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July 5, 2009

SCHANSBERG: Comparing apples and rocks in health care

We’re often told that the United States compares poorly to other countries in terms of infant mortality — especially since we’re a developed country that devotes so many resources to health care.

This is the first myth of health-care reform. Those statistics are skewed by differences in how countries deal with “premature births.” It may be politically useful but it’s not intellectually honest to compare apples and rocks.

We also hear assertions that various forms of government involvement in health care are likely to be effective in the U.S. because they work well in other countries. Aside from whether this is true, it should be noted that these other countries have lower populations and, typically, far less diversity in their populations. So these comparisons are somewhere between somewhat helpful and useless. One of the ironies of the health-care debate is that such comparisons should encourage us to consider state-based reforms (instead of a single, grand federal experiment), since the population and diversity of our states is similar to other countries.

A second myth is far more important: We’re often told that our current health-care system is “free-market.” This is akin to blaming the Great Depression on markets — while ignoring the four tax increases of Hoover and FDR, massive trade protectionism, restrictive monetary policy, laws that artificially increased prices and wages and so on. In both cases, the extent to which we should blame the government is an open question. But ignoring its role in either mess is neither legitimate nor useful.

With health care, there is already massive government intervention. The most obvious example is the double debut of Medicare and Medicaid in the 1960s. In addition, there is a wide array of relatively minor but still significant issues: various labor market restrictions (e.g., you and I are not allowed to receive medical services from professionals who provide the same services to our armed forces), mandated insurance benefits (for everything from in-vitro fertilization to hair transplants), the explosion of medical malpractice awards (and thus, malpractice insurance rates) and so on.

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