A health care system to die for

You have got to see the trap. Otherwise we are in for a disaster. We are in for Canadian health care, French health care, British health care.

In “Measuring the Health of Nations: Updating an Earlier Analysis” (Health Affairs, Jan./Feb. 2008), Ellen Nolte, Ph.D., and C. Martin McKee, M.D., D.Sc., both of the London School of Hygiene and Tropical Medicine, compared international rates of “amenable mortality”—that is, deaths from certain causes before age 75 that are potentially preventable with timely and effective health care.

Tucked away at the bottom of that same speech is the script that most of the Republican presidential hopefuls are already following in one form or another during the current campaign. President Bush’s thoughts on the matter are worth quoting in their entirety if only to show that these guys (and that would be the policy folks and speech writers who will move seamlessly over from the White House to one of the Republican campaigns as the campaign progresses) apparently really do believe in this sort of market magic for health care. Indeed, it’s almost as if President Bush copied and pasted his remarks over from a Rudy Giuliani speech on this same subject. Or was it the other way around?

“Now, secondly, we can help people deal with health care. There’s a fundamental debate taking place in Washington.health club I’m on the side of, let’s strengthen private medicine rather than weaken private medicine. I’m on the side that says the more consumerism, the more choices people have in health care, the better off the health care system will be. I’m on the side of saying to small businesses health savings accounts are a smart way for you to be able to ensure your people. I’m on the side of small businesses by saying I believe businesses ought to pool — be allowed to pool risk across jurisdictional boundaries. That’s fancy words for, if you’re a restaurant in Chicago, health club you ought to be able to put your employees in the same risk pool as a restaurant in Texas, so you can get discounts on your insurance, just like big companies can get discounts on their insurance.

“And I’m for changing the tax code. The current tax code penalizes people who go shopping for health care in the individual market. If you’re a small business owner, you know what I’m talking about. It’s hard to go find insurance in the individual market because the tax code, frankly, discriminates against the individual relative to the person who gets tax — health insurance through corporate America. And I think all families ought to get a $15,000 deduction for health care, or individuals a $7,500 deduction for health care, regardless of where they work. (Applause.)

“And all of a sudden the playing field gets level, and it’s more likely an individual market begins to grow. And when you couple that with transparency of pricing and information technology, you can begin to see the emergence of a health care system that’s patient-reliant, that focuses more on the doctor-patient relationship and less on instruction from Washington, D.C. And there’s a fundamental debate, and I strongly believe the government, by passing good policies, can help us deal — help small businesses deal with health care — is a key issue.”