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?"No one does it better?" That's what Simon once sang. Concerning our American health care system, Klein authored a striking counter claim:
KLEIN: You could almost not do it worse than we do it. I will start there.
ROSE: Go ahead.
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.No one does it as poorly as we do, Klein had originally said. France most likely does it best, he now alleged.
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.
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—Let's note several points:
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.
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, 2015Wow! 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!
United States: $9451
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.