More on Healthcare....

Arguably one of the best articles I have read on the state of health care in this country and a good discussion about that article.

In the modern health-care system, there is no higher power than the insurance market. And the insurers who populate that market have grown all the stronger. The Justice Department judges an industry "highly concentrated" if a single company controls more than 42 percent of the market. By that definition, 94 percent of statewide insurance markets are highly concentrated. A recent study by the advocacy organization Health Care for America Now showed that in Indiana, WellPoint controls 60 percent of the insurance market; in Iowa, Wellmark accounts for 71 percent; and in Alabama, Blue Cross/Blue Shield holds 83 percent. In the past 13 years, there have been more than 400 corporate mergers involving health insurers.

Economics textbooks tell us that concentrated markets reduce the competitive behavior that benefits consumers and lead to outsize profits for the dominant firms. Predictably, health-care premiums shot up more than 90 percent between 2000 and 2007, while the profits of the 10 largest insurers increased 428 percent over the same period. Clinton had promised us managed care within managed competition. Instead, the insurers took control of our care and managed to effectively end competition. Neat trick.

If you do not read Ezra Klein now, you should. He is the sort of thought provoking pundit that we need more of. If for nothing else this exchange showed what it is we are talking about.

Babson Park, Fla.: Medicare is already cutting care to seniors. Does anyone know this? No payment for vaccinations are permitted. I had a friend with a puncture injury by a rusty nail, but Medicare refused payment for a tetanus shot. Is this preventive care or not? Medicare refused payment for a PSA test on an elderly man I know. Is this prevention or not? We have the best health care in the world. The issue is not care, but government waste and management. How to make the government more responsible is the question; fire all the bureaucrats and impose term limits for Congress. Why make things worse with so-called health-care reform? Health care is the best in the world, but how do we keep insurance companies from raising rates beyond affordability and disallowing payments for needed care?

Ezra Klein: No. We don't have the best health care in the world. Not on any broad measure or metric. We don't have the most cost effective health care in the world. We don't have the best outcomes in the world. We can't even manage to give everyone access to health care.

That said, there are certain diseases, like breast cancer, that we are uniquely good at treating. But then we lag on diseases like diabetes. It's a mixed bag. And it's a mixed bag that we are spending twice as much as most other countries on. So it's important to say this clearly: We have a very, even uniquely, bad health-care system. Not for every individual. But in the aggregate. As a country, we spend far too much and get much too little.

If people are interested in the evidence on this score, T.R. Reid's new book

The Healing of America: A Global Quest for Better, Cheaper, and Fairer Health Care

is an extremely good, and extremely readable, explanation of how our system compares to those of other countries.

(emphasis added, mine) There is no point in facile nationalistic verve on this issue. Our system is not that good. And other countries systems are not that bad. We should stop fooling ourselves. We are bankrupting our future and not getting particularly good medical care in the bargain.

The whole debate on "Health Care Reform" has been completely one-dimensional in my estimation. We have allowed ourselves to be absolutely consumed with costs and have not really diagrammed what the root causes are, or the sorts of solutions necessary to meet our goals. We are quibbling over the jellybeans when we do not even know the size of the jar. That seems like a bad way to go about fixing a problem.

-Cheers