Tuesday, August 7, 2007

Ruling Class Senility

Is this really the best they can do? This article, by Theordore Dalrymple, is the cover story this month of conservative mouthpiece National Review. Cleverly titled "the doctor won't see you now," it is an attempted assault on single payer health care plans, which have been gaining momentum ever since Michael Moore's Sicko hit theaters. It's a rather important piece, as National Review is probably the closest thing the right has to a magazine format mouthpiece. As they made the article the cover story, it's fairly safe to assume that they consider this a pretty major statement on the issue.

Which is why I'm puzzled as to how goddamn weak of an argument they put forward. Dalrymple's piece is little more than an anecdotal musing about how British health care isn't all Michael Moore says it is. I was expecting heavy fire directed at the Canadian system, glowing portraits of the high tech miracles workable in US hospitals, dire warnings about the Hell we will undoubtedly plunge into should we hand our precious rights over to faceless government bureaucrats. Instead, we get sentences like:

It is clear that the American system leaves a lot to be desired — as do most systems. It is expensive and not particularly effective when viewed from the point of view of public health
This is not to say that no good work is done in the NHS, or that everyone is badly treated. I myself have received nothing but excellent treatment under it.

These are, of course, offset with anecdotes about mothers who had to wait for operations, old men who waited seven years for operations, and similar argumentative detritus. A brief attack on the French system consists solely of the fact that the French consume more tranquilizers and antidepressants than any other country.

Is this really serious? Can a vicious, heartless, American ruling class magazine really be prepping its readers to do battle with the hordes of big government liberals by sending them this garbage? I must say, being a left winger is hardly as fun when the right wingers are as dumb as this. Factual refutation would be overkill here, but since I'm a heartless SOB I'm going to go ahead with it.

By any of the key indicators, British and American health systems provide comparable care. Life expectancy for UK males is 77, for Americans it's 75. For UK women, 81. Americans, 80. The US has an infant mortality rate of 7 deaths per 1,000 live births. The Brits have 5. Maternal mortality per 100,000 live births in America is 14. In the UK it's 11. This remarkable parity is achieved through a remarkable inequality in spending. In 2004, the US spent $6,104 per capita on health care. The Brits spent $2,546. For less than half the cost, they have achieved a system who's public health results are staggeringly similar to (actually slightly better than) America's.

These big surveys only give us the means, however. When we look at the extremes on the graph, the picture becomes a good deal more disturbing. Infant mortality for Black families in America is 13.6 per 1,000 live births - nearly double the national average. The Black babies that survive their first year can expect to live 6 years shorter than their white playmates. So what we have in America is a system that provides decent enough care on the surface, but is in fact leaving massive groups of people out.

Furthermore, many of the ills Dalrymple attributes to the British NHS are in no way fundamental to single-payer systems. For example, he points to dilapidated facilities and rationing as evidence of the impracticality of the British system. On the point of rationing, two responses are merited. First, we have rationing in America. Deamonte Driver's care was rationed because he didn't have enough to pay for a tooth operation. As a result, he died. The myth that Brits wait in lines while Americans happily skip to the front is precisely that. Second, improper medical facilities and rationing both come down to problems of money. Just last year, Blair cut 21,000 jobs from the NHS. Actions like these unquestionably result in a massive workload increase on the workers who remain. Given that we already spend twice as much as the NHS here in America, if we merely kept spending at the same level but administered the care through a single payer system, it's reasonable to assume we'd see a massive increase in quality of care.

I'm still not sure why the folks at NR decided to lead this week with such a feeble attempt at polemic. The fact that they did so can only bode well for the left however. I can't wait to see what softballs they're going to pitch us about the coming recession.