TWO (REPUBLICAN) WOMEN! Gail Wilensky and Betsy McCaughey present a punishing contrast: // link // print // previous // next //

Your nation seems to ration facts: How much do the Japanese spend on health care? In a nation like ours, where information seems rationed, it’s maddeningly hard to find out.

Consider Blaine Harden’s front-page report on the Japanese health system in yesterday’s Washington Post.

At several points in his lengthy report, Harden cited OECD data on health care spending. But he never cited these OECD data—data which answer that simple question in a simple, straightforward way:

Total spending on health care, per person, 2007:
United States: $7290
Japan: $2581 (2006)

Good grief! According to those basic data, the Japanese spent 35 percent as much as we did in 2007, on a per capita basis. That’s why we were surprised when we met this construction, right in Harden’s opening paragraph:

HARDEN (9/7/09): Half a world away from the U.S. health-care debate, Japan has a system that costs half as much and often achieves better medical outcomes than its American counterpart. It does so by banning insurance company profits, limiting doctor fees and accepting shortcomings in care that many well-insured Americans would find intolerable.

Somehow, Japan’s health system now “cost half as much” as ours! Where did Harden get that formulation? Groan. It had happened again!

HARDEN: Health care in Japan—a hybrid system funded by job-based insurance premiums and taxes—is universal and mandatory, and consumes about 8 percent of the nation's gross domestic product, half as much as in the United States. Unlike in the U.S. system, no one is denied coverage because of a preexisting condition or goes bankrupt because a family member gets sick.

Presumably, that’s why Harden said Japan’s health system “costs half as much” as ours. You see, Japan spends half as much as we do on health care—as a percentage of GDP. That’s an absurdly indirect formulation for a general-interest news report. Of course, the New York Times did the same thing last week, when the great newspaper finally deigned to discuss foreign health care at all (see THE DAILY HOWLER, 9/1/09).

Harden offers a bewildering array of statistics on spending and cost. On balance, the sheer volume of these statistics only makes it harder to get clear on how much the Japanese spend. And he sometimes offers puzzling claims. Like this:

HARDEN: One of the great strengths of Japan's health-care system—the ability to see the doctor of one's choice and be seen quickly—has become one of the greatest curses for controlling health-care quality and costs, experts here agree.

Japan spends 35 percent what we spend. But in this paragraph, Harden discusses just one of the system’s “greatest curses for controlling health-care costs!” By the way: Regarding “the ability to be seen quickly,” Harden had already written this:

HARDEN: To keep costs down, Japan has made tradeoffs in other areas—sometimes to the detriment of patients. Some are merely irritating, such as routine hour-long waits before doctor appointments. But others involve worrisome questions about quality control and gaps in treatment for urgent care.

In Harden’s report, the ability to see your doctor quickly is one of the curses for Japanese cost control. And not only that! Routine hour-long waits before appointments is one of the trade-offs the Japanese have made in order to keep costs low!

A contradiction? Not necessarily. You decide.

Who knows? With this piece, the Post may be embarking on wider coverage of the foreign experience. Such coverage would be years overdue, of course. In the past few decades, this country has been bombarded with pseudo-conservative disinformation about the foreign experience. As this has happened, our greatest newspapers have stared off into air, refusing to correct or challenge the repetitious false claims which have set the table for this year’s hapless health care debate.

That said, it can be maddening when our big newspapers do tackle such topics. To wit:

How much do the Japanese spend on health care? As you may recall, T. R. Reid answered that question in his own recent piece in the Washington Post. He even used straightforward, per-person spending figures! But aaarrgh! Perhaps you recall what happened (see THE DAILY HOWLER, 8/24/09). We’ll blame this on Reid’s editor:

REID (8/23/09): On average, the Japanese go to the doctor 15 times a year, three times the U.S. rate. They have twice as many MRI scans and X-rays. Quality is high; life expectancy and recovery rates for major diseases are better than in the United States. And yet Japan spends about $3400 per person annually on health care; the United States spends more than $7000.

Reid didn’t say what year he was talking about, or where his data came from. Much more important: He gave a fairly precise figure for Japanese spending—and a highly approximate figure for ours! “More than $7000?” That can mean many different things. As of 2007, for instance, the United States was already spending well more than $7000, according to the OECD data. Would it kill the Post to present both numbers in their most precise formulation?

Reid used per-person spending figures—but did some unhelpful rounding. Harden went with the absurdly indirect “as a percentage of GDP” formulation. So did the New York Times before him. Our analysts all tore their hair.

How much do the Japanese spend on health care? In a word, those OECD data are startling. Luckily, there seems to be a law in this country which forbids scribes from giving them out.

Postscript: How much do the French spend on health care: Those French! It can be maddening to try to answer such questions.

On Sunday, T. R. Reid did an hour on C-Span with Brian Lamb. (To real the full transcript, click here.) At one point, Reid discussed those French—and described how much they spend:

LAMB (9/6/09): Who says that France is the number one medical health care system in the world?

