Take a pill

Here's a health care horror story:

Mountain-bike enthusiast Suzanne Aucoin had to fight more than her Stage IV colon cancer. Her doctor suggested Erbitux—a proven cancer drug that targets cancer cells exclusively, unlike conventional chemotherapies that more crudely kill all fast-growing cells in the body—and Aucoin went to a clinic to begin treatment. But if Erbitux offered hope, Aucoin’s insurance didn’t: she received one inscrutable form letter after another, rejecting her claim for reimbursement.

Ms. Aucoin's story wasn't included by Michael Moore in Sicko. It hasn't been told by Sen. Kathleen Vinehout or other state Democrats pushing their new health plan. You'll never hear about it from Nancy Pelosi or Ted Kennedy.

Why not?

Because Ms. Aucoin lives in Ontario, Canada. Her clinic was in Buffalo, New York. There's an inconvenient truth for you.

Dr. David Gratzer in the City Journal discusses this and other difficulties with the Canadian health care system. He might have added that the Canadian Supreme Court found that wait times for surgery in Quebec combined with a ban on private care were a human rights violation.

The large truth here is that there is no such thing as unlimited care. Canada needs to hold down its health care expenditures just as everyone else and, as a consequence, the government becomes one large HMO.

Gratzer's piece did not answer all of my questions but made four points that are worth keeping in mind.

1. There is a free rider problem here. We go into high dudgeon over the fact that American-made drugs are sold less expensively in Canada (where there are price controls) than they are here. Bad greedy drug companies.

But we don't stop to acknowledge that these things are invented in New Jersey and not New Brunswick. This may have something to do with the financial incentives for development that exist here and do not exist in Canada. The cost that must be recouped for drugs is not the cost of stamping them out (much like software, that's minimal), it's in inventing them.

The fact is that an outsized share of medical innovation happens in the US with its "uniquely horrible" health care system. Maybe that's just God's practical joke. Or maybe not.

(Yeah, I know drug companies spend a lot on advertising but that's a function of choice, no?)

2. Health care is better in the US. The argument that it is not is generally based on what Gratzer calls crude indicia of health (as opposed, say, to the outcomes of medical treatment). He writes:

But such outcomes reflect a mosaic of factors, such as diet, lifestyle, drug use, and cultural values. It pains me as a doctor to say this, but health care is just one factor in health. Americans live 75.3 years on average, fewer than Canadians (77.3) or the French (76.6) or the citizens of any Western European nation save Portugal. Health care influences life expectancy, of course. But a life can end because of a murder, a fall, or a car accident. Such factors aren’t academic—homicide rates in the United States are much higher than in other countries (eight times higher than in France, for instance). In The Business of Health, Robert Ohsfeldt and John Schneider factor out intentional and unintentional injuries from life-expectancy statistics and find that Americans who don’t die in car crashes or homicides outlive people in any other Western country. (emphasis supplied.)

This may be why Americans report a high degree of satisfaction with their care, if not their insurers.

3. Other countries are moving away from state directed health care, gradually privatizing what was once state provided care and slowly asking their citizens to assume more responsibility for their own care.

4. The notion that the US pays too much for health care is not evidently correct. The US is a very wealthy country. As national wealth increases, what people spend money on is likely to change. I can only eat so much or wear so many clothes. I might decide, as I grow wealthier, to buy more health care and, as I do, this health care is probably going to be concentrated on the treatment of formerly fatal conditions that are both infrequent and, probably, concentrated among older populations. Thus the US, for its extra money, becomes very good at treating very sick people.

All of this underscores something that we should not lose sight of. Michael Moore is flat out wrong. We have an extremely good health care system here. We have, it is true, a need to reform the way in which it is paid for - a need on which conservatives and liberals agree, even if their proposed reforms are very different.

But in discussing reform, we should not treat the system as a given, unaffected by the way in which we pay for it. We should not throw out the baby with the bath water.