This video from the independent broadcaster, The Real News Network, aired on Jan. 18, and features Donna Smith of the California Nurses Association debating Shikha Dalmia, a senior analyst for the libertarian think tank, Reason Foundation. This segment took place before Republican efforts in Congress to repeal the federal health reform law failed. Both Smith and Dalmia criticize the reform law, but prefer very different alternatives to it. Smith is a single payer advocate who was featured in Michael Moore’s movie, Sicko. Dalmia favors so-called free-market solutions to the healthcare crisis. One should be aware, however, that the Reason Foundation has received funding from Charles and David Koch, the billionaire businessmen who have helped bankroll the anti-tax Tea Party movement and who are behind efforts to undermine health reform.
Dalmia’s arguments here are so riddled with errors and half-truths, it makes one’s head spin. Smith holds her own in the debate, but neither she, nor the moderator completely knocks down Dalmia’s claims. First of all, Dalmia rejects the fact that the United States spends about 17% of GDP on health care. Instead, she makes a dodge, preferring to focus on the rate in health care spending increases, which has indeed slowed recently.
She also says that France and Germany are single payer systems that spend the most in GDP on health care. Wrong again. France and Germany do not have single payer systems. Both countries have Bismarck-style systems similar to the U.S., in which private health providers and private insurance companies deliver care. Where France and Germany differ from the U.S. is that the insurance companies in those countries are prohibited from making a profit on basic health care, and they are heavily regulated. In fact, Switzerland, which also relies on private health providers and regulated private insurance companies, spends the most after the U.S. — nearly 12% of GDP.
Contrary to what Dalmia claims, healthcare spending in the U.S. is out of control because of deregulation in the healthcare industry. Japan, which also has privatized health providers and insurance companies, is famously aggressive at controlling costs. For more information on healthcare systems around the world, read T.R. Reid’s excellent book, The Healing of America: A Global Quest for Better, Cheaper, and Fairer Health Care. In his chapter on Japan, Reid provides the perfect counter-example to Dalmia’s assertion that innovation only arises from “competitive” (libertarian-speak for “unregulated”) markets. Reid writes about how the Japanese government’s tight cost controls prompted MRI manufacturers in the country to invent smaller and less expensive scanners.
Next, Dalmia says that you can’t “cram 35 million people in the system and not go bankrupt.” Ridiculous. We’re going bankrupt now because the millions of uninsured aren’t contributing to the risk pool, and when they end up seeking care in emergency rooms, that drives up costs for everyone else. Then Dalmia says Medicare does a bad job at controlling costs. A big reason for this is our fragmented, profit-driven system. Also, the program was partially privatized after then-President George W. Bush enacted his big Medicare drug giveaway to Big Pharma in 2003. In addition, the government is prohibited from negotiating drug prices for Medicare recipients, contributing to spiraling costs. Even so, the growth in healthcare costs for Medicare has been slower than for private insurance.
What’s most laughable is how Dalmia complains that any sort of government involvement in health care is a civil liberties violation – that the government will end up making healthcare decisions for people. But, the private insurance companies do that already. The insurance companies dictate what kind of treatment people can have and whether they get any treatment at all — sometimes resulting in deadly consequences. Under a publicly funded, privately delivered, single payer system, patients and their doctors – not government bureaucrats or insurance company bean counters – make the healthcare decisions.
I agree with Dalmia that the U.S. needs to end the connection between employment and health insurance. But her solution is to essentially throw every American into the individual private insurance marketplace, where people would be at the mercy of insurance companies. This would make an already bad situation infinitely worse. With nearly half the U.S. population having preexisting conditions, the 50 million uninsured would quickly grow to over 100 million uninsured. That situation would drive up costs to unimaginable heights. And the deregulated environment would rapidly result in more insurance company monopolies. But Dalmia’s last idea is a real head scratcher. She suggests that to help people who can’t afford insurance in this newly deregulated environment, they should receive government-subsidized tax credits! First of all, any tax credit the government might provide would probably be paltry, and not enough to cover any major medical treatment. Second, I thought Dalmia was a libertarian. Aren’t tax-hating libertarians supposed to be against government-subsidized anything?