Critical Condition

NRO’s health-care blog.

Nicolas Kristof Hosts Straw Man of the United States to Talk Health Reform


The other day, one Noam Neusner, writing in the Wall Street Journal, identified the fellow whose been saying “No!” to all the president’s goals: The Straw Man of the United States.

SOTUS just made a guest appearance in Nicolas Kristof’s column in the New York Times, “Do We Really Want the Status Quo on Health Care?” Hands up! Anyone want the status quo?

I didn’t think so. Everyone wants some kind of reform, but only those who want more government control over people’s access to medical services are called “reformers” by the media. Those of us who advocate that the American people, not their employers or their governments, should own health coverage of their own choice are naysayers (or, perhaps soon, “health-crisis deniers”).

A New York Times columnist calling for government-monopoly health care is not surprising. What is surprising is Mr. Kristof’s use of international evidence. He cites a recent New England Journal of Medicine editorial, which cites a debunked World Health Organization survey from 2000, which ranks the U.S. 37th in the world in health care.

Strangely, the NEJM editorialists, via Mr. Kristof, also present a graph reporting that the probability of death for boys and men, aged 15 through 60, has declined significantly faster in Australia and Sweden than the U.S., from 1970 through 2007. As an argument for a government take-over of health care, it has a couple of problems.

First, Australia already performed better in 1970: Five years before it instituted its national health program. True, as Mr. Kristof notes, Australia has improved at a faster rate than the U.S. However, it has improved at a relatively constant rate throughout the period, despite significant changes in the system. Although the 1975 “Medibank” plan promised “universal” coverage, it was rolled back almost immediately. Between 1976 and 1984, the public hospitalization benefit was rolled back from “free” to covering only 75 percent of costs for most patients, a tax credit was introduced to encourage purchasing of private insurance, and finally the “pay or play” condition of paying a levy or buying private insurance was tossed out. In 1984, “Medicare” was launched, with benefits similar to the original Medibank. However, in 1999 a 30 percent rebate on private-insurance premiums was introduced to increase the number of people covered privately, which it achieved. Clearly, crediting government with Australia’s relatively greater success in improving the probability of death is an inaccurate narrative.

Second, Sweden’s health-care system is run locally: County and municipal councils, not the national government, are responsible for health coverage. 72 percent of counties’ revenue is from own-source taxation; and only 18 percent is transfers from the national government. Imagine how U.S. health care would change if the federal and state governments cut taxes and spending on health care to the level of that of the Swedish national government! Furthermore, counties’ have been privatizing hospitals since the mid-1990s. According to an article in the Canadian Medical Association Journal, this has resulted in flexibility and better performance than in Canada, where provincial governments persist in monopolizing hospitals.

As an argument for more federal government control of health care, Mr. Kristof’s column flops. Of course, he also ignores the host of variables that make international comparisons of health outcomes extremely challenging, and those where care in the U.S. is superior.

John R. Graham is director of Health Care Studies at the Pacific Research Institute.


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