Skip to main content

The health care reality conservatives ignore

By Paul Waldman
updated 1:03 PM EST, Fri November 29, 2013
STORY HIGHLIGHTS
  • Paul Waldman: Americans still optimistic Obamacare will be fixed; conservatives hope not
  • He says conservatives ignore that market solutions on health care have led to failed system
  • He says U.S.'s peer nations all have government control in their successful health systems
  • Waldman: Health care has been incredibly costly, exclusionary; conservatives say: "Whatever"

Editor's note: Paul Waldman is a contributing editor at The American Prospect and the author of "Being Right Is Not Enough: What Progressives Must Learn From Conservative Success." Follow him on his blog and on Twitter.

(CNN) -- For all the difficulties of the Affordable Care Act's rollout, Americans are more patient than you might think: A new poll shows a majority expressing optimism that the problems are going to be ironed out.

Not only that, a majority continues to support the law or think it didn't go far enough. Nevertheless, the conservatives rooting for its demise have been expressing not just vindication, but triumph. "We could be looking at the collapse of American liberalism," said columnist Charles Krauthammer. "Liberalism is crumbling in front of our eyes," echoed Michele Bachmann.

Yes indeed, a glitchy website and people moving from junk insurance to real insurance prove once and for all that government should have as little to do with health care as possible, and the entire liberal project lies in tatters.

Paul Waldman
Paul Waldman

That's a little like proclaiming that your team will inevitably lose the World Series, then go bankrupt and disband because the other team scored a run in the first inning of Game 1. But the momentary political situation aside, conservatives still face a fundamental problem when they confront America's health care system. Their ideology dictates only one solution to all health care problems, and that solution -- less government, more free market -- is exactly what gave us our dysfunctional health care system in the first place.

Let's step back a moment to consider why we needed the Affordable Care Act and what it says about the health care market. The basic conservative position is that the more you let market forces operate, the better the outcome will be. "More markets" is the answer to everything: Let people buy insurance across state lines. Make it virtually impossible to sue for medical malpractice. Create more health savings accounts.

But where do you think the problems of America's health care system came from? It wasn't government that gave us nearly 50 million uninsured Americans and denials for pre-existing conditions. It wasn't government that gave us the yearly and lifetime caps on insurance coverage that have sent so many people into bankruptcy when they've faced a serious illness or accident. It wasn't government that gave us "rescissions," where your insurance company cancels your policy if you get sick.

It wasn't government that gave us a system in which the gap between what we spend and what we get is so enormous.

It was the free market.

The conservatives who profess to love markets so dearly seem unable to grasp that the market for health care isn't like the market for shoes or cars. Other developed countries understand this. Every one of our peer nations has a system with more government control than ours, ranging from almost completely socialized systems like Great Britain's to ones like those in Switzerland and the Netherlands, which resemble Obamacare but with tighter regulation.

New Obamacare setbacks
Insurers fear more Obamacare trouble

We don't have to wonder whether a health care system built on capitalist profit-seeking is more efficient and less expensive than those in which the government exercises more control. There has been a test running for decades, with many developed countries doing it one way, and the United States doing it the other. The results couldn't be clearer.

On almost any criterion you can come up with, the government-controlled systems work better. They cover everyone, while spending far less than we do. Their health outcomes are as good or better than ours. A recent Bloomberg News analysis rated America's as the world's 46th most efficient health system, right above Serbia and right below Iran. Among the developed countries in the Organisation for Economic Cooperation and Development, the U.S. ranks first (by a mile) in health spending per capita, but 26th in life expectancy.

There are some, however, who love the American health care system. American doctors make far higher salaries than their counterparts in other countries. American insurance companies do very well. As a recent New York Times investigation revealed, makers of devices like artificial hips mark up their prices double, triple, or even more when they sell to American hospitals as they do when they sell the same devices to European hospitals. The same is true of a hundred other devices and procedures. Why? Because in Europe, Japan, and other places with highly regulated health care, government rules keep the costs low.

In the American system, there are multiple points where companies do the rational thing: Extract as much money as possible from the system. That's why an MRI costs three times as much in the U.S. as it does in France or Holland.

But people living under the oppression of those other governments' systems must hate them, right? Wrong. The Commonwealth Fund recently released a study of health systems in 10 developed countries around the world which included a survey of satisfaction. America's health system was the least popular, with only 25% of Americans saying it works well and the other 75% saying it should be fundamentally changed or completely rebuilt.

The most popular was the most socialized, Great Britain's, with 63% saying it works well. You may remember that the opening ceremonies of the 2012 summer Olympics in London included a tribute to the National Health Service, so proud are Britons of their health system.

