I finished Howard Dean's Prescription for Real Healthcare Reform. I have three items.
1.
On page 113, Howard Dean disagrees with the notion that illegal
immigrants drive the United States' uninsured problem. Dean argues that
American citizens make up the bulk of the uninsured and that illegal
immigrants "have significantly lower per-capita healthcare expenditures"
because they lack "a usual source of care" and usually cannot enroll in
Medicaid and S-Chip.
I wouldn't be surprised if illegal immigrants play some role in driving up the cost of health care (see here),
however. They are uninsured, and they use emergency rooms, and
hospitals then pass on the cost of treating them to everyone else. I
think it would be inhumane not to treat them, though.
2.
On page 115, Dean argues against the notion that requiring employers at
large companies to provide health insurance or to "pay into a fund that
[would] help finance health insurance for their workers" would result
in large companies dropping health insurance altogether. Dean says
that, in Massachusetts, the employer mandate has not resulted in
employers dropping health care for their employees during the first year
of health care reform.
But Dean earlier in the book says that
health insurance is burdensome for large companies, which is why some of
them locate in Canada, where the government takes care of health
insurance costs. If that is the case, why wouldn't companies drop their
private insurance plans and tell their workers to enroll in a public
option (if it exists) or Medicaid (if the workers are eligible for
that)? (And I'm not saying it would be bad if people were covered by a
public option.)
3. In Chapter Twelve, Dean goes into how different
countries handle health care. Some have the government pay for it, and
others have a fairly effective health care system in which private
health insurance companies compete and yet are under certain
regulations. On pages 105-106, Dean discusses Great Britain's system,
in which the government pays for a lot of the health care expenditures.
Dean quotes Ezra Klein as saying: "In the case of ill health, they're
actually in much better health than their American counterparts, though
that's a function of lifestyle more than hospital choice. You're
probably better off getting your breast cancer treated in America and
getting your diabetes treated in Britain. In the aggregate, however,
the evidence is fairly clear that the British are better off."
What
Klein says coincides with what some have told me: that countries with
national health insurance are better in terms of preventative care,
since people are not afraid to go to the doctor on a regular basis. But
the United States reportedly has superior technology and is better at
treating cancer. Can we have our cake and eat it too? Does America
have to have a system in which people fall through the cracks in order
for it to have superior technology?