Pangloss’s Health Policy

One of the key impediments to real reform of American health care is the framing of its shortcomings as individual, isolated problems. Doing his best Dr. Pangloss imitation, Greg Mankiw urges us to “look behind” numbers that indicate a) lower life expectancy in America than in Canada, and b) that 47 million Americans are uninsured. He appears to believe that if you make over $50,000 per year and don’t have health insurance, it’s you’re own fault, and your condition says nothing about the overall state of the health care system.

Maybe if Mankiw gave us some evidence on how much disposable income such families have, and how much of that health insurance would eat up, I’d be a little more open to his interpretations. But for now, I’m inclined to agree with the perspective of Tim Jost. He is a health law scholar who has thought seriously about comparative health systems, and does not share Mankiw’s tendency to “look on the bright side:”

[A] series of studies over the past decade have shown that the quality of health care in the United States is seriously deficient, and, in particular, that medical errors are common and often have serious consequences. Indeed, the quality of the health care Americans receive is no better, and in some respects worse, than that provided in many other countries that spend far less on health care and yet provide it for all of their citizens.

But I will credit Mankiw for one David Cutler-ian insight that I do think should inform current debates:

[O]ur incomes are growing, and it makes sense to spend this growing prosperity on better health. The rationality of this phenomenon is stressed in a recent article by the economists Charles I. Jones of the University of California, Berkeley, and Robert E. Hall of Stanford. They ask, “As we grow older and richer, which is more valuable: a third car, yet another television, more clothing — or an extra year of life?”

Mr. Hall and Mr. Jones forecast that the share of income devoted to health care will top 30 percent by 2050. But in their model, this is not a problem: It is the modern form of progress.

Hat Tip: VC.

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