Left Center Left

I’ve had ambivalent feelings about tort reform before: feelings that Republicans are looking at the trees at expense of the forest of health care problems. And feelings that liberal replies that fears of malpractice juggernaut are ill-founded, in fact don’t address whether legal means are the best for allocating limited resources in caring for people’s health.

Fortunately, Jonathan Cohn has an excellent analysis piece in this week’s New Republic.

It’s not hard to envision a better medical malpractice system–one that still allowed for large jury awards in cases of true negligence, but that handled the majority of bad medical outcomes through a no-fault system requiring more disclosure and analysis of medical errors. Ideally, such a system would also include more aggressive disciplinary action against habitually negligent physicians, either by licensing boards or a government body. And most of the money coursing through the system would end up where it belongs: not in the pockets of trial lawyers, but of those who suffer physical harm. But that’s not something you’re going to hear from the trial lawyers–and, as a result, it’s not something you’re going to hear from most Democrats, at least until somebody else starts the conversation.

Unfortunately, the Republicans have their own favored political financiers, many of whom represent corporate interests. And, like the trial lawyers, they seem less interested in improving medical care than in advancing their own agenda–in this case, limiting their financial exposure and reducing lawsuits generally.

Now, political financing shouldn’t be mere ad hominem: just because a policy is in someone’s narrow pecuniary interest doesn’t necessarily make it wrong in a broader, universal sense. (Though it should give us red flags in examining the true universality of policy ideas.) But the current setup isn’t really working: it generates a substantial amount of new research into treatment and medical drugs, but fails by most measures. As Jeff Madrick points out,

Americans spend some 14 percent of gross domestic product on health care, while other advanced nations spend an average of 8 percent. In the United States, the proportion may rise to 18 percent by 2013.

Yet in general, judging by life span and infant mortality, most developed nations are healthier than the United States. More detailed studies find similar results. For example, a study recently published by the Commonwealth Fund measured quality of care in specific areas of medicine in five nations. It showed that America was superior in only a few. For example, this country topped the list in survival rates for breast cancer but was at the bottom for kidney transplants. It was typically in the middle in most other areas measured.

What may surprise readers, and certainly surprised this writer, is that Americans, by paying so much more, do not have many more services. In fact, according to recent research, they typically have fewer. Consider the number of doctors. In 2001, the United States had 2.7 doctors per 1,000 people, compared with a median of 3.1 in the countries in the Organization for Economic Cooperation and Development. France, accused of having a doctor shortage in last summer’s heat wave, had 3.3 per 1,000.

Also, consider the number of hospital beds. The United States has only 2.9 hospital beds per 1,000 people, compared with the O.E.C.D. median of 3.9. Germany has 6.3. The United States is also behind in the actual days spent in a hospital and hospital admissions per capita. These are not necessarily bad in themselves, but the question is why we spend so much.

So while not exactly in crisis, health care in this country is under an unsustainable system. Certainly this version of free enterprise is delivering neither economic efficiency nor universal care (admittedly, it’s generating good research, though with some dysfunction in the market). To solve this, the synthesis of political finance and party ideology needs to be broken, for Republicans and Democrats alike.

UPDATE: Kieran Healy has a useful graph charting national health care expenditures in advanced capitalist democracies. He points out that such data doesn’t resolve all the arguments around efficiency of health care provision but that “a picture like this makes it easy to see that mainstream debate about health care in the U.S. happens inside a self-contained bubble, and that one of its main conservative tropes — the inevitable expense of some kind of universal health care system — is wholly divorced from the data.”