To Your Health
What Americans Won’t Learn About Health Care

We could learn a lot from the rest of the world when it comes to health care, if only we would let go of a few persistent myths.

Appeared in: Volume 10, Number 2 | Published on: October 6, 2014
Pascal-Emmanuel Gobry is a Paris-based entrepreneur and writer.
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  • qet

    Excellent piece. I don’t concur with every statement, but the writer argues his case very well. Two statements that I do endorse and that I think bear emphasis are the statement about demand elasticity being as much, or more, a matter of psychology than of economics, and the Marx-ish statement at the end about the ACA amplifying the contradictions inherent in our current “system,” which will lead to beneficial changes.

  • Boritz

    “So, for example, a frustrating number of right-wing politicians, instead of questioning whether a global regime of carbon taxation might have more costs than benefits as a response to global warming, will instead question whether global warming is, in fact, actually occurring.”

    Because the Left doesn’t consider ‘more costs than benefits’ an argument against spending other people’s money.  They dismiss that notion even more quickly than they dismiss the idea that there is no man-made global warming.

    • Andrew Allison

      The author made a grave mistake in introducing the Church of AGW into a discussion about health care, thereby diverting attention from the issue. Since the subject has come up, whilst only the stupid or mendacious question whether global warming is occurring (the fact that it hasn’t for the past 17 years doesn’t mean that it hasn’t been trending upward for 150 years or so), the question is the extent to which it is anthropogenic. The evidence suggests that the answer is: very much less that the AGW scriptures propound.

      • ljgude

        And it hasn’t helped that the high priests of East Anglia and others of their ilk have been caught red handed abusing their cute little graphs with the result that no one really can tell what is happening.

    • jburack

      I will add my voice to others here by saying this excellent article is marred thoroughly by bringing AGW theory into it. Not merely a non-sequitur, but a perfect way to discredit the rest of it entirely. I am soooo sick of having my doubts about global warming described as extreme anti-science. I based my views on the best science, which I keep up with very closely. Anyone who does knows how thin the claims of a consensus on it are. Yet this article, like so much else, dismisses the critics and seeks to label them cranks. This site ought to wean itself from this game. It is a game that the warmists are losing, without apparently seeing this at all.

  • Arkeygeezer

    “The only thing that everyone agrees on in this drama is that the U.S. health care system is broken—and very expensively so.”

    Your premise is faulty. The U.S. already has the best health care system in the world. Thats why most advanced drugs, new surgical procedures, and ultimate place of treatment for serious diseases is the U.S.A. The life expectancy in the U.S. has improved dramatically. The Affordable Care Act did add some good elements to the system, but dogmatically dictating that coverage for pre-existing conditions was not one of them.

    The ACA is not going to be repealed, so it is incumbent on both political parties to continue to tinker with the health system to make it more cost effective and better. This will be done as we have improved Medicare to take care of senior citizens. ACA has caused Medicare premiums to increase, and that needs to be addressed.

    The U.S.A. will develop its own system, making our own mistakes, and improving our system. The world will end up copying us, not the other way around.

    • Andrew Allison

      That “The U.S. already has the best health care system in the world.” is, as the post demonstrates, a myth.

      • bannedforselfcensorship

        Cancer survival rates suggest otherwise.

        • Andrew Allison

          Actually, they prove the point. U.S. male cancer mortality per 100,000 is the same as the average for OECD countries (at ridiculously greater cost), meaning that half of them do better. Female mortality is slightly better than average . The US is 10th in tombined per capita mortality.(http://www.oecd.org/els/health-systems/Health-at-a-Glance-2013.pdf).

  • Thom Burnett

    Superb piece with lots of great information. Myth #3 is certainly a big part of our problem.

  • wigwag

    I read this essay twice; it did not improve on rereading. What the author presents us with is a series of cliches and banalities masquerading as keen insights.

