Looks like I touched a nerve with Dale Franks, because he just released a 2,500 word blast on the infeasibility of universal health care which is, quite literally, one of the strangest things I have ever read. I've not got time to respond to the whole thing, but a few points:
• The French pay their premiums through payroll taxes. We pay them through bills. Franks does some math with this that genuinely made me want to bang my head into the wall, concluding that "what is troubling about the French system is the cost" because "payroll "contributions" for health insurance would have to increase by 73%." I could go into the multifaceted, deep reasons it's wrong -- there's the issue of implicit vs. explicit taxes, for instance -- but let's do this the simple way.
The question at hand is total money spent because, in the end (and a libertarian like Dale should know this), the cash is basically all coming from the same pot. Whether you call it a payroll tax or a premium doesn't matter, the issue is how much money you've got left at the end of the day. The French spend $2,900 per capita on health care, and that covers every member of their citizenry. We spend $5,600, and we leave 46 million out in the cold. If you somehow think the former is more expensive than the latter, you're practicing what Tom Lehrer so aptly termed "the new math," and should really just let me know when you've descended back into the realm where basic mathematical concepts come into play. Then we'll talk.
• Dale doesn't like the American system. He prefers it to the French system, but he doesn't like the American system. He wanted you to know that.
• He writes, "the French medical system isn't a bad one by most standards." Well that's certainly true. Take the World Health Organization's standards, which rank the French #1, and the US 37. Or take health outcomes, where they beat us across the board. Or take cost, or percent of population covered, or system responsiveness, or patient experiences, or pharmaceutical prices. So yeah, by most standards, the French system isn't bad. In fact, by quite a few, it's the best. But the American system, which Dale prefers, is loathsome.
• He asks how I can recommend the French system when Medicare has an unfunded liability in the trillions. This would be one of those times when we need to explain the difference between socialized insurance and socialized medicine. For a more accurate comparison, let's look at the VA's cost balances and outcomes. And if we don't want to do that, let's look at how America spends twice as much per capita than any socialized system in the world, despite lacking full coverage or better health outcomes.
It sort of goes on like this, descending into blather about the "true" meaning of the word insurance and attempting to explain why America's high costs are are the guvmint's fault. If you want to read it, you can. In the end, though, this argument isn't complicated, though Dale is trying to make it so. Every other industrialized country in the world has nationalized health insurance. Every other industrialized country in the world covers all its citizens. Every other industrialized country in the world pays around 50% what we do. And most every other industrialized country gets better health outcomes than us. As the journal Health Affairs put it:
In other developed countries, experience has repeatedly demonstrated the superior capacity of more-universal social insurance programs to restrain growth in overall medical spending. Any comparison of growth in health spending of the United States and social-insurance nations like Germany, the Netherlands, and France would show that U.S. spending has grown more rapidly in recent decades. And these are countries with both older populations and more widespread use of health care than is the case in the United States.
And that's what Franks, even in 2,500 words, simply can't explain away.
