There is fact based argument and there is ideological  based argument. While ideology may benefit from a judicious selection of facts, any proposal that intends to change an actual situation will not be successful if inconvenient facts are ignored or distorted. Political parties that are not in power have a real advantage here - they don't have to propose something that works. Vague generalities and selective attacks are good enough.

Which brings me to the topic of this week's blog: US health care proposals. Opponents of changes to the health care system say that the US medical system is the best in the world. A health care system that guarantees universal access it too expensive in a recession. They object to government interference, and say that the private sector performs better than the public sector. They use the demon word 'socialism'.

1. "Best in the world" - The US world ranking for life expectancy is 47th and for infant mortality rate 43rd. Infant mortality ranking in 1960 was 12th; in 1990, 20th. It's not only not the best in the world, it's getting worse.

Infectious diseases ignore class boundaries. The population as a whole is less healthy as a result of a section of it unable to pay for treatment of an illness or vaccinations to prevent that illness. TB was almost wiped in the US - no more. Do you want the dishwasher in your favorite restaurant to have an active case of TB?

2. The expense: Democratic opponents as well as Republicans like this.

The US pays twice as much per person as any other country in the world for health care. Private, for profit insurance, has overheads of 26% compared to Medicare, 3% overheads. Almost 50% of bankruptcies are caused by medical expenses. "The average family health insurance premium, provided through an employer health benefit program, was $11,480 in 2006. Employees paid an average of $2,973 towards the premium amount." (Kaiser Foundation) Payments for insurance are going up; health care premiums increased 87% between 2000 and 2006.  Can either business or the individual afford not to do something about health care?

A government provided insurance program will cut into the profits of private insurance. They will probably be forced to lower their own premiums. Sounds very market friendly to me.

3. Government interference: Which had you rather have determining whether you get a medical procedure: an insurance company employee whose bonus and bottom line depend on profit, thus your not using the system, or a government clerk whose salary has nothing to do with the expenditure?

There is absolutely nothing in the plan before Congress to take you away from your current health care plan. This is an additional choice: Government supplied insurance becomes an option; to substitute for or in addition to private insurance. 

4. Government does things badly: Well, actually, I think the government is pretty effective. The post office works considerably better than the banking industry; the highway system in the US really may be among the best in the world - definitely better built than the US cars driven on it;  the Armed Forces  are well equipped and trained. All in all, I think the US civil service is more effective, more honest and more competent than its political office holders.

5. Socialism: I have no idea how these people are defining socialism. The major costs of the health care system are already funded by taxes.

Medical care relies on an infrastructure: medical schools, hospitals, regulations that make sure the drugs you are proscribed are produced and stored safely, nursing schools. These things are supplied in large part by public money -taxes that everyone pays. (An income tax is only one form of taxation.) An insurance system that deprives a percentage of Americans from facilities that they have paid for because they are not insured is not fair.

In 2005, personal health care expenditures were paid by private health insurance 36%, federal government 35%, state and local governments 11% , and out-of-pocket payments 15%. (Source: National Center for Health Statistics) [I don't know why it doesn't add up to a 100%. The bankruptcies where no one pays? Cut and run after the emergency room visit and stitch up? Private charities providing free clinics? All those bake sales so cute little Bobbie can actually get the operation he needs?]

So the Government, federal, state and local combined, is already paying for 46% of personal health care expenditures. This is not surprising.

The private insurance industry in the US insures people that are probably going to be healthy - working people between 18 and 65 and their families. Depending on the insurance obtained, there may be a cut off for paying for any one illness episode. Some insurance companies do not pay for medication. Private insurance companies do not cover pre-existing conditions. If you're old, have a chronic illness or are disabled, the government will probably supply your health care.

So there is a kind of socialism at work here: socialism for the rich. Insurance relies on shared risk. The private insurance industry in the US shifts foreseeable risk to the public, the tax payer, while taking the profit.

