Cause of Death: Capitalist Health Care

The best country in the world for a mother is Sweden. The 27th best country in the world for a mother is the United States, according to Save the Children’s “State of the World’s Mothers” report, just released.

Among the factors figured into the ratings are risk of maternal mortality, female life expectancy, and under-5 mortality rate. Norway and Iceland are in second and third place.

Why are those Scandanavian countries so high, and the U.S. – which spends wildly on health care – so low? Because the Scandanavian countries have a long tradition of social democracy, and the United States has a market-driven health care system. There are some things that socialism does much better than capitalism. Health care is among them. Let’s be clear: More mothers die in childbirth, more infants and toddlers die in the United States, because the U.S. does not have universal, government-backed health care.

As Ezra Klein just wrote , the standard claim for American health care – no waiting for care – is nonsense. Some waits are hidden by poor reporting. More important, many people don’t wait for care – they don’t get it all.

The Save the Children report anachronistically lists Israel in Tier II, Less Developed Countries, so it doesn’t directly compare us to Sweden and the United States. In Tier II, Israel is the best place for mothers. Women’s life expectancy is higher than that in the U.S. (83 years in Israel, 81 in the U.S.). In Israel, 5 children out of 1,000 die under the age of 5. In the United States, 8 do.

Why is it healthier to live in Israel than in the United States? Uh, it’s not because life is less tense here, or because people drive better. Nor is it because we are a richer country. It’s because we have socialized medicine. Because the government still stands behind medical care. Not as firmly as it used to, unfortunately. The neoliberal economic policies of recent governments combine lower tax rates on the rich with insufficient health funding, leading to a transfer of the some health costs (prescriptions) from the government to the patient. But the socialist tradition of Israel’s founding days still has a strong enough influence on the structure of society that fewer kids die here, even though we spend a smaller portion of our GDP on health care than America does. Am I glorifying Israel’s socialist past here? You bet I am.

I’m not claiming that the government does everything better than the market. But the opposite claim is mere propaganda for policy decisions that benefit business.

I’d even be willing to put up with rude clerks in order to insure that poor people are less poor, and get the medical care they need. Fortunately, the choice is nowhere near so simple.

Example: Out of blind belief in privatization, the government recently gave up administering the written tests for drivers’ licenses, turning that over to a private company. My daughter went to take her test. The line outside was hours long. No numbers were given out, so people just stood and tried to get in the office. The private company, obviously, was trying to make a profit by reducing its costs, and the customer paid in misery.

It’s true that service at both the post office and the phone company have improved in recent years. Both remain highly regulated utilities. Service also improved drastically at the Interior Ministry – which is still simply a government bureaucracy.

In the meantime, service has gotten much worse on U.S. airlines, which already had a rep in the world for rudeness. Faced with falling profits, the airlines have cut back on services rather than trying attract customers with better treatment. This is a death spiral: The same attitude killed Pan-Am and TWA. But stupid management is not a monopoly of government or the private sector. (See under: Enron.)

I suggest that the all-present propaganda for the market influences perception: When service improves at a private company, we tend to associate it with market forces. When service gets worse, we just complain. When the lines get shorter at the Interior Ministry, the change gets little notice, because it doesn’t fit the prevailing paradigm.

On Independence Day, I choose to toast the socialists who founded this country.

7 thoughts on “Cause of Death: Capitalist Health Care

  1. From your description, I can only surmise that Israel has recently adopted something along the lines of the Bush privatization ideology. That’s the ideology that says the market can do a better job of delivering government services, so the best option is to dole out monopoly rights to unaccountable private companies based not on competence and relevant experience, but on demonstrated fealty to the Republican party. It’s basically a patronage system operating under the guise of “free market economics”.

  2. I’m with you on the US airlines. I’d rather fly Lao Airlines on a modified Soviet cargo plane (they still have some). At least you get a decent meal. My favorite airlines are now Emirates and Thai. The good news is that you can fly pretty much anywhere between those two carriers. Once you leave the US, of course.

  3. Joe, Milton Friedman’s market ideology/idolatry is far older than either Bush’s administration, and Ronald Reagan isn’t the current Bush’s avowed idol for nothing. Nepotism makes it far worse, of course, but that, in all fairness, isn’t Friedman’s fault.
    (My favourite privatisation blunder by far is still law enforcement – whenever it works according to the market ideology of its proponents, it defeats its own purpose.)

  4. I believe that innovative private firms can help us along our way ;unfortunately they are few and far between and small . The airline industry could stand competition ,real competition like letting foreign companies come in on domestic routes.They are like the domestic auto industry was. Toyota and Honda has created more new jobs than the big 3 in a short time and I have always lived in the Detroit area but reality is here.

    The health care industry here has no reason to improve as long as the majority of doctors and hospitals can shove off their responsibilities on t he insurance companies , historically the kings of greed and incompetence. Threaten to nationalize the entire system and see how fast there is a wellingness to engage in real progress

  5. For privatization to work there has to be regulation. The Bush years have seen regulating agencies look the other way, a recipe for disasters.

    You spoke of ratings for different countries. I recently looked over the WWF publication on the ecological footprint of countries. To come out high in this rating, a country must have a sustainable economy. The ONLY country rated with a sustainable economy is Cuba. This is the place where up until recently nobody could trade a car manufactured since the revolution in 1959. Socialism is enforced with a will though Raul Castro is making some changes. Cuba is reputed to have good health care for everyone.

    Overall, the question must be asked: would one want to live in a country taking all things into account? Many have fled Cuba. I don’t know of many who have willingly moved there and the news I read is that the people there are discontented with the restrictions they must live under.

    I mention all this because it sure looks like the whole world is going to have to move toward sustainability, whereas health care, sad to say, can be optional. How would most Westerners view a future tending toward the situation in Cuba when even the Cubans want out? When things get bad, people will continue to want all the goodies they have grown used to. The Cubans are queuing for newly permitted DVD players and cellphones as we speak.

    To me, socialism puts the good of the whole ahead of the good of the individual with the aim that the overall good will be increased and equitably distributed. To my way of thinking socialism must be the future, whether we like it or not and I think a lot of folks will not like it. The US will be the battleground for this to play out.

  6. There’s nothing ‘Cuban’ about the Canadian health care system, which works just fine. Yes, there have been some unreasonable, even dangerous waits for certain procedures. Emergency rooms are clogged, often by ignorant people who should wait and see a family physician, and that can result in very unfortunate results for acutely ill people. Canadian doctors are independent professionals and we choose our own primary-care physicians, by the way. Having lived in the USA for four years and in Germany for around three, I can honestly say that the Canadian system (which is hardly ‘socialist’, just a string of single-payer state-run provincial systems) seems to me to work much better than anything else I have experienced. It also encourages small business owners and the self-employed by providing them with the same free or nearly free health care (depending on which province you live in) as everyone else gets. I know American and German professionals who have dropped their health insurance because they cannot afford the premiums. That’s insane and unjust.

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