Part 2—Sadly, a futile attempt: Except on nights like last night, when cable news got totally hijacked, you'll hear a lot, in the next few weeks, about American health care.
You won't hear about the USA 9400, a very important group whose very existence is constantly disappeared.
That USA 9400! They're disappeared on "cable news" and in the New York Times. They were missing from the Times editorial we quoted in yesterday's report—the editorial which cited the very high cost of insurance for the average American family.
You aren't allowed to know that the 9400 exist. Sic semper contemporary pseudo-journalists! Also, manufactured consent!
Who are the USA 9400? How are they relevant to the ongoing pseudo-discussion? To answer your thoughtful questions, we're going to take you back to 2005, when Paul Krugman, perhaps naively, published a series of columns.
At this point, we're going to take a guess. Even as late as 2005, Paul Krugman may have believed that it's possible to introduce information into the mainstream discourse.
We'll guess he knows much better now. Back then, perfectly sensibly, he may have been a believer.
At any rate, Krugman published a series of columns about American health care. More precisely, he discussed the level of spending in American health care, as compared to the level of spending in other developed nations.
Uh-oh! In his series of columns, Krugman reported a very important fact. Our Here in our exceptional nation, we were spending much more on health care, on a per person basis, as compared to other nations whose health care systems were as good as ours, or perhaps even better. Over here in our struggling but self-impressed nation, a very large amount of money seemed to be missing in action.
Krugman's nugget column appeared on April 15, 2005, the very day when modern presidents refuse to report their taxes. The column bore this headline:
"The Medical Money Pit"
Uh-oh! Krugman planned to compare American health care spending to that in other nations. Early on, he issued a sensible note of caution:
KRUGMAN (4/15/05): Before I get to the numbers, let me deal with the usual problem one encounters when trying to draw lessons from foreign experience: somebody is sure to bring up the supposed horrors of Britain's government-run system, which historically had long waiting lists for elective surgery.Say what? Per capita health care spending in Great Britain was only forty percent as large as ours?
In fact, Britain's system isn't as bad as its reputation—especially for lower-paid workers, whose counterparts in the United States often have no health insurance at all. And the waiting lists have gotten shorter.
But in any case, 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.
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. (Yes, Canada also has waiting lists, but they're much shorter than Britain's—and Canadians overwhelmingly prefer their system to ours. France and Germany don't have a waiting list problem.)
Already, that sounded like a rather remarkable fact. Still, Krugman said the more important comparison would be to countries like Canada, Germany, France. He seemed to say that those countries had better health care systems than Great Britain, "but still spend far less than we do" on a per capita basis.
How much less were those countries spending as compared to us? At this point, Krugman turned to the numbers—to the types of numbers our modern news orgs and big cable stars constantly disappear:
KRUGMAN (continuing directly): Let me rattle off some numbers.Say what? In the most recent year available, France and Canada had spent roughly half as much on health care, per person, as we had spent over here?
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? U.S. health care is so expensive that our government spends more on health care than the governments of other advanced countries, even though the private sector pays a far higher share of the bills than anywhere else.
For our money, Krugman complicated the issue a tad when he broke that spending down into private and government spending.
But yes! Unless we Americans were receiving much better health care, those spending numbers did seem somewhat "amazing."
Were we getting much better health care? Sadly, no, Krugman said:
KRUGMAN (continuing directly): What do we get for all that money? Not much.Uh-oh! According to Krugman, we Americans were spending much more on health care than our peers in other developed nations. But despite our (roughly) double spending, we weren't receiving more or better health care.
Most Americans probably don't know that we have substantially lower life-expectancy and higher infant-mortality figures than other advanced countries. It would be wrong to jump to the conclusion that this poor performance is entirely the result of a defective health care system; social factors, notably America's high poverty rate, surely play a role. Still, it seems puzzling that we spend so much, with so little return.
A 2003 study published in Health Affairs (one of whose authors is my Princeton colleague Uwe Reinhardt) tried to resolve that puzzle by comparing a number of measures of health services across the advanced world. What the authors found was that the United States scores high on high-tech services—we have lots of M.R.I.'s—but on more prosaic measures, like the number of doctors' visits and number of days spent in hospitals, America is only average, or even below average. There's also direct evidence that identical procedures cost far more in the U.S. than in other advanced countries.
The authors concluded that Americans spend far more on health care than their counterparts abroad—but that they don't actually receive more care. The title of their article? ''It's the Prices, Stupid.''
Where was all that extra money going? In that nugget column, Krugman offered a few quick ideas, then said he'd discuss the question in a later column. But way back then, twelve years ago, he'd described a remarkable state of affairs:
We were spending twice as much as our peers, but receiving no extra health care!
As you may have noticed, the USA 9400 didn't appear in that column. There was a very good reason for that:
The USA 9400 didn't exist at that time.
Today, that disappeared group does exist—and you'll see them disappeared from every report you read about health care. They weren't mentioned in the Times editorial we quoted in yesterday's report. Rachel would jump off the Golden Gate Bridge before she'd interrupt her corporate clowning with news of this very key group.
Who are the USA 9400? Tomorrow, we'll remind you. They were glancingly mentioned by Bernie Sander's in Chris Hayes' brilliant hour from West Virginia on Monday night—a program whose power was wiped away as cable news dumbly agreed to chase a shiny nothingburger last night.
Twelve years ago, Krugman wrote a series of column designed to help us grasp the current role of the USA 9400. At that time, he may have believed that information could be injected into our discourse.
Sadly, we'll guess he knows better now. Today, as our big news orgs pretend to conduct a discussion of health care, the 9400's very existence is almost completely unknown.
Tomorrow: Meet the 9400