What’s the New York Times' beef against American health care? 

Well, it’s sure not the same as our beef: that patients don’t control nearly enough of the money churning through the system.  Indeed, the Times' editors think we’ve got too much of that already, thank you very much.  Too bad they don't have their facts straight.

The Times actually does a good job representing the Commonwealth Fund’s conclusions about the superiority of actual health care in America, especially preventive care like Pap smears, mammograms, and cholesterol checks as per clinical guidelines.

Nevertheless, the editors are concerned about a seven year old report by the World Health Organization (WHO), a branch of the United Nations bureaucracy, which ranked U.S. health care only 37th in the world.  Michael Moore’s absurd SiCKO documentary caused the editors to resurrect this study in support of their call for a complete government take-over of U.S. health care.

Michael Moore “extolled the virtues of government-run health care systems in France, Canada, and even Cuba while deploring the failures of the largely private insurance system in this country”.  But how did those countries perform in the WHO’s rankings?

Well, France was number one.  Case closed?  Not quite.  At 30th, Canada, which has the most closed government health monopoly in the developed world, barely beat us out.  The United Kingdom achieved a little better at 18th, but I suppose we can be glad we squeaked by Cuba, which lies down at 39th spot.  Hmm ... It doesn’t look like an open & shut case for government health care, does it?

Meanwhile the Netherlands, which the WHO notes re-introduced private health insurance in 1990 after abolishing it in 1941 (under Nazi German occupation, if my memory of history serves me well) comes in nicely at 17th spot.  Also, (modern) Germany ranks 25th and Switzerland 20th.  These two countries also have private health insurance (although subject to mandatory purchase, similar to that recently imposed in Massachusetts, so it’s hardly “free”).

The Times’ idea that “all major industrialized nations provide universal health coverage, and most of them have comprehensive benefit packages with no cost-sharing by citizens” is also wrong.  Perhaps the Times believes that a state funds its national health budget from a chest of gold in the basement, rather than full cost-sharing via taxation, but even so, the statement is incorrect.  The U.S. relies on 3rd party bureaucracies, both public and private, to fund 86% of health spending, a greater share than 17 other OECD countries, including Canada (see Michael F. Cannon & Michael D. Tanner, Healthy Competition, Washington, DC: The Cato Institute, 2005: pp. 46-47).

Nor do the WHO rankings support the Times’ claim that the U.S. “ranks dead last on almost all measures of equity”.  When it comes to “equality” of health outcomes, measured by Disability-Adjusted Live Expectancy (DALE), the WHO shows the U.S in 24th place, leading Belgium (26th), Monaco (30th), South Korea (37th), and even that paragon of equality – Sweden (28th)!

In any case, the WHO rankings include other measurements of “equality” with which one might quibble.  For example, if one country has an average life expectancy of 80 years, with one half of the population living to 90 years and the other half to just 70, its ranking will suffer versus a country where everyone lives to be exactly 60 years old – the latter being more “equal”.

The WHO also ranks by “fairness of financial contribution”, whereby the U.S. rates poorly versus most other developed countries.  But that is surely because pre-tax payments for employer-sponsored health care under our progressive income taxes favor higher earners.  Either a flat tax or a refundable tax credit would improve this measurement – to which I say (in the words of Senator John Kerry), “Bring it On!”