HEALTH CARE $$$$: Charlie Rose turned to Ezra Klein first!

WEDNESDAY, MAY 31, 2017

Part 2—No one could do it worse:
"Nobody does it better?"

That's what Carly Simon once sang. It was part of a gigantic hit devoted to 007.

Last Thursday night, on the Charlie Rose Show, Ezra Klein authored a bit of a spin-off. It came when Klein was asked to comment on the American health care system.

Rose was midway through a 21-minute segment about American health care. He spoke with Vox's Klein and with Peter Orszag, former head of both the CBO (under President Bush) and the OMB (under President Obama).

Toto, we weren't on CNN any more! Rose wasn't handling a panel of six. He wasn't asking a string of guests to speculate about the motives behind an exciting act which may or may not have occurred.

This was PBS. Rose was speaking with only two guests—and each could be assumed to know what he was talking about. They were discussing a major policy matter—a policy matter concerning which there are oodles of real information.

For the first twelve minutes of the segment, Rose asked his guests about the GOP's latest health care proposal. Also, about the strengths and weaknesses of Obamacare.

At that point, Rose expanded his field of review. Twelve minutes into his discussion, he threw an expansive question to Klein and received an expansive reply.

To watch the whole segment, click here:

ROSE (5/25/17): Is there a place where they have perfected health insurance?

KLEIN: You could almost not do it worse than we do it. I will start there.

ROSE: Go ahead.
"No one does it better?" That's what Simon once sang. Concerning our American health care system, Klein authored a striking counter claim:

No one could do it worse!

Let's repeat one basic point. Klein and Orszag aren't a pair of cable news time-killers. They tend to know whereof they speak.

In that sense, Klein had made a remarkable claim about our health care system. Responding to Rose's guiding hand, he quickly proceeded from there:
KLEIN (continuing directly): There are a lot of interesting models out there. And different people like different ones.

So I think the model most people think is the highest performing is France, where you get a basic level of insurance and then the state gives some people supplementary insurance and other people buy it themselves.

Conservatives like Singapore, a lot, and Singapore is kind of interesting. They have a supercharge in individual mandate where they force you to save a large percentage of your paycheck to cover health bills, and then they have a sort of universal catastrophic plan, not quite universal but most people buy into it.
No one does it as poorly as we do, Klein had originally said. France most likely does it best, he now alleged.

Also, conservatives like the way they do it in Singapore! You'd almost think that these would be seen as intriguing, important statements.

Something else was interesting as Klein continued to speak. As he continued, he instantly turned to the question of health care costs.

No one does it worse than us? Instantly, Klein seemed to say that we're spending too much, and that this central problem involves the setting of prices. Orszag jumped in to agree:
KLEIN (continuing directly): But the thing that every one of these countries has in common, every single one, is that in one way or another, in one way or another, they set prices centrally. Every single country that is a developed democracy—just a developed country, except for the United States, the—

ROSE: They set prices on—

KLEIN: The government says, "Here is how much, here is how much an MRI is going to cost. Here is how much a Xanax is going to cost." No matter how they do it—and that is the key thing that makes all of them cheaper. And when it's cheaper, then you have a lot more room how you design insurance.

ROSE: But we just had [Nebraska senator] Ben Sasse in this taping, taping at this table, saying what the Republicans were horrified by is the idea of government setting the prices.

ORSZAG: Right. And first of all, Ezra is absolutely right. The reason that U.S. health care costs more than other countries, it's not, as is often repeated, that we do more here. It's that what we do, the prices are much higher.
Let's note several points:

After saying that no one does it worse, Klein moved directly to the question of costs. He seemed to say that our problem involves the cost of health care, not the quality of the care that is available and/or provided.

Klein seemed to say it's the matter of cost which makes France so much better. He then attributed our nation's high health care costs to a single central problem—to our failure to "set prices centrally."

At this point, Orszag jumped in to say that Klein was right. He didn't explicitly second the claim that no one does it as poorly as us. But he agreed that health care costs more in this country because the prices are higher.

Health care costs more because prices are higher? It almost sounds like something Chance the Gardener would say. But Orszag was making this completely coherent point:

We don't spend more on health care because we provide more services, Orszag said. We spend more because we charge more for those services.

Wow! At this point, we were only 90 seconds into this part of Rose's discussion. Already, though, very large claims had been made about a very big policy area.

Klein had said that our health care system is the worst in the world. Throughout the rest of the discussion, Orszag never disagreed with that.

The pair had then quickly focused on costs. They said our health care costs were high because, unlike every other developed nation, our government doesn't set health care prices.

No one does it worse than us? Most likely, France does it best? The problem revolves around health care costs?

