Not That There's Anything Wrong With That

Krugman on health care:

The smear-and-fear campaign has already started. The Democratic plans all bear a strong resemblance to the health care plan that Mitt Romney signed into law as governor of Massachusetts, differing mainly in offering Americans additional choices. But that didn’t stop Mr. Romney from denouncing the Clinton plan as “European-style socialized medicine.” And Fred Thompson claims that the Clinton plan denies choice — which it actually offers in abundance — and relies on “punishment” instead.

There's a problem here, though. Neither Krugman nor I actually believes that "European-style" constitutes a "smear" in the health care context. Nor do we believe that "European-style" health care is something people should be afraid of. But the Democrats, Clinton included, have assiduously attempted to differentiate their approaches to universal health insurance from "European-style" health care plans. This, though, puts liberals in an awkward position. Like in the famous Seinfeld episode, we need to angrily denounce insinuations that the Democrats are "European-style" but always with the caveat not that there's anything wrong with that. But it seems to me that if we're doomed to have a debate about European-style socialized medicine, we might as well propose European-style socialized medicine.

Comments

The problem with that is that Clinton likely wouldn't want European style healthcare. And Obama would likely give a flowing speech about European and Scoailized and Helath Care it is and that we all need to come together about something or other.

Posted by Rob | September 21, 2007 3:44 PM

Maybe the way to respond is to say:

"While better than what we have today, these plans won't be as good as French or German style health systems. But unfortunately given the obstructionism from the Republicans they are the best we can do at this time"

Posted by Eric K | September 21, 2007 3:46 PM

Republicans are masters at exploiting American provincialism; Democrats haven't yet figured out a good way to say, "Most of what you've heard about healthcare systems outside the U.S. is wrong. It's possible to improve what we have now, by looking at what works elsewhere."

Posted by RSA | September 21, 2007 3:49 PM

Could we please stop calling what European countries have "socialized medicine"? These countries have government-sponsored single payer systems and all parties from left to right accept and support them.

When Lyndon Johnson proposed Medicare, the AMA attacked it as socialism. When FDR proposed Social Security the Republicans attacked it as socialism. When the progressives proposed workers comp the right opposed it as socialism.

As soon as these programs get enacted and everyone sees that they work, shazam! - they're no longer socialism, and instead they fit right in to our capitalist system. So why not start out now by explaining that single-payer health care is GOOD for capitalism because it takes the drag of health care costs off employers, where it doesn't belong, and spreads it among the actual consumers of health care, the public.

Posted by Bloix | September 21, 2007 3:52 PM

The Clinton plan does necessarily involve punishment, since it mandates that people obtain health insurance. You can't make something mandatory without a stick to back it up. Claiming otherwise is reminiscent of those right-wingers who are against abortion, but who seem not to give a moment's thought to how long they propose to throw women in jail if they decide to have an abortion anyway.

Posted by bbartlog | September 21, 2007 3:56 PM

The American health care system would work stupendously well and make great profits if half the people didn't have insurance and that half was shut out of the system, totally. That's the problem with the GOP plan, they won't go to the mat for the market. Just because you want a 42" plasma TV doesn't mean you can just walk out of Best Buy with one, unless you pay for it. The same should hold true for a free market health care system. No insurance, bubuy.

Your kid is blue but you have no insurance, So sorry. That's how markets are supposed to work, Period. Even Bush misses this point when he says anyone can to the Emergency Room. DUH, Dubya, who is paying for it stupid. I mean really, why are you against free markets.

Posted by rapier | September 21, 2007 3:57 PM

What makes Democrat be such spineless goops? Remember this is for posterity so, please, be honest.

Posted by Jeffrey Davis | September 21, 2007 3:57 PM

Last night I heard a talk on S-Chip, and against making it more expansive was that it covered too many kids. The for argument was that, no, it was really difficult to get into the program and not too many kids would be covered.

Why not argue that all kids should be covered, but in the context o S-Chip this is all we can do right now, rather than taking the standard Democratic reflexive crouch.

Posted by theCoach | September 21, 2007 3:58 PM

From what I understand, Germany doesn't even have socialized medicine. What it does have is a highly regulated insurance industry that is required to cover everyone.