    Mr Gobry may think that he’s sharing great revelations with his readers when he points out that America doesn’t really have a free-market in health care or that health insurance actually works differently from all other forms of insurance that we are familiar with, but great revelations they are not. Anyone who has thought seriously about the subject for as little as about ten minutes understands that the myths Gobry alludes to are, well, myths. Health economists know it; public administrators know it; the tiny number of intelligent pundits and journalists know it and so do most people who toil in one capacity or another in the behemoth we call the American health care system. It is true that given the relatively low IQs of American Congressmen and Senators that many of the myths that Gobry outlines are viewed by them as facts, but even if our elected representatives are mostly stupid, their legislative aides are mostly not.

    Singapore? Is that really an example of a nation that has lessons about health care access and delivery that are likely to resonate in the United States? Why didn’t he pick France or Germany? What about Japan? First Gobry points out that Singapore is a city-state with a relatively homogeneous population of around 5 million and then he reveals that public gum chewers risk being caned. Yet after highlighting the enormous differences between Singapore and the United States, he drones on for paragraph after tedious paragraph about how Singapore provides its residents with health care. Gobry said it himself,

    “As if the way other societies do things could readily be exported around the globe.”

    That’s exactly right, Mr. Gobry, which is why your doctoral thesis on the Singaporean health delivery system is not exactly revelatory.

    In his otherwise excruciating essay, Pascal-Emmanuel Gobry does provide his readers with one kernel of brilliance; it’s this,

    “In the West, medical doctors are a cartel, using their political influence to protect their livelihood, with predictable consequences in terms of both innovation and cost.”

    I don’t know if its true everywhere in the West, but it’s true in the United States in spades, and the medical cartel (or several interrelated medical cartels) are public enemy number 1 when it comes to the disastrous healthcare superstructure in our country. The medical cartel keeps the number of physicians artificially low which dramatically increases the amount that physicians (especially specialists) can charge. The medical cartel works with American medical and osteopathic schools to limit the number of students that they admit and it uses its muscle with government to make it extraordinarily difficult for outstanding physicians from other nations to practice in the United States. Double or triple the number of American physicians and watch health care costs plummet.

    The medical cartel conspires with one of its key vassals, the medical school industry to keep medical school tuition remarkably expensive. Mostly its because medical schools are filled with untold number of dead-wood faculty who can’t stand the thought that they might have to actually be a little more productive. Maybe they should teach five or six classes a semester instead of one or two. If young doctors didn’t graduate hundreds of thousands of dollars in debt, maybe they could chose less lucrative fields of practice like primary care or endocrinology or rheumatology which are hemorrhaging doctors.

    If it wasn’t for the medical cartel maybe nurse practitioners or even physician assistants could provide the bulk of primary care and it it wasn’t for that same cartel maybe the scores of useless procedures that put patients at risk while providing limited or no benefit would be less ubiquitous.

    When it comes to limiting the enormous costs of medical care, everyone focuses on the demand side of the equation; but price is not set by demand alone. Reducing demand by implanting intelligent reforms is a fine idea, but dramatically increasing the number of professionals permitted to provide health care could be even more effective at bringing health care costs down.

    If the average physician in the United States earned $80,000 per year instead of $150,000 a year Walmart could afford to hire one to work in a medical clinic in every Walmart store in the country. If twice as many urologists were competing for the relatively static number of patients who need urological care year after year, the price those urologists could require would fall precipitously.

    If $80,000 doesn’t sound like a decent salary for a physician, take a look at the average salaries of French physicians, German physicians, Canadian physicians or Japanese physicians.

    Maybe Mr. Gobry will be a nice guy and tell us the average salary of those Sinaporean physicians he knows so much about.

    • Andrew Allison

      Given the 10 years of schooling it takes to produce a physician and the ferocious resistance of the breed to increasing the supply or permitting alternatives (NPs, in-store clinics, etc.), supply-side economics is a pipe dream. What’s needed (and which ACA is accidentally providing by way of it’s high deductible and co-pays) is having the consumer pay, at least in part, for healthcare decisions. Given the difficulty of increasing the supply, we should look at decreasing the demand, which has the same effect.