Charlie's guests were trashing our health system hard. If our journalistic system was better, these extremely basic data might have appeared at some point:
Per capita spending, health care, 2015
United States: $9451
France: $4407
Wow! In a slightly more rational world, jaws would have dropped as PBS viewers gazed on the size of the problem. We spend more than twice as much, on a per person basis, as highly-regarded France!

No one does it better than France, and no one does it as poorly as us. Theoretically, those remarkable data help us ponder the remarkable size of this problem.

That said, we think you know the rules! Long ago, the gods who rule our public discourse issued a major decree. The American people must never be shown the size of this ludicrous problem.

Those data come from the OECD. Within the world of American discourse, they've long since been disappeared.

Klein and Orszag continued to speak, but those data were never mentioned and never appeared. Even worse, the discussion by Rose's guests now took a peculiar turn.

Rose's viewers were never shown how vast our over-spending is. Instead, they were quickly told that nothing ever will or even should change around here!

Tomorrow: "If we take it for granted..."

Concerning Singapore's spending: Singapore is a small, high-income city-state which isn't part of the OECD. For that reason, we can't give you OECD data on their health care spending.

Data from the World Health Organization seem to show Singapore spending substantially less than France. We haven't worked with these data before, but you can give them a shot.

Charlie Rose viewers saw zero data last Thursday night. Within our journalistic system, those remarkable data about health care spending are routinely, by law, disappeared.

7 comments:

  1. This is about as simplistic as a discussion can get.

    First, our government does set prices for what it reimburses. Prices for what will be reimbursed are also set by insurance companies. The remainder is written off against taxes. If someone is wealthy, they may be asked to pay that remainder. If someone cannot pay, that extra amount becomes a writeoff.

    The highest costs are often because providers are mandated to treat everyone who comes to an emergency room in urgent need, regardless of ability to pay. The costs of treating the indigent are spread across the other patients in the form of increased charges per procedure. Hospital or practice administration costs are also reflected in the charge per visit or procedure. Those administration costs include the cost of equipment and insurance and nursing and other support staff, not simply the doctor's time. It matters whether rents or buildings cost the same in France, not just how much a procedure is priced at.

    The markups on supplies and drugs arising from a slew of middle-men and involvement of private companies are passed along to patients. There are no cost controls on these and pharma is called Big Pharma for a reason.

    Notice that both France and Singapore are including only the costs of basic services in those dollar amounts. Catastrophic illness is covered by insurance or separate policies, not the public health service. It is unclear whether and how those costs are included in the dollar amounts listed. Same in many of the OECD countries. In the US, there is not a distinct public/private dividing line so it is unclear how US services are measured compared to these other countries. For example, we have a huge alternative medicine market that is intermingled with regular health care. How is that included in the OECD numbers?

    Somerby loves Klein and seems to regard him as some kind of expert, but to my knowledge, he has no expertise in the medical field. He is a journalist. I doubt he would be able to explain whether France includes the cost of digital medical records in its health care numbers (these are mandated by ACA) or whether HIPAA exists in France necessitating more red tape and clerical staff, or whether France permits doctor-shopping, or whether homeless are part of the client base.

    So, it is facile to say that we must set prices without know anything at all about how health care works in our country compared to France.

    When a corporation wants to cut costs, it generally lays people off. It doesn't think about costs to hire and retrain the staff they will need later when business conditions change, or how the layoffs will affect their business. It is the easiest way to reduce the bottom line. Klein is doing the same thing here. His grasp of what contributes to medical costs is superficial so he says set prices. He doesn't know the first thing about how that will affect the medical industry or what actually drives higher costs and what inefficiencies need to be addressed in the market. You need to know how medical services operate to know what should be cut. The rest is nonsense, made more dangerous because the disruption of health care services would affect the wellbeing of so many people, if not their lives.

    ReplyDelete
    Replies
    1. 1:38 PM,

      You've got us convinced, you have a lot of time on your hands.

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  2. OT, but according to the Wall Street Journal yesterday, Mike Flynn's consulting company was paid $530,000 by The country of Turkey to produce a documentary.
    That is all.

    ReplyDelete
  3. Anon 1, if we had single-payer, we wouldn't have the ER prices for the uninsured, first. Derp!

    Second, you yourself said it on insurers setting prices, or trying to. However, single payer has one paying entity swinging some heavy payment lumber.

    Third, single payer has one billing system, or it does except for supplemental policies. Lot less doctor and hospital overhead. Related to that, it would probably give them leverage to demand that "gap" insurers use exactly the same billing system as the feds.

    Otherwise, no, your complaint against the OECD is simply wrong. Both it and the WHO list per-capita expenditures. Period. https://en.wikipedia.org/wiki/List_of_countries_by_total_health_expenditure_per_capita

    That said, per that link, a few countries, like Norway and Switzerland, are as close to the US as to France in costs.

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