We may look back at the last few weeks as a historic time in American politics. Free market rhetoric used to denigrate government-sponsored health care is finally being seriously challenged. But is media debate on health care truly open? Commentary on Congress’s attempts at health care reform fluctuates between restrained optimism at best, to distortion and outright demonization at worst. At the liberal end of the corporate press, the New York Times supports the “public option” as an alternative to single payer health care, while conservative outlets like Fox News and the Wall Street Journal repeat clichéd stereotypes about the dangers of big government and inefficient public administration of health care.
The New York Times is the most open to the limited reform of corporate care. Its editors concede that the status quo of ever increasing health care costs is unsustainable for the American public, economy, and the business community. Addressing the United States’ “bloated, inefficient health care system” may cost over a $1 trillion under the Obama plan, the Times concedes. The alternative is to allow for “costs [to] continue to soar, [while] millions more people lose their health insurance and individuals and families face rising premiums and greater cost-sharing as employers shift more of the burden or drop their coverage.” Of course, the Congressional Budget Office has challenged the claim that the Obama plan will effectively reduce costs, despite the Times’ promises that this plan will do so.
The Times has long refused to support a genuinely non-profit single payer health care system. In a November 2007 editorial, for example, the paper claimed that “single payer is no panacea for the cost problem,” citing as evidence the rising expenses associated with Medicare. Of course the Times’ editors ignored the most important reason for Medicare’s cost increases: a for-profit pharmaceutical system that has presided over a double digit, 24 percent increase in the costs of pharmaceutical drugs from 2006 to 2008 (Medicare is a major purchaser of pharmaceuticals). It also doesn’t help that the Congress voluntarily neutered itself in a 2003 bill that made it illegal for the federal government to negotiate lower drug prices with pharmaceutical corporations that provide drugs to the Medicare program (an attempt to repeal the negotiation ban was blocked in Congress in 2007). Don’t expect, however, to hear about any of these inconvenient truths in the editorial pages of the Times.
The Times editors are diverting public attention from the real reason for rising medical costs – the for-profit, private health care system. They prefer to explain rising costs as a function of over indulgent patients who seek too many medical services, with consumers overly reliant on “costly specialists who overuse advanced technologies and resort to costly surgical or medical procedures.” The Times is certainly correct that health care costs would dramatically decrease if people just stopped seeking medical services their doctors deemed necessary, but the implications of such a plan are so grotesque that they shouldn’t be entertained by those with any humanity.
The Times editors also frames high health care costs as a function of American wealth and affluence: “almost all economists agree that the main driver of high medical spending is our wealth. We are richer than other countries and so willing to spend more.” This explanation is superficial at best. Conceding that the U.S. and other First World countries spend more and get better health care than Third World countries does nothing to distinguish between competing health care models in wealthy countries. It is clearly the case that some people – particularly Americans – spend far more for medical services, yet systematically receive worse care than other those living in other wealthy countries. Yet again, these are troubling truths ignored in the editorial pages of the Times.
The Times’ neoliberal approach to framing U.S. health care is also reflected in other news outlets. However, while the Times is at least willing to concede that there should be some sort of government intervention (even if it’s not to establish single payer care), other outlets won’t even go this far. In an alarmist piece titled “The End of Private Health Insurance,” the editors of the Wall Street Journal attack the Democrats’ “public option” as an attempt to “coerce” citizens and force them to shift to public health insurance. Exactly how tens of millions of Americans without health insurance will be “coerced” by getting health coverage is never discussed. The Wall Street Journal’s editors also fall back on age-old stereotypes, railing against the dangers of big government, and its “reckless” “bulldozing” of the private health care market. Bill O’Reilly reflects the consensus at Fox News in his July 17th “Talking Points Memo” that the federal government is unable to “run an efficient health care system.” The editors at the Washington Times accuse Obama of “health care rationing” with government “bureaucrats deciding when to pull the plug” on Americans’ health care services. “Our health,” the paper reminds readers, “is not a commodity to be brokered.” Rational citizens can be forgiven for being outraged at the utter ignorance, hypocrisy, and idiocy of such propaganda. In the case of the Washington Times, readers are thought to be so blind and stupid that they accept the claim that government health care amounts to “commodity” dealing, whereas profit oriented health care does not.
The “government is inefficient” ideology is supported by little empirical evidence. Fortunately for private health care providers, this hasn’t stopped corporate media outlets from repeating such dogmas in opposition to the Democrats’ “public option.” On the question of “efficiency,” there is little to reason to expect that private health care providers are superior to a government health care system. For those who are actually interested in reality, the following points are worth contemplating:
- Under the for-profit system, upwards of 50 million Americans are currently uninsured. Another 25 million are estimated to be underinsured (an increase in 16 percent from 2003 to 2008), bringing the total to 75 million people uninsured (or 25 percent of the public) in the richest country in the world. It would seem that, were a private health care system really that efficient, it would be able to better provide for such a large segment of the population.
- U.S. health care costs are actually the highest in the First World, with its quality of care ranked among the worst providers. In the 2000 World Health Organization (WHO) quality of care rankings, the U.S. ranked 37th behind virtually all of the First World. The U.S. competed alongside non-First World countries such as Cuba, Slovenia, Brunei, Bahrain and Croatia in terms of quality of care. With the worst quality, the U.S. is also charges the highest amounts for care. As of 2006, the U.S. spent between 52-55 percent more than Switzerland, Norway, and Luxembourg, the second, third, and fourth most expensive countries in per capita health care expenditures. The U.S. spent per capita between 158-160 percent more than the lowest cost health care countries: including Italy, Japan, and Finland. All of these countries, I should note, provided better quality coverage than the U.S. according to the WHO.