Posted by tree, | September 21, 2007 3:58 PM

Fred Thompson is in favor of Tenneesse-style health insurance: if you can afford Bill Frist's hospital, you might get treatment. If not, go ahead and bleed to death.

Posted by Garuda | September 21, 2007 4:25 PM

There was this one French guy once who died because he had to wait 18 months to have an infected toenail treated. And this other English guy who couldn't get prostate surgery because he was 103.

Posted by Kelly Coyle | September 21, 2007 4:31 PM

Kelly Coyle,

There are poor kids in America who have died because their parents couldn't afford to give them proper dental care. One kid in particular died from an abscess in his brain, which was the result of an infected and decaying tooth that could have been removed with a simple visit to the dentist. Unfortunately, because of their poverty, they didn't have access to a dentist.

I wouldn't doubt it if Americans without health insurance have died from untreated toenail infections also. Moreover, I'm sure a 103 year-old man in America would have trouble getting private healh insurance to pay for prostate surgery. He might even have difficulty getting Medicare to pay for it.

If you don't think that our multi-payer health care system engages in unjust rationing and denial of health care, you haven't been paying attention. Most of our health care is paid through MANAGED care health insurance plans. How is health care "managed"? Rationing and denial, that's how.

The real question is, are the flaws and shortcomings of a single-payer system worse than our multi-payer current system, just as bad, and not as bad? Argument by anecdote is not enough.

Posted by eltoro | September 21, 2007 4:58 PM

Eltoro, I think your funny bone needs immediate surgery. The irony detector seems to be malfunctioning.

Posted by mq | September 21, 2007 5:05 PM

There's a problem here, though. Neither Krugman nor I actually believes that "European-style" constitutes a "smear" in the health care context.

Yeah in the first paragraph, Krugman writes: "All the evidence suggests that it has finally become politically possible to give Americans what citizens of every other advanced nation already have: guaranteed health insurance."

Democrats won't put it like this either. The best thing about that Seinfeld episode was at the end when Kramer acted gay and got a new boyfriend even though he really wasn't gay. He did it b/c he believed the rumors his friends were gay and he wanted to be cool too.

Posted by Peter K. | September 21, 2007 5:13 PM

I will admit, it's hard to be extreme enough to do irony anymore.

Posted by Kelly Coyle | September 21, 2007 5:35 PM

We might as well propose European-style socialized medicine unless, of course, we believe that, although European-style socialized medicine is better than our current system, we can create some third alternative to either our current system or European systems which would be superior to both of them. In that case we should propose the best system we can possibly think of regardless of how much or how little it resembles, say, the Italian system.

Overall, though, it seems like we don't really have some brilliant idea of how to do health care administration better than, say, the French, so this seems unlikely.

Posted by Julian Elson | September 21, 2007 5:49 PM

Could we please stop calling what European countries have "socialized medicine"? These countries have government-sponsored single payer systems and all parties from left to right accept and support them.

Single-payer is socialism. Calling it something else and talking about how many "right-wing" European parties support them doesn't change that.

When Lyndon Johnson proposed Medicare, the AMA attacked it as socialism. When FDR proposed Social Security the Republicans attacked it as socialism. When the progressives proposed workers comp the right opposed it as socialism.

As soon as these programs get enacted and everyone sees that they work, shazam! - they're no longer socialism, and instead they fit right in to our capitalist system.

They are socialism whether we call them that or not.

So why not start out now by explaining that single-payer health care is GOOD for capitalism because it takes the drag of health care costs off employers, where it doesn't belong, and spreads it among the actual consumers of health care, the public.

But it isn't capitalism, whether or not you want to argue that it is good for the rest of capitalism. If you support socialism in health care, say so, don't try to pretend you don't.

Posted by Glaivester | September 21, 2007 6:19 PM

I think eltoro=Sean Penn. If you really want to set him off, tell a story about how Jude Law is on the verge of death due to the inefficiency of UK health care

Posted by The September Fool | September 21, 2007 6:31 PM

Glaivester,

uless you use the right wing-nut distortaion of calling anything the government does soclialism, single payer is not socialism, and most of the European systems aren't single payer anyway.

