The Price of Everything - Eduardo Porter [27]
IT’S HARD TO overcome the belief that we are entitled to all the health care we need. During President Obama’s push to reform American health insurance, the White House reminded its allies never to use the dreaded word “rationing.” Democrat Max Baucus, who as chair of the Senate Finance Committee was one of the leading legislators crafting the bill, said: “There is no rationing of health care at all” in the proposed reform.
Of course, rationing is pervasive across the American health-care system. For starters, in 2009, 46 million Americans lacked health insurance. A study of victims of severe traffic accidents who landed in hospital emergency rooms in Wisconsin found that those without health insurance received 20 percent less care than the insured. They were kept only 6.4 days in hospital, on average, compared to 9.2 days for those with insurance. And hospitals spent on average $3,300 more on the insured than the uninsured. The uninsured, of course, were 40 percent more likely to die. The study found that if hospitals had treated the uninsured equally to the insured, each life saved would have cost $220,000, which amounts to about $11,000 per additional year. This is a bargain compared to Sutent; well within the limits imposed by Britain’s NICE.
Nonetheless, Obama’s political tactics made sense in the face of accusations from American conservatives that the government wanted to take over the decision of who lived and who died. The president got a foretaste of the opposition’s tactics when a White House proposal to study the relative effectiveness of new drugs and therapies, to decide which were most worthwhile, drew a furious reaction. An editorial in the Washington Times compared the proposal to a program called Aktion T-4 put in place in Nazi Germany to euthanize elderly people with incurable diseases, critically disabled children, and other unproductive types.
The rhetoric was effective because it tapped into the belief that life is priceless, that when it comes to matters of life and death we should spare no expense. As Joy Hardy, the wife of a British cancer victim who was temporarily denied Sutent by the NHS, said: “Everybody should be allowed to have as much life as they can.” This belief has burdened the United States with a uniquely inefficient health-care system. In 2009 health care consumed 18 percent of the nation’s income. And without any mechanism to ensure cost-effectiveness, it could swallow more than a fifth of the economy by 2020. Yet all this spending does not buy better health.
Somehow Americans have a lower life expectancy at birth than the Japanese, French, Spanish, Swiss, Australians, Icelanders, Swedes, Italians, Canadians, Finns, Norwegians, Austrians, Belgians, Germans, Greeks, Koreans, Dutch, Portuguese, New Zealanders, Luxembourgeois, Irish, British, and Danes. We achieve this while spending, collectively, much more on health care than any of them: about $6,714 a year for every American. In Japan, by contrast, health-related expenditures amount to about $2,600 per head, and in Portugal to only $2,000. What’s more, allocating health care by patients’ ability to pay rather than an analysis of the costs and benefits of treatment ensures that the American distribution of health, and life, is as inequitable as one can get in the industrial world. More than half of Americans who earn less than the