- As economist Paul Krugman explains, by 2004, the U.S. spent 15.3 percent of its GDP on health care (more than a 100 percent increase since 1970), as compared to Canada, which spent 9.9 percent of GDP, Germany at 10.6 percent, and the U.K. at 8.1 percent. Those systems demonized for “inefficient” socialized medicine, then, provide far superior and cheaper health care than the U.S. system.
- Tremendous differences exist between efficiency in public and for-profit health care organizations within the U.S. In the case of HMOs, a study published by the Journal of the American Medical Association found that “investor owned” HMOs performed more poorly than non-profit HMOs in 14 different areas of service. Private HMOs provided for eye exams at a rate 27 percent lower than non-profit HMOs, at a rate of 16 percent less for drug treatment and for heart attack survivors, and at a rate of 9 percent less for mental patients. Disturbingly, the proportion of people enrolled in for-profit HMOs has increased from 26 to 62 percent from 1985 to 1998.
- Aside from providing the most expensive and worst care, costs in the U.S. have increased since the studies above were conducted. Health insurance premiums in the U.S. increased by 140 percent from 1999 to 2008 according to a 2009 Kaiser Family Foundation study. Company health care costs are projected to rise another 9 percent by 2010, with 42 percent of employers expecting to increase employee contributions to health care plans, and 41 percent expecting an increase in employee co-payments and deductibles.
- The Kaiser study mentioned above also found a tremendous amount of inequality in access to health care along class lines. As of 2006, a staggering 96.8 percent of all health care spending was concentrated amongst the wealthiest 50 percent of Americans, leaving just 3.2 percent for the poorest 50 percent. The richest 10 percent of Americans accounted for 63.3 percent of all spending, meaning that this subset of the population (equaling only about 30 million out of 300 million Americans) enjoyed nearly two-thirds of all health care spending.
- Under a for-profit system, those who can afford better care receive it, while the less fortunate are left to fend for themselves. One 2009 survey found that, within the 12 months before being questioned, 35 percent of all respondents chose to rely on “home remedies or over the counter drugs instead of going to see a doctor.” Over one third (34 percent) of respondents skipped dental checkups and care; 23 percent put off “recommended medical tests and treatment”; 21 percent could not afford to fill a medical prescription; 27 percent couldn’t get basic health care they needed. These statistics hardly reinforce the notion of an efficiently run health care market that provides for health care as a public good.
- Contrary to the claim that national health care stifles doctor initiative, American medical practitioners actually support a socialized medical system. In one 2002 survey published by the Annals of Internal Medicine, 59 percent of physicians surveyed supported legislation that would create a national health insurance system, with only 32 percent opposing such an initiative (a nearly 2:1 imbalance). A majority of medical practitioners supported national health care in every specialty area surveyed, with the few exceptions being surgical subspecialists, anesthesiologists, and radiologists.
- High costs impose a tremendous strain on the American economy, as health care corporations play a parasitic role by draining resources from other industries that are unable to pay for radical increases in cost of medical services. This is most evident at the macro-level, as the average growth rate in annual health care expenditures eclipsed economic growth rate (measured in GDP) by 2.25% each year from the 1970s through the post-2000 period (ending in 2007). We can see the corrosive effects on many sectors of the economy, particular when looking at small companies (employing half of American workers) and the automotive industry (directly and indirectly employing nearly 3 million workers). Approximately 10 percent of small business owners are considering dropping their health coverage of employees altogether in the next year due to increased costs. In the case of the auto industry, skyrocketing health care costs ensure that U.S. workers suffer from a comparative disadvantage when competing with other countries. In 2005, for example, General Motors reported that a single car produced in the U.S. cost about $1,500 in health benefits, whereas the same car produced in Canada cost $500 – a $1,000 difference. In 2006, the Conference Board of Canada estimated that U.S. health care and pension expenses cost $1,400 to $1,800 more for each vehicle produced in the U.S. when compared to Canada.
It should be painfully obvious from the statistics above that our private health care system is not more efficient than other First World countries that enjoy socialized care. We should reject media commentary that scares Americans with phantoms of lost freedom should they choose government sponsored medical care. In providing for mass-based care, socialized systems are far more efficient than the U.S. for-profit system. It is certainly true however, that privatized health care is far more efficient at generating massive profits for corporate America. Pharmaceuticals and Medical Products and Equipment industries, for example, rank as the third and fourth most profitable economic sectors in the Fortune 500 rankings, demonstrating who has really profited from the boom in medical costs over the last few decades. When looking at the human consequences, however, our privatized system has produced rather dismal results in serving the public good – defined as the providing of the best quality service for the largest number of people. The sooner we realize this reality, the better served Americans will be in the current media debate over health care reform.
Anthony DiMaggio teaches U.S. and Global Politics at Illinois State University. He is the author of Mass Media, Mass Propaganda: Examining American News in the “War on Terror (2008) and When Media Goes to War (forthcoming February 2010). He can be reached at: [email protected]