In search of Eduardo Porter!

THURSDAY, APRIL 24, 2014

Also in search of the very high cost of our American health care: Eduardo Porter is one of the nation’s most interesting journalists.

His “Economic Scene” analysis column appears in the New York Times every Wednesday. The column appears on the front page of the Business Day section.

Porter’s columns are rather lengthy and they’re always intelligent or intelligent-seeming. Perhaps for those reasons, we don’t think we’ve ever seen his name mentioned in the national discourse.

Consider yesterday’s piece, which ran 1255 words. As he started, Porter cited a troubling prediction about health care costs.

That said, there’s something else we want you to notice about that column.

The column bore an unhappy headline: “Acceleration Is Forecast for Spending on Health.” As he started, Porter recalled an upbeat prediction about health care spending—an upbeat prediction from 1993 which turned out to be wrong:

PORTER (4/23/14): Standing before a roomful of economists, policy makers and health care experts earlier this month, Amitabh Chandra, director of Health Policy Research at Harvard's Kennedy School of Government, closed a presentation about the slowdown in health care spending over the last decade by citing an article in The New York Times.

''Changes in the way doctors and hospitals are paid—how much and by whom—have begun to curb the steady rise of health care costs in the New York region,'' the article declared. ''Costs are still going up faster than overall inflation, but the annual rate of increase is the lowest in 21 years.''

Then came the punch line. The article, written by my now-retired colleague Milt Freudenheim, was published in December 1993, when the so-called managed care revolution promised for a few hopeful years to...curb the breakneck rise in health care costs for good.

It is a sobering reminder that the recent improvements could wither away just as they did two decades ago.

Alas! That upbeat prediction from 1993 turned out to be wrong. At the time, it looked like health care costs were being reined in. Then they took off again.

In yesterday’s column, Porter discussed some of the reasons why that ancient prediction failed. He also discussed the possibility that our current lull in health care spending might soon go away too:

PORTER (continuing directly): And that experience undergirds, in part, a fairly ominous forecast by Mr. Chandra, Jonathan Skinner of Dartmouth College and Jonathan Holmes of Harvard that spending on health care, which already consumes nearly 18 percent of the nation's gross domestic product, will continue to grow 1.2 percentage points faster than the economy over the next 20 years.

''It's very scary,'' Professor Chandra told me.

At the very least, it suggests that health care reform is by no means over. The Affordable Care Act may well be on track to meeting its primary goal of providing coverage for most uninsured Americans and protecting everyone against the risk of losing their insurance. But for all its innovative proposals to flush waste out of the system, reining in health care spending still appears well beyond the grasp of Obamacare.

For ourselves, we can’t judge these predictions and assessments. That said, no one else is going to judge them either. For whatever reason, Porter’s semi-egghead columns never seem to produce any external discussion.

Does Porter know what he’s talking about? In the case of this topic, we don’t know. But he’s in a somewhat gloomy mood as he considers the possibility that recent slowing in the growth of health costs may not continue long.

We think it’s interesting that Porter’s work is never discussed. We thought yesterday’s piece was intriguing for a second reason—because of that famous old hound, the dog that didn’t bark.

Porter wrote his usual lengthy, erudite piece. He talked about the terrible difficulties this country seems to have in controlling the costs of health care.

Here’s what Porter didn’t do—he never mentioned the baseline from which our growth in health care spending starts.

Per person, we already spend two to three times as much on health care as other developed nations. Starting from a baseline like that, you’d almost think it would be easy to find ways to reduce our health care spending, let alone rein in the growth.

But in an erudite seeming piece, Porter never mentioned the crazy baseline from which our growth in spending starts. Readers weren't asked to process the fact that we already spend twice as much per person (or more) as everyone else in the developed world.

As Humphrey Bogart once said: Our of all the health care systems in the world, we had to get born into ours!

Since we already spend so much, why should our health care spending continue to rise? We have told you many time—the data we post below seem to be carefully kept from American eyes.

A conspiracy theorist would say this: American citizens aren’t allowed to know about our nation’s rising test scores. And we also aren’t allowed to know about our crazy health care spending.

These are the craziest data we know about. In big newspapers like the Times, these data are verboten:

Health care spending, per person, 2011:
United States: $8508
Canada: $4522
Germany: $4495
France: $4118
Australia: $3800
United Kingdom: $3405
Japan: $3213
Spain: $3072
Italy: $3012

All that extra money disappears from American pay checks. And remember, that figure’s per person.

Who knows? Maybe Eduardo Porter is nuts and that’s why no one discusses his work.

His columns never strike us that way. But even Porter doesn’t mention our highly exceptional level of American health care spending.

You’re allowed to discuss the way it goes up, pretty much not where it starts.