Moreover, a wholesale shifting of healthcare from the private to the public sector simply means replacing rationing by wealth with rationing by number, and a drastic decrease in individual freedom on both sides of the medical equation. You’d replace insurance company bureaucrats who deny care with government bureaucrats who deny care. Removing the financial incentive from doctors simply means they will provide sloppier treatment. They’re not saints. They’re human beings. And slashing the profit motive from the drug companies will simply mean fewer new drugs for fewer illnesses. This is the trade-off the left will deny till they’re blue in the face. But it’s a real trade-off.
But for the most part these trade-offs are not happening elsewhere. So why would they happen here if they are not happening in, say, France?
In one part of Sicko a doctor — I can’t remember if he’s British or French — explained that his income goes up if his patients get healthier. Meaning, if his records show he is providing patients with good preventive care, as opposed to just writing prescriptions, he gets bonuses. Here, doctors get paid for not treating people.
Patients in those nasty foreign countries like Canada actually have shorter waiting lines in emergency rooms than they do here. They get better general care, which is why they live longer and have lower infant mortality rates. Patients are not being denied care because of some technicality in their private insurance contracts. People are not being driven into bankruptcy by medical bills. Other nations’ plans are not perfect, but nearly all of ’em are a whopping huge improvement on what we’ve got.
As far as the “fewer drugs for fewer illnesses” line — what’s actually happening is that highly subsidized American Big Pharma cranks out tons of boutique drugs for boutique illness (toe rot; restless leg syndrome) or “new” drugs advertised as breakthrough but which usually are just minor tweaks to the old drugs, or perhaps not as good as the old drugs. “Life-saving” often means “terminal patients get one more month.” That sort of thing. I’ve written about his before; see “Demand Supply” and “Unhealthy Care.”
The European health systems have, of course, been free-riding on private U.S. drug research for decades. Name a great new drug developed in Europe these past ten years. Their own pharmaceutical industries have been decimated by the socialism Moore loves (and many of Europe’s drug companies have relocated to the US as a result). But I fear the left is winning this battle; and the massive advantages of private healthcare are only appreciated when you lose them.
European drug companies move here because they make money like bandits here. But let’s play Andy’s game. Name a great new drug developed in Europe these past ten years. Then name a great new drug — and I mean really great, and really new, not just advertised as great and new — developed in the United States these past ten years. Most of the “new” drugs I know of coming out of America are either variations on old stuff, drugs that had to be withdrawn from the market after patients developed nasty side effects, or drugs that really don’t deliver all that much — one fabulous “new” drug I discussed here increased overall survival rate in cancer patients by 4.7 months, for example. That’s nice, but that’s the “trade off” Andy doesn’t want to give up for single payer health care. I’m not convinced.
Update: Kevin Drum writes,
This business about America providing all the world’s pharmaceuticals is a common trope on the right, but it’s absurd. There are more biotech startups in Europe than in the U.S. Pfizer is targeting Japan as one of its biggest near term growth opportunities (and Japan is also a major source of new biotech development). And plenty of pharmaceutical research is done outside the U.S.: The #3 pharmaceutical company in the world, GlaxoSmithKline, is British. The #4 company, Sanofi-Aventis, is French. The #5 company, Novartis, is Swiss. #6, Hoffman-La Roche, is also Swiss. #8, Astra-Zeneca, is Anglo-Swedish. Their combined R&D spending is slightly higher than the American companies that make up the balance of the top ten.
Now, what is true is that American capital markets are both bigger and generally friendlier to startups than European capital markets, which means that small biotech companies often migrate to the United States in order to get funding. My sense is that Europe is improving on this score, but in any case this has nothing to do with the state of European healthcare. What’s more, an enormous amount of basic research is done in American universities and the NIH, most of it publicly funded. This speaks well for our system of higher education, but doesn’t really say anything about our healthcare industry, which is famously hesitant to invest in genuinely innovative (but chancy) new ventures. Ironically for big pharma’s cheeleaders, it turns out that America’s titans of capitalism mostly prefer to leave the risky stuff to the feds.