less important for this debate?). I'd also point out he pulls some debating sleight-of-hand by implicitly comparing those who could get Medicaid (but presumably don't need it) to those who "could buy insurance." The latter group may well have *reasons* why they can't spend aspects of their >50,000 income on insurance, and he doesn't address that. At all.
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