Part 1—Plutocrat looting ignored: Amazing amounts of money get looted in the normal operation of American health care.
Way back when, in 2005, Paul Krugman tried to raise this issue with a series of columns in the New York Times. He may as well not have bothered. The rest of America's press and pundit corps is committed to avoiding this ginormous policy matter.
But along the way, Krugman offered the basic outline of a puzzling situation. On April 15 of that year—Tax Day!—he discussed the “amazing” state of American health care spending:
KRUGMAN (4/15/05): Britain isn't the country we want to look at, because its health care system is run on the cheap, with total spending per person only 40 percent as high as ours.“Now is a good time to ask why other advanced countries manage to spend so much less than we do, while getting better results,” Krugman said. That was eight years back.
The countries that have something to teach us are the nations that don't pinch pennies to the same extent—like France, Germany or Canada—but still spend far less than we do...
Let me rattle off some numbers.
In 2002, the latest year for which comparable data are available, the United States spent $5,267 on health care for each man, woman and child in the population. Of this, $2,364, or 45 percent, was government spending, mainly on Medicare and Medicaid. Canada spent $2,931 per person, of which $2,048 came from the government. France spent $2,736 per person, of which $2,080 was government spending.
Amazing, isn't it?
In 2005, Krugman called our health care spending “amazing”—and he noted that the Brits spent only 40 percent as much as we spend, per person. But uh-oh! As of 2007, the United States was spending two to three times as much, per person, as all large developed nations, including the other countries Krugman had praised, also including Japan.
As of 2007, we were spending $7290 per person; France was spending $3601. (Great Britain: $2992.) An amazing amount of money was disappearing down some large, unnamed hole.
This is a remarkably large policy story, one the press and pundit corps struggles heroically to ignore. They give you tales about Hillary Clinton. They obsess about Anthony’s weiner.
They invent a range of facts to turn the Zimmerman case into Selma. But their heroic silence has been unyielding when it comes to the looting involved in this major policy area.
Even in the year 2009, the press corps and the pundit corps didn’t waver. August professors didn't step forward to explain those amazing numbers. As the Affordable Care Act was thrashed, the press corps pretended to spend a year discussing health care policy. But as we kept noting at the time, none of the major news orgs conducted any real reporting on The Case of the Missing Loot.
The NewsHour, the Washington Post, the New York Times? All three orgs pretended. They offered truncated, Potemkin reports about per person spending in the U.S. as compared to that in all other developed nations. Even that year’s ballyhooed book about health care—T. R. Reid’s The Healing of America—offered a truncated pseudo-explanation of where all that money was going.
Where does all that money go? For reasons which may be obvious, we can’t exactly tell you! But the size of this problem has become clear through the efforts of the handful of Irish monks who defy Hard Pundit Law and discuss this “amazing” problem. The gigantic cost of American health care helps explain stagnating wages. And as Dean Baker endlessly notes, federal deficits would disappear overnight if American per person health spending suddenly matched that of France.
The silence has been general all over the “press corps” concerning this massive looting. Wherever all that moolah is going, the boys and girls in that Potemkin assemblage haven’t wanted to “follow the money” this time. That of course is the basic nature of moral and intellectual paralysis.
That’s why the analysts came out of their chairs not so long ago! On Sunday morning, June 2, a new series made its debut on the front page of the New York Times.
PAYING TILL IT HURTS, the new series was called. Elisabeth Rosenthal started her first report like this, headline included:
ROSENTHAL (6/2/13): The $2.7 Trillion Medical BillGood lord! Rosenthal was going where her colleagues had not gone before! As she continued, she began to discuss The Problem That Has No Name and Permits No Discussion. She even explained that headline:
Deirdre Yapalater's recent colonoscopy at a surgical center near her home here on Long Island went smoothly: she was whisked from pre-op to an operating room where a gastroenterologist, assisted by an anesthesiologist and a nurse, performed the routine cancer screening procedure in less than an hour. The test, which found nothing worrisome, racked up what is likely her most expensive medical bill of the year: $6,385.
That is fairly typical: in Keene, N.H., Matt Meyer's colonoscopy was billed at $7,563.56. Maggie Christ of Chappaqua, N.Y., received $9,142.84 in bills for the procedure. In Durham, N.C., the charges for Curtiss Devereux came to $19,438, which included a polyp removal. While their insurers negotiated down the price, the final tab for each test was more than $3,500.
