A month ago, the Kaiser Family Foundation released a report comparing healthcare spending in the U.S. with countries in the Organisation for Economic Co-operation and Development (OECD). Here's just a snapshot of that report:
Ezra Klein has a full column in today's WaPo, further exploring the report, and coming to the same conclusion most healthcare economists and policy analysts reach.
Everyone knows—or should know—that the United States spends much more than any other country on health care. But the Kaiser Family Foundation broke that spending down into two parts: the government’s share and the private sector’s share (both measured as a percentage of total gross domestic product), then compared the results to figures from 12 other countries that are members of the Organisation for Economic Co-operation and Development. And here’s the shocker: Our government spends more on health care than the governments of Japan, Australia, Norway, the United Kingdom, Spain, Italy, Canada or Switzerland.
Think about that for a minute. Canada has a single-payer health-care system. The government is the only insurer of any note. The United Kingdom has a socialized system, in which the government is not only the sole insurer of note but also employs most of the doctors and nurses and runs most of the hospitals. And yet, measured as a share of the economy, our government health-care system is the largest of the bunch.
And it’s worse than that: Atop our giant government health-care sector, we have an even more giant private health-care sector. Altogether, we’re spending about 16 percent of the GDP on health care. No other country even tops 12 percent. Which means we’ve got the worst of both worlds: huge government and high costs.
This is where a “serious conversation” on health-care costs would start—with what has worked, and what we can learn from it. Instead, it’s where our conversation about health-care costs never quite goes.
The Republican plan, in fact, heads in the opposite direction: The GOP outsources Medicare to private insurers and gives senior citizens checks that cover less and less of the cost of insurance every year. Republicans hope that when faced with more cost pressure and more options, seniors will be able to exert the sort of consumer pressure that lowers prices while retaining, or even improving, quality.....
The Democratic plan, conversely, quietly recognizes that government-run health-care systems that are willing to throw their weight around can control costs. So the plan is to have Medicare try to pay for quality, not volume.
[T]hat’s the choice we’ve been left with: a plan that has never worked or a plan that’s never been tried. As for the approach that’s helped every other industrialized country achieve universal coverage at about half our costs? Well, we’re still not ready to talk about that.
That's not entirely true, as a handful of individual states are taking action to establish single-payer systems. Vermont has passed a phased-in single payer system, which "calls for establishment of a five-member board to set reimbursement rates for health-care providers and streamline administration into a single, unified system called Green Mountain Care that will cover all Vermont residents." Activists in California are well organized behind the California OneCare initiative, Senate Bill 810, authored by Senator Mark Leno. Previous versions of the bill have passed in the state legislature twice, only to be vetoed by former Gov. Arnold Schwarzenegger. (Eve Gettleson (nyceve), who is involved in the California effort, and I talked about it Sunday on Virtually Speaking Sundays.) The Oregon legislature is also seriously considering it.
But while the process is slowly moving in a few states, with the insurance industry fighting it all the way, Ezra's right that it's moving nowhere fast nationally, and for the skyrocketing costs for the nation to really be controlled, we will need a national system. Medicare for all would have been a pretty damned good one, but at this point it looks like it will be a long way off.