As I try to navigate through this mess, I’m struck by the example of Taiwan. In 1995, the country undertook a reformation of its healthcare system and did a very sensible thing: it looked abroad to study how other countries provide healthcare to their citizens. They ended up developing a Canadian-style model. By the end of 2004, 99 percent of Taiwan’s population was covered. By contrast, we have all these committees, political parties, interest groups and corporations, each which different proposals and ideas. Of course, it’s the fact that the government itself is lacking in focus. The Senate Health Committee, the Senate Finance Committee, the White House – what’s that bit about too many cooks in the kitchen? If there is a methodical process at work to reforming U.S. healthcare, it eludes me. One would think that a reasonable method would involve some kind of task force representing a variety of interests, tasked with 1) Establishing the nature of the problem, 2a) Collecting and centralizing data, including public input, 2b) Studying how other healthcare systems perform around the world, 3) Developing and pricing out options, 4) Forming a recommendation that will form the basis of legislation. Facts? Where?
Numbers to Study and Digest
In this reality-defying chaos, however, facts are just as much in question as opinions and ideologies. Is healthcare in need of reform or isn’t it? The famous World Health Organization study ranked the U.S. 37th in the world in terms of performance but 2nd in terms of expenditures. Critics take aim at the survey’s assumptions, a fair critique however right or wrong. But then, what do we make of the statistic of 6.8 infant deaths out of 1000 births, which is higher than other countries with socialized or universalized medicine? (Japan: 2.8, U.K.: 5.1 Germany: 3.9, Switzerland: 4.2) Or how about the results of a study published in the American Journal of Medicine estimating that 62.1 percent of all bankruptcies filed in 2007 could be attributed to medical and/or illness-related debt? The authors concluded the healthcare system was broken, given how not just the poor, but also the middle class come to be crushed by high medical bills or the loss of coverage when they are too sick to work. Then there’s that pesky number of 43.6 million uninsured individuals under the age of 65 in 2008, as reported by the National Health Interview Survey.
But while these facts are certainly subject to scrutiny and the worthy topic of methodical research, the underlying pathology of the healthcare debate rests in ideology, not pragmatism. I’m reminded of the observation from media observers how the mass media tends to skewer audience perspective. For example, seasonal flu typically results in the deaths of 250,000 to 500,000 people a year across the world, according to the World Health Organization. “Ordinary” seasonal flu. By contrast, the WHO has confirmed over 180,000 cases of swine flu infection and 1,799 deaths. Logically, there is no reason to panic about swine flu any more than seasonal flu. Yet super-saturated media coverage fostered an atmosphere of panic. So it is with healthcare coverage, filled lots of information and, as Baudrillard might argue, very little meaning. And suddenly, a public option isn’t treated as competition between the government and the private sector but as the end of the private sector. Public healthcare is made out to be a form a fascism in the which the government decides who lives or dies, which is incredibly insulting to capitalist democracies like Canada. (Really. It’s insulting. Most Western countries have some form of public health insurance and all adhere to the same values of freedom and capitalism as the U.S.) Then again, people can’t even tell the difference between socialism and communism, let alone appreciate that it is possible to have degrees of socialism. Of course, the difference is subject to debate. Nevertheless, I’m reminded of that scene in “What’s New Pussycat” when Dr. Fritz Fassbender is called a lascivious adulterer and he replies, “Don’t you dare call me that until I’ve looked it up!” People could benefit from a refresher in political science before hurling the word socialism around. Beneath all of this is the hypocrisy-rich Republican fear that American democracy is under threat, as Congressman Wally Herger recently told a town hall meeting in Redding.
Between the lack of courtesy in the political discourse, the dubious news quality of the corporate mass media, popular ignorance and political grandstanding, it’s discouraging but hardly surprising that there’s no signal in the noise. Democrats bear a part of the blame for presiding over a chaotic mess, Republicans even more so for deliberately stoking ignorance and fears by disseminating misinformation. And President Obama, who so far hasn’t shown that flinty Chicago toughness we keep hearing about, is a disappointment to those of us who actually expected something progressive from him. Although it’s obviously too early to pass the final judgment on the healthcare “debate” since it isn’t over. The lack of a methodical, rational, problem-solving process doesn’t bode well.
A few interesting links used in writing this week’s column:
http://prescriptions.blogs.nytimes.com/faq-health-care/
http://www.photius.com/rankings/who_world_health_ranks.html
http://www.washingtonpost.com/wp-srv/politics/documents/american_journal_of_medicine_09.pdf
http://www.pbs.org/wgbh/pages/frontline/sickaroundtheworld/
http://www.cdc.gov/nchs/fastats/hinsure.htm
Frédérik invites you to discuss this week’s column at his blog.