''Could that be right?'' said Ms. Yapalater, stunned by charges on the statement on her dining room table. Although her insurer covered the procedure and she paid nothing, her health care costs still bite: Her premium payments jumped 10 percent last year, and rising co-payments and deductibles are straining the finances of her middle-class family, with its mission-style house in the suburbs and two S.U.V.'s parked outside. ''You keep thinking it's free,'' she said. ''We call it free, but of course it's not.''
In many other developed countries, a basic colonoscopy costs just a few hundred dollars and certainly well under $1,000. That chasm in price helps explain why the United States is far and away the world leader in medical spending, even though numerous studies have concluded that Americans do not get better care.
ROSENTHAL (continuing directly): Whether directly from their wallets or through insurance policies, Americans pay more for almost every interaction with the medical system. They are typically prescribed more expensive procedures and tests than people in other countries, no matter if those nations operate a private or national health system. A list of drug, scan and procedure prices compiled by the International Federation of Health Plans, a global network of health insurers, found that the United States came out the most costly in all 21 categories -- and often by a huge margin.Can Elisabeth Rosenthal say that? On June 2, the answer was suddenly yes. And Rosenthal was saying these things on the front page of Gotham’s own New York Times, our most famous incompetent newspaper!
Americans pay, on average, about four times as much for a hip replacement as patients in Switzerland or France and more than three times as much for a Caesarean section as those in New Zealand or Britain. The average price for Nasonex, a common nasal spray for allergies, is $108 in the United States compared with $21 in Spain. The costs of hospital stays here are about triple those in other developed countries, even though they last no longer, according to a recent report by the Commonwealth Fund, a foundation that studies health policy.
While the United States medical system is famous for drugs costing hundreds of thousands of dollars and heroic care at the end of life, it turns out that a more significant factor in the nation's $2.7 trillion annual health care bill may not be the use of extraordinary services, but the high price tag of ordinary ones. ''The U.S. just pays providers of health care much more for everything,'' said Tom Sackville, chief executive of the health plans federation and a former British health minister.
That first report by Rosenthal ran 4200 words—and she said more reports would be coming. “In coming months, The New York Times will look at common procedures, drugs and medical encounters to examine how the economic incentives underlying the fragmented health care market in the United States have driven up costs, putting deep economic strains on consumers and the country,” she wordily but brassily wrote.
And sure enough! On Monday, July 1, Rosenthal returned with a second lengthy front-page report: “American Way of Birth, Costliest in the World” (3200 words).
On Sunday, August 4, she was back on the front page again: “In Need of a New Hip, but Priced Out of the U.S.” (3800 words).
In short, Rosenthal has now done three massive front-page reports about The Problem That Dare Not Be Named. And sure enough! Her reports have produced zero discussion everywhere else in the “press corps!”
According to Nexis, Rosenthal’s name hasn’t been mentioned on The One True Liberal Channel, a clownish frat house which won’t touch a topic unless it gives Our People a way to drop R-bombs on Their People. This is now the pleasing shape of corporate-funded progressive politics.
But then, Rosenthal’s name has also been missing from CNN and the Fox News Channel. According to Nexis, she hasn't been mentioned on ABC, NBC or CBS or on the august NewsHour.
Last Wednesday, Rosenthal did a lengthy segment with Terry Gross on NPR’s Fresh Air. According to Nexis, that represents the only time her name has so much as been mentioned by any of the Potemkin “news orgs” we have mentioned above. (Search term: Rosenthal AND health.)
Those news orgs like to serve weiner. They keep distracting you into the future. But even with this major topic being thrashed right there in plain sight, the eyes of the Potemkin press corps have been kept wide shut.
Some of this silence may stem from Rosenthal’s style, a point we will explore tomorrow. But please feel free to savor the irony of this unfolding drama:
Elisabeth Rosenthal is going to win the Pulitzer Prize for a series of front-page reports about one of our most pressing policy problems. And her front-page reports have appeared on the front page of our most famous national newspaper!
But on the day she accepts her award, the communal silence will not have been broken! Not a word of discussion will have been generated by the reports which will be gaining the biggest prize our “press corps” has to offer.
Some of the silence we’ve seen this summer may result from Rosenthal’s style, which seems to plead for no further discussion. But has the complexity of our plutocracy ever been more “amazing?”
Tomorrow: Frankly, we were puzzled