      • Margaret

        So right! Those pontificating on doctors being the cause of our problems should try surviving medical school, residency, sleepless nights for the rest of your working lives, the stress of being responsible for other peoples’ lives, the fear of lawsuits by the greedy, etc. They should be well compensateed for what they do for those in need of care.

        Health care is never free; either the provider gets stiffed, or someone else has to pay the bill (tazppayers.

    • wigwag

      Actually, Mr. Gobry doesn’t have to tell us how much money the average Singaporean physician makes; it took about ten seconds to find it on the internet. Converted into U.S. dollars, the average Singaporean doctor makes about $85,300 per year which is almost identical to the salary of the average physician in France. It also happens to be less than 60 percent of the average salary of U.S physicians. Yes, none of this takes into account purchase power parity and a few other largely irrelevant factors, but the difference in what American physicians earn versus what they earn in other nations is stark. A major reason that health care costs are dramatically smaller everywhere else in the world than in the United States is that American doctors make way too much money. It’s the medical cartel which works overtime to insure that will never change.

      This is far and away the most important thing that needs to be fixed if health care costs are going to be contained in the United States.

      • bannedforselfcensorship

        This is one of the reason’s the goal of achieving European costs will be a mirage, unless some politician begins cutting doctors and nursing salaries. Not gonna happen.

  • Anthony

    In sum, WigWag nails it: “the health care industry is crying out for supply side economics – increasing the number of professionals permitted….”

    • Andrew Allison

      I beg to differ, see above.

  • Charles Hurst

    I have been told that I don’t understand the definition of Marxism in relation to ACA. And what is Marxism? The takeover of means of production by the government and each according to need.

    As a former provider I can tell you our hands are being tied. I would never open up my own clinic in this environment. I would not operate at the dictation of the government. For they are taking the means of production–my former occupation.

    And each according to need. One man pays higher premiums so another does not. I don’t remember paying a higher rate based on my salary with car insurance. And many in healthcare do not pay at all.

    So ACA is Marxist by definition. And it will fail as all Marxist policy does. Many of us have left the field or will soon. There was a poll I read once that 80% of doctors in practice do not recommend to youth to go into medicine. That’s terrific Barry. Well done.

    And the bigger picture is this may be the final nail that closes the coffin on America. ACA cannot sustain itself. All of these problems and the employer mandate hasn’t even hit yet. It will be a disaster. And this may be the beginning of the end for America. As I predict in my own writing, based on History, we will fall into tyranny or we may engage in our second civil war.
    And maybe it’s time now for shots to be fired. Because we are following the exact pattern of other nations who lost their prosperity as well.

    Charles Hurst. Author of THE SECOND FALL. An offbeat story of Armageddon. And creator
    of THE RUNNINGWOLF EZINE

    • FriendlyGoat

      Who is supposed to be “firing shots” at who? EXACTLY, PLEASE. On what justification? Seriously, other than fueling our supposition that you may be living in a gun fantasy, what the heck are you talking about?

    • Andrew Allison

      Here we go again with the conflation of insurance and health care. ACA regulates the former, not the latter. As amply demonstrated by the narrowing of insurer networks, practitioners are free to participate or not. ACA is a monstrosity, but it’s not health care. Even absent the well-publicized failure of the VA, socialized medicine is not going to happen in the U.S. Socialized insurance is a different matter entirely, and this part of the Singaporean model (known in the U.S. as Medicare) would make a lot more sense. Unfortunately, the extremely lucrative health insurance industry will do everything in it’s power to prevent that.

  • FriendlyGoat

    1) Considering that this is a sort of conservative/libertarian place, we should be grateful for this explanation of how the Singapore government is up to its ears in regulating its health care and financing. Most other places also enjoying good outcomes at good prices share that reality, even if details vary. THE PEOPLE, THROUGH GOVERNMENT, EXERCISE SOME ACTUAL CONTROL OVER THE INCORPORATED PROVIDERS.

