Is Megan's problem with health care writing really that the literature is too narrative-driven? Yikes. She should read some issues of Health Affairs, or the Annals of Internal Medicine, or the New England Journal of Medicine. This is not a debate that lacks for data.
Meanwhile, Megan actually gets a few things wrong in her argument with Chait. She suggests that waiting lines are longer in Europe. That's, uh, untrue. France and Germany don't have waiting lists. Americans do, by the way, with around 40% of patients waiting one month or more for elective surgery. She then suggests that moving to a French or Canadian system would require walking back the medicine we actually provide, telling people they can't have MRIs anymore. That's similarly incorrect. Care utilization in France and Germany is as high -- and in France, higher -- than it is in America. But they pay less per unit of care. And the technology isn't radically different. Germany actually has more CT scanners per million than we do, while the French have three less. The French and the Germans both have more physicians per capita and more acute care beds. Oh, and the French and Germans pay less, and don't have 47 million uninsured.
All this information -- and more! -- can be found in various data-heavy books on the subject, like Thomas Bodenheimer and Kevin Grumbach's wonderful Understanding Health Policy. The thing is, they tend to point towards the same conclusions Jon Cohn's book does, albeit with fewer anecdotes. One reason I spend less time arguing health care with libertarians these days is that it doesn't seem productive. If you really don't want to believe that other system's in the world are better, you won't. If the costs, outcomes, access, and equity advantages offered by the French, German, Japanese, Scandinavian, or Veteran's Affairs systems don't convince you, you simply don't want to be convinced. There are issues, like card check, where I see how the counterargument could be convincing, the data isn't overwhelming, and understand it is, to some degree, a values judgment. Health care isn't one of those issues. If the evidence already on offer doesn't convince you, there is nothing more I can say, no cleverer argument I can muster, that will.