A lot of information in today's blog comes from HealthPac

http://www.healthpaconline.net/health-care-statistics-in-the-united-states.htm

I've copied and am posting in full the stats provided.  You want to argue about national insurance coverage?  Ideology isn't good enough. Look at the some of the stats; they support change to the system. If you think a private insurance based system can actually deliver affordable health care to the entire population, tell me how.

Health Care Statistics in the United States

Health Insurance

•The United States is the only wealthy, industrialized nation that does not have a universal health care system. Source: Institute of Medicine of the National Academy of Sciences

•In 2006, the percentage of Americans without health insurance was 15.8%, or approximately 47 million uninsured people. Source: US Census Bureau

•Among the 84.2% with health insurance in 2006, coverage was provided through an employer 59.7%, purchased individually 9.1%, and 27.0% was government funded (Medicare, Medicaid, Military). (There is some overlap in coverage figures.) Source: US Census Bureau

•The primary reason given for lack of health insurance coverage in 2005 was cost (more than 50%), lost job or a change in employment (24%), Medicaid benefits stopped (10%), ineligibility for family insurance coverage due to age or leaving school (8%). Source: National Center for Health Statistics

•More than 40 million adults stated that they needed but did not receive one or more of these health services (medical care, prescription medicines, mental health care, dental care, or eyeglasses) in 2005 because they could not afford it. Source: National Center for Health Statistics

•Medicaid, which accounted for 12.9% of health care coverage in 2006, is a health insurance program jointly funded by the federal and state governments to provide health care for qualifying low-income individuals. Source: US Census Bureau

1. •Medicare, a federally funded health insurance program that covers the health care of most individuals 65 years of age and over and disabled persons, accounted for 13.6% of health care coverage in 2006. Source: US Census Bureau
   

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3. •Medicare operates with 3% overhead, non-profit insurance 16% overhead, and private (for-profit) insurance 26% overhead. Source: Journal of American Medicine 2007
   

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Health Care Expenditures

•In 2005, personal health care expenditures were paid by private health insurance 36%, federal government 35%, state and local governments 11% , and out-of-pocket payments 15%. Source: National Center for Health Statistics

•The United States spends twice as much on health care per capita ($7,129) than any other country . . . and spending continues to increase. In 2005, the national health care expenditures totaled $2 trillion. Source: National Center for Health Statistics

•75% of all health care dollars are spent on patients with one or more chronic conditions, many of which can be prevented, including diabetes, obesity, heart disease, lung disease, high blood pressure, and cancer. Source: Health Affairs

•From 2000 to 2006, overall inflation has increased 3.5%, wages have increased 3.8%, and health care premiums have increased 87%. Source: Kaiser Family Foundation

•The average family health insurance premium, provided through an employer health benefit program, was $11,480 in 2006. Employees paid an average of $2,973 towards the premium amount. Source: Kaiser Family Foundation

Infant Mortality

•The United States ranks 43rd in lowest infant mortality rate, down from 12th in 1960 and 21st in 1990. Singapore has the lowest rate with 2.3 deaths per 1000 live births, while the United States has a rate of 6.3 deaths per 1000 live births. Some of the other 42 nations that have a lower infant mortality rate than the US include Hong Kong, Slovenia, and Cuba. Source: CIA Factbook (2008)

•Approximately 30,000 infants die in the United States each year. The infant mortality rate, which is the risk of death during the first year of life, is related to the underlying health of the mother, public health practices, socioeconomic conditions, and availability and use of appropriate health care for infants and pregnant women. Sources: CDC and National Center for Health Statistics

Life Expectancy

•Life expectancy at birth in the US is an average of 78.14 years, which ranks 47th in highest total life expectancy compared to other countries. Source: CIA Factbook (2008)

Bankruptcy

1. •About half of the bankruptcy filings in the United States are due to medical expenses. Source: Health Affairs Journal 2005