REID: The World Health Organization did a big four-year study of all the health systems in the world, 191 countries...They rated them from one through 191. And France came in first. So they rated it as number one. And I—is it best in the world? I don’t know what—I think it’s a very good health care system. Their results are great, they live longer and healthier than Americans do, and spend maybe 60 percent of what we do on health care per capita.

The French spend “maybe 60 percent” what we do? Reid may be right, of course. But here are the OECD data:

Total spending on health care, per person, 2007:
United States: $7290
France: $3601

Sorry, but these questions matter. Why does an interested citizen have to flounder around, attempting to puzzle such matters out? Because our biggest newspapers—and our “liberal journals”—have ignored these questions. For decades.

So have Democratic politicians, of course—even the ones our news orgs describe are our liberal heroes.

Special report: Enabling the (un)real McCoys!

PART 1—TWO (REPUBLICAN) WOMEN: Last week, we watched two different Republican “experts” as they discussed proposed health care reform. We were struck by the contrast between these well-known women.

First, we watched Gail Wilensky at a panel discussion sponsored by the non-partisan, non-profit Alliance for Health Reform. Two decades ago, Wilensky was in charge of Medicare and Medicaid under President Bush the elder. She has been a familiar Republican expert on health care issues at least since the late 1980s.

And one other thing: Gail Wilensky isn’t insane. No, she isn’t a Democrat, or a “liberal;” she wouldn’t necessarily support major parts of the current reform proposals. But below, you see what Wilensky said in response to this forum’s first question.

Sigh! Sadly, the forum’s first question came from a man who seemed to be worried about those “death panels.” This man seemed completely sincere in his question—but then, so did Wilensky, in his answer. As Wilensky batted this “unfortunate” “red herring” away, her long, thoughtful answer recalled an earlier day—a time when major Republican experts were still allowed to be sane.

What follows is the work of a Republican expert from a different era—from the late 1980s. We’ll present most of Wilensky’s answer, which can be seen starting at 32:30 of this C-Span tape:

WILENSKY (9/3/09): I would like to comment on the “death panels” charge, which I’ve done now a number of times.

I think it is really unfortunate that this has been raised and received so much attention because there are serious issues to debate in the health care reform—how we finance the money; the whole notion of a public plan and whether it is or is not compatible with private insurance as we know it; whether we’re not talking enough about reforming health and health care costs and talking only about health insurance reform. Many issues.

I regard the “death panel” as a red herring issue, to the extent we are talking about proposing payment for physicians that are asked by their beneficiaries, by their patients, to have counseling on either hospice benefit or end-of-life advance directives once in every five years.

And the reason I think it’s unfortunate is really two-fold. In the first place, this is already—the hospice—is already a Medicare-covered benefit now. And in addition, nursing home administrators and hospital admissions individuals are supposed to ask people who are on Medicare when they’re admitted to hospitals and nursing homes if they have advance directives, and if so to mark it in their chart so that those advance directive can be followed.

Given that that’s already the case, I regard this as a way to pay physicians to provide that counseling if they’re asked to by their patients, and fundamentally to empower patients to have their wishes known about advance directives if they choose to do that...

Allowing people, particularly not when they’re going into a nursing home or a hospital, to have this discussion with their physician or their nurse practitioner or their family members, to try to help them think through what is an issue that individuals may face, being put in a position when they’re not able to register their own will in terms of how they would like to be treated, is an important part of life.

It doesn’t in any way require people to have these discussions, just as Medicare doesn’t require people to have hospice as a benefit. It allows it. I think it is a major empowerment for seniors, but any senior that doesn’t want to have this discussion, either about a hospice benefit or about an advance directive, need not do so.

And that’s why I find it so upsetting that there’s this notion of “death panels.”

Wilensky was sane and thoughtful throughout. She batted the poisonous nonsense away. She was talking about Betsy McCaughey as she did—and about Sarah Palin.

But then too, there was McCaughey herself, on display that very same day. That same morning, McCaughey had written this gruesome, poisonous letter in the New York Times.

McCaughey is one of the most repugnant figures in modern American politics. The fact that she still drives our major political debates in a howling indictment of the Democratic Party—and of the career liberal world. In 1994, McCaughey invented “ridiculous, blatant falsehoods” about the Clinton health plan. Fifteen years later, she was able to do the same about the Obama health plan!

The fact that McCaughey could do this again, some fifteen years later, says something very unflattering about our whole liberal “movement.”

Go ahead—look at Wilensky’s statement, in which she bats McCaughey’s bullshit away. Then read McCaughey’s grotesque missive, published that very same day.

McCaughey seems to be one of our biggest fakes. Or she may be a genuine nut. But fifteen years later, she did it again! Meanwhile, here’s the question we asked when we read her letter:

Is Betsy McCaughey speaking English here? Fakes like McCaughey have been at this for decades. Why don’t they get kicked to the curb?

Tomorrow—Part 2: Enabling McCaughey.