Posted by Eric K | September 21, 2007 7:10 PM

Re: Could we please stop calling what European countries have "socialized medicine"? These countries have government-sponsored single payer systems

Not all of them have single-payor systems. In fact pure single-payor systems (eg.g, Canada) are rare. Germany's healthcare, for example, closely resembles what Hillary put together back in 1994 (in fact the 1994 proposal was modeled on Germany). And in most of Europe private health insurance still exists-- but as a very strictly regulated public utility. In that respect, the Democratic proposals we have today are a big step in the direction of Europe.

Re: There was this one French guy once who died because he had to wait 18 months to have an infected toenail treated.

I would love to see that documented. Either it is made up out of whole cloth, or there's very much more to the story (for example, the guy had a toenail infection for 18 months, but died of something unrelated). As for the 103 year old story, you are aware that people that age are generally considered very poor surgical risks and there are quite a few operations that no doctor will perform on them because the outcome is quite likely to be fatal.

Posted by JonF | September 21, 2007 8:28 PM

Matt and the gang:

it seems to me that Americans have a striking provincial distaste for Europeans and their society and governments in general. So regardless if Americans are too ignorant to realize that they publicly support a universal health-care ("single-payer") system, the fact is, that the attack scares away voters.

I think an interesting poll would be to ask:

(a) Do you support a single-payer universal health-care plan?
(b) Do you support a European style health-care plan.

I have a sneaking suspicion that more would answer A than B. Again - the attack works because it resonates with ignorant voters.

(b)

Posted by Brad | September 21, 2007 9:13 PM

Brad:

People aren't generally apprised of the details between single-payer, single-provider and other universal systems. The debate is between 'American' and 'Foreign'. Although actual experience shows that 'American' is shit, the chauvinistic presumption is that 'Foreign' must be worse.

I'd assault it head-on, and say 'yes, it's European. The European system works for rich and poor alike; ours doesn't. Something's wrong with the world when the Europeans do healthcare better than us, and I intend to fix it.'

Posted by pseudonymous in nc | September 21, 2007 10:05 PM

This is ridiculous.

I am surprised that there are not national strikes demanding healthcare.

Posted by hal | September 21, 2007 10:12 PM

Something's wrong with the world when the Europeans do healthcare better than us, and I intend to fix it.

"... even the Costa Ricans have health care."

Posted by drjimcooper | September 22, 2007 12:42 AM

Healthy 20-something year-old lefty bloggers offer valuable perspectives on health care. Here are some questions I would like to hear them address.

In a nationalized health care system, what will the incentives for companies and individuals to develop new drugs, operations, and medical equipment?

How will you continue to attract top-quality Americans to go into medicine and allied fields after the inevitably large drops in compensation?

Since elderly Americans are, at the same time, the largest health care consumers, the ones with the best deal now (Medicare + private insurance or Medicaid), and the most politically powerful demographic, how do you imagine you'll be able to cut their health care consumption to European levels?

Can we afford European-style nationalized health care with American-style consumption and expectations?

The HI portion of the payroll tax, currently covers less than half the costs of Medicare. Medicare costs have been rising at double the rate of inflation. Wouldn't it make sense to figure out how to pay for this (e.g., double the HI portion of the payroll tax?) before nationalizing the rest of health care?

Posted by Juan | September 22, 2007 1:21 AM

Could we please stop calling what European countries have "socialized medicine"? These countries have government-sponsored single payer systems and all parties from left to right accept and support them.

Don't use the the word "please." There will be no genuine progress on healthcare unless people are forced to do so. That means doing things your opponents don't like.

Posted by Alfred | September 22, 2007 1:21 AM

I like the part where ignorance and xenophobia of anything European means that Americans view the place as if it were one monolithic block of peoples that all did everything the same way. As if, using the example of health care, the English system is anything at all like the German system which is anything at all like the "system" in Romania.

The problem is, of course, that "European-style" is simply code for anything that is bad. It has been reduced in a way similar to the word "fascism." This is, of course, insane, since Europe has some of the highest living standards in the world, but there you go. How you get around that with an American public that seems to agree with the sentiment is a good question.

