March 1, 2009
Franklin Delano Obama
By NICHOLAS D. KRISTOF
Most presidents are tacticians, but President Obama is a strategist. His budget suggests that he aspires to be an echo of Franklin Roosevelt and Ronald Reagan, harnessing his charisma, vision and political capital to transport America to a different place.
The best measure of that is Mr. Obama’s “down payment” to move closer to universal health coverage from womb to tomb. That is something that Roosevelt also sought, a lifetime ago.
The absurd system of health coverage we now have is a historical accident from World War II. Because of wage controls, employers competed for workers by offering health insurance as a fringe benefit — and so we’re stuck today with a system in which the loss of a job is compounded by the loss of health insurance.
Titanic ambitions encounter titanic opposition, and opponents of health reform are already rehearsing the arguments that they successfully used in the past:
We have the best health care in the world, and you want to create a socialized bureaucracy? You want to wait months for a necessary operation, as in Canada? And you really want higher taxes to pay for this, stifling the economy and undermining our long-term competitiveness?
So let’s examine those arguments.
It’s true that the existing system offers top-line medical care. The top five American hospitals conduct more clinical trials than all the hospitals put together in any other country in the O.E.C.D., the club of industrialized nations.
Yet over all, it is preposterous to argue that we have the best medical care in the world. Partly because so many Americans fall through the cracks and don’t have insurance, life expectancy is higher in most of Europe than in the United States. Even the people of Cyprus live longer than Americans, according to United Nations figures.
Meanwhile, American children are twice as likely to die by the age of 5 as children in Portugal, Spain or Slovenia. And the World Health Organization found that an American woman’s lifetime risk of dying in childbirth is more than three times that of a woman in Greece, Spain or Germany.
Meanwhile, Americans spend $6,800 per person to get these second-rate results, about double what is paid in Canada or much of Europe.
It’s true that Canadians and Britons wait longer for non-urgent medical procedures than we do. But we have to wait a bit longer than Germans do.
McKinsey Global Institute found that the United States spends about $650 billion more on health care each year than one would expect for a country at its income level. That’s $2,100 per American, and it’s one gauge of the waste of our existing system.
Repairing the system is thus not only a moral imperative but also an economic one. American businesses are at a competitive disadvantage when they have to pay for health care and foreign companies don’t. Among General Motors’ burdens is that it has to pay health costs equivalent to $1,500 for each car it sells.
Sometimes the financial incentives for aggressive care even lead to excessive treatment. One study found that Medicare patients admitted to high-spending hospitals were up to 6 percent more likely to die than patients admitted to lower-spending hospitals.
So if our health system is broken, is it really so awful that we increase taxes for the wealthiest Americans to make repairs? In 1980, the top-earning 1 percent of Americans accounted for 8 percent of the total income pie; by 2006, they grabbed nearly 23 percent.
Think of the way the system treated Michelle Morse, a full-time student at Plymouth State University in New Hampshire. Michelle was found to have colon cancer in 2003, and her physician recommended that she take a leave of absence for chemotherapy.
But if she took a leave, she would lose her insurance. Michelle stayed in school and underwent her treatments, while campaigning bravely for a law (eventually passed nationally last year) to let students remain on their parents’ health insurance while on medical leave from college. The law came too late for her: she died in 2005.
Would it have made a difference if Michelle had been able to take a leave and focus on treatment? “We’ll never know,” said her mother, AnnMarie Morse.
“It was horrible,” she said of her dealings with the insurance companies. She said that when one executive told her indignantly that the company had already paid out a lot of money for Michelle, she responded, “I would give my life for you not to have to pay one cent for my daughter.”
Not surprisingly, Mrs. Morse fervently hopes that Mr. Obama will be able to move the country toward a national health care system. If he can lead us there, even gradually, he has a chance to join the pantheon of truly great presidents like F.D.R. himself.