    2) Although we want consumers to think before spending and share in some fraction of the cost of procedures, we DO NOT want to demand that people with medical emergencies or serious illnesses “shop” for their interventions. NO ONE wants to do this in real life. We should not even pontificate on this in theory.

    You do not have to run to every grocery store in town to find out whether milk is priced at $2.50 or $15.00 a gallon—-(and certainly not while sick or worried to death about yourself of a loved one.) The ongoing competition BETWEEN THE STORES is going to keep retail milk (depending on your location) about $3.50 a gallon, give or take fifty cents.

    But in health care, we really do have providers selling —-or trying to sell—-the equivalent of $5.00, $10.00 and $15.00 milk as well as the regular $3.50 level. This is because of a norm of secrecy in pricing (until the minute you need it) and because people, through government, have not figured out how to positively COERCE all the pricing into bright daylight 24/7/365. This is the one thing we need to do. We need to have employers, insurers, media, networks, agencies, and non-profits (everyone BUT the sick person and family) constantly pressuring the provider prices by constantly comparing and publicizing the care by line item—-down to whatever minute level of chargeable item appears on any provider’s “ChargeMaster”.

    Then, when you’re sick and “need some milk”, your caring society will have already assured that you can walk in anywhere “milk” is sold and pay “about” $3.50 for a quality gallon. Your caring society will have also assured that you are not paying $5.00 for the same milk in the same store that others are somehow buying there for $3.00. (Yes, hospitals routinely charge different people different prices for the same services—-unless outlawed.)

    • Jeremy Fuller

      Price transparency would do wonders for our healthcare system.

  • pacificwaters

    It;s a foolish way to get there and both parties are to blame. Instead of searching for practical answers both parties push idealogical answers but I must say some of the fringe republicans have tendered a few plausible approaches, incomplete but plausible.

    “The structure of the Affordable Care Act, by removing health care decisions even further from consumers, all but ensures that costs will escalate even faster. At some point, most employers in America will only be able to afford catastrophic health insurance for their employees. If and when that irony busts onto the scene, perhaps real consumer dynamics will emerge, and perhaps America will stumble backward into a Singapore-style system.”

  • ljgude

    A fresh view of the topic, and welcome. As an American having lived half of my life in Australia I can’t say I am horrified by socialized medicine. When you get run over or keel over with a heart attack it just doesn’t matter if you have insurance or your parents have. They take you to the hospital and , and whether you are lucky enough to walk out, you don’t get a bill. I had only been in Australia a few weeks when a new friend fell on some stairs and smashed her knee cap. Really smashed. We got her to the hospital and getting that knee fixed was the only concern. We pay for it with a universal levy that you have to be really poor not to pay. It is a separate item on our tax return so we know where a lot of the money comes from. But we also have a private insurance system because after many decades of socialized medicine we know what the drawbacks are – waiting lists, and bureaucrats to compile them. Or fake them like they caught the VA doing in our socialized medicine for Vets system in the US. So if you can afford it, you buy private health insurance in Australia and it costs a lot less than in the US and gives access to the private hospital system with no waiting. Here is the point which I have made many times: the two systems are complementary. If waiting lists get too long people take out insurance. If the premiums get to high they drop it and rely on the public system. The private system actually takes a lot of the pressure of the public system. I think of it as a kind of second order competition – cleverly designed to control costs which are about half, as a percentage of GDP, of the US. The ACA is a massive disruption of the insurance market which has a clause capping costs at 17.5% of GDP by 2017 up from 1% in 2008. It exacerbates the problem of how the US pays for healthcare and has no structural innovations to reduce costs. I see the Singapore system discussed in the article as putting forward innovative structural reforms of much greater magnitude than Australia’s rather ordinary combination of public and private systems. It will take stiff competition like medical tourism to the Caymans to really put the US medical cartel out of business.That or collapse.

  • Curious Mayhem

    Thanks for the myth-busting. I’ve tried to do a few of these myself on anyone who wanted to argue about it.

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