Posted by josephdietrich | September 22, 2007 6:31 AM

Heh, even I'm doing it, and I've lived here for a while. "... since many European countries have some of the highest living standards in the world."

Posted by josephdietrich | September 22, 2007 6:35 AM

How you get around that with an American public that seems to agree with the sentiment is a good question.

This is nonsense. There is no such anit-European sentiment except in a few rabid-right wing groups.

Quite frankly, this sort of talk sounds just like the talk coming from "liberals" who supported the Iraq War.

Once adequate steps are taken to ensure that the comfort level of those who oppose universal healthcare is diminished, then serious reform will become possible.

Posted by Mitchell | September 22, 2007 9:44 AM

Re: In a nationalized health care system, what will the incentives for companies and individuals to develop new drugs, operations, and medical equipment?

People who develop new healthcare treatments may not make quite the fortune they do today but they will still make something respctable. Moreover you discount the "glory" motive: who wouldn't want to go down in history as the person who brought us a breast cancer cure (for example) and maybe even win a Nobel prize.

Re: How will you continue to attract top-quality Americans to go into medicine and allied fields after the inevitably large drops in compensation?

OK, so medicine doesn't pay quite as well (though many physicians will no longer have to spend a large fraction of the their income on billing so that may even out). It will still pay better than average and the job security will be superb. Not to mention there are altruistic motives for a career in medicine too-- at least I hope our doctors and nurses have such motives. Hence I see no problem attracting people to the field. (As an additional incentive I would suggest doing something about the malpractice issue and also maybe a student loan forgiveness program in areas that are poorly served)

re: Since elderly Americans are, at the same time, the largest health care consumers, the ones with the best deal now (Medicare + private insurance or Medicaid), and the most politically powerful demographic, how do you imagine you'll be able to cut their health care consumption to European levels?

I very much doubt this is an issue as I don't think those levels are significantly different than our own. Given that the European elderly are at least as healthy as ours (if not slightly more so) the hard evidence of results suggests that they are NOT poorly served, on the whole, by their healthcare systems.

Re: Can we afford European-style nationalized health care with American-style consumption and expectations?

Obviously we need people to accept something less than gold-plated benefits. That's mostly an issue at the upper echelon of society. Most of the rest of us get by with barely nickel-plated benefits and our healthcare is of the same quality (or even worse, for the poor) than Europpean healthcare.

Re: The HI portion of the payroll tax, currently covers less than half the costs of Medicare. Medicare costs have been rising at double the rate of inflation. Wouldn't it make sense to figure out how to pay for this (e.g., double the HI portion of the payroll tax?) before nationalizing the rest of health care?

You ignore that fact that most people brought into such a system would be young and healthy and would be net payors into the system, not a net drain on it.

Posted by Jonf | September 22, 2007 5:06 PM

This is nonsense. There is no such anit-European sentiment except in a few rabid-right wing groups.

Maybe. Perhaps I hang out with too wingnutty a crowd, since my perception is based on the anecdotal evidence of "things my friends and coworkers have said." Sadly, a quick Google search tells me that polls on this question are harder to come by than ones that ask "What do other people think about America." Still, here's one from 2004:

A new Harris Poll finds that many more Americans have strongly positive attitudes toward Canada and Britain than they do toward other major European countries or Japan, Russia and China. This is true for perceptions of their systems of government, their quality of life, their present governments, their economies, their environments and the health care systems. For each of these, more Americans, probably substantially more, say they feel very positively about Canada and Great Britain than they do about France, Germany, Italy, Spain, Russia, Japan or China.

However, with the one important exception of their health care system, more Americans give their own country positive ratings than give Canada or Britain positive ratings.

Note that last bit. Americans think the Canadian healthcare system is better than their own. But look at the numbers for the other European countries. We don't think too highly of our own healthcare system, but we think everyone else's is far worse.

But obviously one poll is a pretty weak argument, so maybe you're right. I hope so, for the sake of American healthcare. But it makes me wonder why Romney's PR people thought using "European-style" as a pejorative was a good idea ...

Posted by josephdietrich | September 23, 2007 1:59 PM