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Post-Supreme Court Thoughts on Obamacare

July 10, 2012

In the aftermath of the Supreme Court’s decision upholding the Affordable Care Act, Republican leaders have taken to the airwaves to pronounce that the American health care system is the best in the world.  You don’t fix what ain’t broke, so Obamacare must be repealed to save the Republic.  On July 1, Republican House Speaker John Boehner went on Face the Nation to announce that the Affordable Care Act will “ruin the best health care delivery system in the world.”  On the same day, Republican Senate Leader Mitch McConnell went on Fox News Sunday to proclaim that the United States has “the finest health care system in the world.”

What does it mean for a country’s health care system to be the best in the world?  American medicine no doubt has the newest, shiniest technology – does that make our system the best?  Many Americans have their choice of doctors – at least, their choice of doctors whose fees they can afford.  Does that make us the best?

Surely the measure of the quality of a country’s health care system is the results that system achieves.  Measuring health care results is complicated – to know the effects of a health care system for sure, we would have to run controlled tests to compare how Americans do under American health care system versus how identical Americans would do under every other country’s health care system.  We would have to measure the value that is added to American lives by the American health care system versus the value that would be added to American lives by other health care systems.

Since that controlled test is pretty much impossible, I propose a proxy:  let’s compare American life expectancy and per capita health care costs to the life expectancy and per capita health care costs of other countries.  If a health care system is effective, then the more we spend on health care, the longer we should live.

Here’s the bad news:  by that measure, the American health care system is not even close to the best in the world.

American expenditures per capita on health care are by far the highest in the world, at $7,164 per year.  Second place goes to Luxembourg, at $5,750 per year.  The average of all 175 countries for which the World Health Organization has data is $954 per year.  The low is $18 per year, for Eritrea.

What Americans get for $7,164 per year in health care costs is a life expectancy of 78.2 years – 31st out of 175 in the world.  Top honors go to Japan, with a life expectancy of 82.6 years, which they buy for $2,817 per year in health care costs – five percent longer life expectancy for 60 percent lower health care costs.

Consider the dollars spent per year of life expectancy:  the United States is again at the top of the list, spending $91.60 for each year of life expectancy.  Number 2 is again Luxembourg, which has better life expectancy, but spends only $73.10 for each year of it.  Japan spends $34.10 for each year of life expectancy – truly a bargain when compared to us.

But here’s the real rub:  Cubans can expect to live one-tenth of a year longer than Americans, but they spend just $495 per year per person on health care – 93 percent less than we spend.  (If socialism means longer life for lower cost, sign me up!)  Aside from Cuba, American life expectancy is in the same league as Slovenia, Kuwait, Portugal, Chile, the United Arab Emirates and Brunei.  None of them spend much more than a third of what we spend on health care per person.

These figures defy the claim that American health care is the best in the world.  These figures say that our health care system is inefficient and expensive.  What’s broke needs fixed.

*          *          *

The House of Representatives is getting ready to vote on a bill that would repeal the Affordable Care Act.  The vote was scheduled some time ago.  The vote was supposed to be the final anti-Obama indignity – after the Supreme Court struck down the law, the House would sweep it away.  But Chief Justice Roberts didn’t play along.

Either way, the vote is a waste of time.  This will actually be the 31st time since Republicans took control of the House just 18 months ago that the House voted to repeal or defund Obamacare.  Republicans are actually proud of the time and effort they’ve spent on what they know is a futile effort.  As long as either Democrats control the Senate or President Obama wields the veto pen, Obamacare will not be repealed.  For a party that claims to be the guardian of the public fisc, Republicans have shown themselves to be ready, willing and able to waste a lot of money on gestures.

*          *          *

Even as the Republican leadership gears up for a futile House vote to repeal the Affordable Care Act, some rank-and-file Republicans are having second thoughts.  As the New York Times reports, Republicans from moderate districts are beginning to question whether some elements of the Affordable Care Act are really so bad – like allowing young adults to remain covered by their parents’ insurance until they are 26 years old; like prohibiting insurance companies from dropping people when they get sick; like requiring insurance companies to cover people who have pre-existing conditions – like every part of Obamacare that people want, but only works if there is a mandate.

David Brooks criticizes Republicans for having no alternative to Obamacare.  He lays out six elements of a plan that sounds an awful lot like the Affordable Care Act.  Element Number 2 is that “Americans should be strongly encouraged” to buy health insurance.  Letter-writer Julia Rubin of New York pithily responds that Brooks didn’t say “what form the encouragement would take:  a) Asking nicely?  b) Explaining that buying insurance is good for them and for their fellow Americans?  c) Charging a penalty tax for not buying insurance?”  Obviously, only option (c) will have any effect, and – surprise! – option (c) is in Obamacare.

So if the Republicans want to talk about health care, let’s talk about health care.  American health care costs us too much for what we get.  President Obama’s solution is better than the Republicans’ alternative, in that both propose the same results but only President Obama proposes the means to get to those results – the individual mandate.  And the Supreme Court says the President’s solution is perfectly legal.

This is a debate Democrats should be eager to have.  This is a debate Democrats can’t lose.

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