Wait a Minute

Fresh from lying about Dick Cheney's stock options--they've been donated to three charities, and Cheney has no financial interest in them--Kevin Drum moves on to health care in America, to decry the waiting lists. Based on one sad sack's anecdote.

Unfortunately for Mr Drum, he tried to defend himself:

The cries of despair from conservatives about my use of an anecdote are genuinely pitiful. My heart goes out to you guys.

Anyway, feel free to dredge up statistics.

And they were produced, showing that waiting times for health care were not at all significant in the United States, or in European Countries such as France with more market based systems (the majority of the French have private insurance to supplement the government's). But were a huge problem in Canada, Australia, and the UK.

Further, last summer a Quebec court ruled that Canada's prohibitions against private provision of health care violate Canadians' rights, specifically saying that access to waiting lists is not the same as access to health care.

And the Quebec government is more or less ignoring the court:

The Quebec government reacted by saying it would apply immediately for a stay of between six months and two years before the decision takes effect, given the chaos it could cause in the delivery of medical services in Quebec.

Intergovernmental Affairs Minister Benoit Pelletier said the province would consider using the notwithstanding clause in Quebec's constitution as an alternative to abiding by the court's decision.

The plaintiffs in the case – a Montreal patient and a doctor wanting to set up a private clinic – asked Canada's top court to strike down sections of the Quebec Hospital Insurance Act that prevent people from buying health insurance for medical procedures covered by the public health plan.

We expect all of the above to register not a bit with Kevin Drum and his hardy band of commenter brothers. Nor would this letter from Jacob Arfwedsen to John Kerry during the 2004 election campaign, about the supposedly first rate system in France:

Dear Senator Kerry,

I'd like to give you an update on France for your campaign since you regularly refer to it as an example.

As you are well aware, wine consumption in France is financed by government and every citizen is subject to a payroll tax which finances the central wine fund. There are also private wine funds but these are regulated and basically depend on subsidies from the government wine officials.

Bottles of wine may be picked up for a symbolic charge by each citizen paying contributions; particularly needy or extremely thirsty users pay nothing. There may be waiting times of course, and users may not always pick their favorite Burgundy (no foreign wines, unless you go abroad and get them at your own expense). People are also advised to stick to the local merchant and not skip around town looking for better deals, although this is tolerated; the possibility of shopping at special stores for exclusive brands is considered one of the system's great virtues.

The system is managed by the wine funds, their representatives are appointed by the unions and politicians. The problem is that wine consumption is constantly increasing as citizens pay nothing or very low refill fees. Administrators try to cap consumption by raising the taxes on corkscrews and wine coolers; recently the government recommended that thirst be quenched with less expensive products, such as grape juice or mineral water, although the effects are not the same. Costs are exploding, but people are still thirsty; wealthy consumers go on drinking binges abroad, the less well-off are still lining up in front of their local provider. The Minister of Essential Beverages recently announced the 17th plan to reform financing in close cooperation with vineyards and wine merchants.

Sorry, did I say "wine"? I meant of course health care; apart from that, the principles outlined above are the same; this is how the brunt of the French health care system is managed.

Mr. Arfwedsen then goes on to detail the impending bankruptcy of that system:

The deficit of the compulsory health insurance is currently increasing by € 21,000 per minute. In January the deficit was estimated at € 11 billion for 2004, equivalent to one month of consumption; this figure was recently revised upwards to € 11.9 billion. The Health Minister Douste-Blazy declared that "the health insurance is bankrupt". In fact, nobody knows exactly how much the system costs, which doesn't make for wise policy decisions.

And, that things are only to get worse as France's population ages.

High hopes were placed in the High Council for the future of social insurance (a k a the Fragonard Commission), which presented its report in January 2004. The report summarized the dilemma of reform as follows:

• current debt financing is unsustainable
• increasing revenues is not an option (this would mean doubling contributions, from 5.25 to 10.75 points)
• reimbursements must not be curtailed, since this would be contrary to the founding principles of solidarity
• health care rationing is unacceptable

In other words, socialized financing means the next generation will have to foot the bill; our children will also have to pay for the generous retirement benefits which are not funded. Raising taxes is ruled out (although it will eventually prove the easiest way out politically) and the current principles of Soviet management are deemed sacrosanct. Today's "reforms" are essentially geared towards cost containment, for instance by favoring generic medicines to cap drug expenditure, without considering an opportunity cost analysis to establish whether for instance increased use of innovative drugs or ambulatory surgery may help reduce hospital stays.

We cannot do anything really, says the High Council, except keep trying what doesn't work.

And closes with some advice for the loser:

Please remember the above when you use France as an example, Mr. Kerry.