Right Thinking From The Left Coast
If everything seems under control, you're not going fast enough. - Mario Andretti

I Dream of Rwanda

This is something so stupid it has to be seen to be believed:


SNYDERMAN: One other sort of tough question. Some experts this weekend have said we are looking at class warfare in the United States and you have to say those words if we’re going to move forward.  Would you agree with that?

ROBINSON: As somebody who works in this country but as a guest, if you like, I’ll leave it others to put it in sharper terms.  What I would like to suggest from a global health perspective is look at what some of the very poorest countries have done. Rwanda, a post-genocide country, has 90% health insurance cover.  I was there last September and I was there in March --

SNYDERMAN: You’re making me jealous.

ROBINSON: Doesn’t it?

Caveat time.  This is from Newsbusters (Lee once described them as the turd swirling around the toilet bowl of journalism) and the clip cuts off very suddenly.  It’s possible—in fact, very likely—that Robinson immediately noted that Rwanda is a basket case of a nation and not exactly an example of a great healthcare system.  But I looked up the numbers from the ballyhooed WHO report that Michael Moore based his stupid movie on.  It’s five years old but I doubt much has changed.  Rwanda ranked 145th in responsiveness but 58th in the Fairness Index.  So the care is shitty, but it’s not too unequal in its shittiness (the US ranks 54th in fairness, a key factor countering our off-the-charts ranking in responsiveness).  Their overall ranking is 181st.

So, yeah.

When even the WHO says your healthcare sucks, your healthcare sucks.  I shouldn’t pick on something so stupid.  No doubt if she had to say it over again, she’d pick a better example like ... um ... Cuba?  Anyway, her answer is less important in the specifics than in the principle.  The emphasis we are getting from the Left is entirely on insurance and having coverage.  Forgets costs, forget quality, forget freedom.  As long as we can get 300 million plastic cards into 300 millions wallets, that’s a noble achievement in and of itself, even if those cards are about as useful as credit card issued by Lehman Brothers.

But being insured is not the end-all be-all.  People without insurance get care (and no, Joe Klein, it’s not all expensive emergency care and giving them coverage won’t save money—see Massachusetts, People’s Republic Of).  People with bad insurance are denied care.  Insurance is not some a magic wand that heals the sick and forces cancer into remission.

Just ask the people of Rwanda.  Or even a first world nation with socialized medicine like ... um ... Robinson’s own country, which the WHO ranks 25th in responsiveness, just a hair above the UK (and way below the US) and has 41,000 people on waiting lists.  And Ireland’s system is good by the standards of socialized systems.

As a palette cleanser, I’ll refer you to McArdle’s diatribe today that gets at the heart of why I oppose national healthcare.

Basically, for me, it all boils down to public choice theory.  Once we’ve got a comprehensive national health care plan, what are the government’s incentives?  I think they’re bad, for the same reason the TSA is bad.  I’m afraid that instead of Security Theater, we’ll get Health Care Theater, where the government goes to elaborate lengths to convince us that we’re getting the best possible health care, without actually providing it.

That’s not just verbal theatrics.  Agencies like Britain’s NICE are a case in point.  As long as people don’t know that there are cancer treatments they’re not getting, they’re happy.  Once they find out, satisfaction plunges.  But the reason that people in Britain know about things like herceptin for early stage breast cancer is a robust private market in the US that experiments with this sort of thing.

So in the absence of a robust private US market, my assumption is that the government will focus on the apparent at the expense of the hard-to-measure.  Innovation benefits future constituents who aren’t voting now.  Producing it is very expensive.  On the other hand, cutting costs pleases voters this instant.  This is, fundamentally, what cries to “use the government’s negotiating power” with drug companies is about.  Advocates of such a policy spend a lot of time arguing about whether pharmaceutical companies do, or do not, spend too much on marketing.  This is besides the point.  The government is not going to price to some unknowable socially optimal amount of pharma market power.  It is going to price to what the voters want, which is to spend as little as possible right now.

You really should read the whole thing.  There’s much more, such as the inevitability of lifestyle police and arrogance of power.

In the end, for all the remarks I make about efficiency and freedom, this is my biggest concern—that national healthcare will destroy innovation. Cheap Viagra will be paid for by future epidemics of antibiotic-resistant disease; our children will never see a cure for Alzheimer’s or Parkinson’s because we insisted on affordable angioplasty; our grandchildren will never know what it’s like to live without pain because they government decides how much percocet you can take.

The defining motto of today’s politics is “Fuck the Future!” And national healthcare has become a distillation of every greedy, selfish, child-robbing, future-crippling instinct out there.  From massive deficits to cost controls that will be somebody else’s responsibility to the destruction of pharma research, the entire debate is focused on benefitting today’s voters at the expense of tomorrow’s.  From both sides.

Update: Check Mark_M’s comment, in which he notes that we have an insurance rate in this country that actually exceeds Rwanda’s.

Posted by Hal_10000 on 07/28/09 at 05:26 PM (Discuss this in the forums)


Posted by on 07/28/09 at 07:30 PM from United States

On any issue, the left would rather have 100% of the people miserable as long as we were all equally miserable*, than have most people happy, but have some happier than others. 

*Note that usually the elites that make the decisions aren’t part of this 100%-they get better everything because they deserve it because they make all the decisions about all of us.

Posted by on 07/28/09 at 08:51 PM from United States

90% coverage in Rwanda? Even assuming that’s true, and assuming that the 46 million U.S. uninsured is true (which it isn’t, but for sake of argument let’s go with it), then with a population of 304,000,000 in the U.S., that leaves 258,000,000 with coverage.

The U.S., then, has 85% coverage, which isn’t a whole heck of a lot less when you consider the unbelievably better care you get here, not to mention the massively larger population. (Rwanda has a little over 8 million people. I’d like to see the healthcare they get with a 37x larger population.)

If you go with the more realistic number of people uninsured at any given moment (rather than anyone who was without coverage during the previous year), the number drops to something like 25,000,000, which gives coverage of about 92%.

I’m sick of various talking heads throwing numbers around..it’s easy to state percentages like that and people think “Oh my God! Fucking Rwanda has better healthcare than us!”

As a footnote, I’ll leave you with this quote, from a report on Rwandan medical care. (I found this on the first link on Google, if a reporter happens to put in the effort...)

Fifty-three percent of facilities (93 percent of hospitals but less than half of health centers or dispensaries) have regular electricity or a generator with fuel.

Onsite water was available at 74 percent of facilities, however, only 47 percent had year-round onsite water. Soap and water for hand-washing were present in all service delivery areas at 55 percent of facilities. Items for infection prevention were more consistently available in GAHFs than public facilities.

Eighty-six percent of facilities had functioning equipment for either high-level disinfecting or sterilizing reusable equipment, however, only 42 percent had the equipment, staff present who knew the correct processing time, and an automatic timing device.

Posted by Ed Kline on 07/29/09 at 07:24 AM from United States

Good post Hal!  Are you guys ever going to do a best of Lee type thing on here?

Posted by Hal_10000 on 07/29/09 at 07:34 AM from United States

Damn, I forgot about that, Ed.  Jim?

Posted by on 07/29/09 at 11:23 AM from United States

Jim, Hal, et al: Do you want to start a nomination thread?  I still have bookmarked the first post I read on this site.  I was doing a little research on some medical issues.  After reading Lee’s post on medical experiments and his Dad, I abandoned my research and spent a while reading his other stuff.  Lee was a powerful writer.  I wish I could see something from him on our current administration.

Posted by Ed Kline on 08/02/09 at 10:02 AM from United States

Maybe someone should email Jim about this....

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