Despite all the problems created by America's private health care market, we do have versions of big-government, socialized insurance. They're called Medicare and Medicaid. They are far more efficient than private insurance, and Medicare recipients in particular love their coverage. It's no accident that in every election, Republicans -- who fought against the creation of Medicare and would love to privatize it -- try to pretend to voters that they're the program's greatest defenders. The champions of free-market capitalism decide they can't get elected without supporting a single-payer insurance program.

In all their glee about the troubled rollout of the Affordable Care Act, most Republicans are barely bothering to offer an alternative, other than a return to the way things used to be. It isn't surprising, because to be brutally frank, they never much cared about the spectacular human suffering created by free-market health care.

For decades, liberals have been working to devise policy solutions and create the political conditions for health care reform that would achieve secure, universal coverage. On the other hand, in the face of millions who can't get insurance because of pre-existing conditions and millions more who just can't afford it, the conservative response was always, "Whatever." The market spoke, and you lost. Too bad for you.

The Affordable Care Act can certainly be improved. But in health care -- to paraphrase Ronald Reagan -- the free market isn't the answer to our problems. It is the problem.

Follow us on Twitter @CNNOpinion.

Join us on Facebook/CNNOpinion.

The opinions expressed in this commentary are solely those of Paul Waldman.

ADVERTISEMENT
Part of complete coverage on
updated 8:21 AM EDT, Mon September 1, 2014
Carlos Moreno says atheists, a sizable fraction of Americans, deserve representation in Congress.
updated 12:25 PM EDT, Sun August 31, 2014
Julian Zelizer says Democrats and unions have a long history of mutual support that's on the decline. But in a time of income inequality they need each other more than ever
updated 12:23 AM EDT, Sun August 31, 2014
William McRaven
Peter Bergen says Admiral William McRaven leaves the military with a legacy of strategic thinking about special operations
updated 12:11 PM EDT, Fri August 29, 2014
Leon Aron says the U.S. and Europe can help get Russia out of Ukraine by helping Ukraine win its just war, sharing defense technologies and intelligence
updated 1:24 PM EDT, Fri August 29, 2014
Timothy Stanley the report on widespread child abuse in a British town reveals an institutional betrayal by police, social services and politicians. Negligent officials must face justice
updated 9:06 PM EDT, Fri August 29, 2014
Peter Bergen and David Sterman say a new video of an American suicide bomber shows how Turkey's militant networks are key to jihadists' movement into Syria and Iraq. Turkey must stem the flow
updated 11:16 AM EDT, Thu August 28, 2014
Whitney Barkley says many for-profit colleges deceive students, charge exorbitant tuitions and make false promises
updated 10:34 AM EDT, Fri August 29, 2014
Mark O'Mara says the time has come to decide whether we really want police empowered to shoot those they believe are 'fleeing felons'
updated 10:32 AM EDT, Thu August 28, 2014
Bill Frelick says a tool of rights workers is 'naming and shaming,' ensuring accountability for human rights crimes in conflicts. But what if wrongdoers know no shame?
updated 10:43 PM EDT, Thu August 28, 2014
Jay Parini says, no, a little girl shouldn't fire an Uzi, but none of should have easy access to guns: The Second Amendment was not written to give us such a 'right,' no matter what the NRA says
updated 1:22 PM EDT, Sat August 30, 2014
Terra Ziporyn Snider says many adolescents suffer chronic sleep deprivation, which can indeed lead to safety problems. Would starting school an hour later be so wrong?
updated 9:30 AM EDT, Fri August 29, 2014
Peggy Drexler says after all the celebrity divorces, it's tempting to ask the question. But there are still considerable benefits to getting hitched
updated 2:49 PM EDT, Fri August 29, 2014
The death of Douglas McAuthur McCain, the first American killed fighting for ISIS, highlights the pull of Syria's war for Western jihadists, writes Peter Bergen.
updated 6:42 PM EDT, Tue August 26, 2014
Former ambassador to Syria Robert Ford says the West should be helping moderates in the Syrian armed opposition end the al-Assad regime and form a government to focus on driving ISIS out
updated 9:21 AM EDT, Wed August 27, 2014
Ruben Navarrette says a great country does not deport thousands of vulnerable, unaccompanied minors who fled in fear for their lives
updated 9:19 AM EDT, Wed August 27, 2014
Robert McIntyre says Congress is the culprit for letting Burger King pay lower taxes after merging with Tim Hortons.
updated 7:35 PM EDT, Tue August 26, 2014
Wesley Clark says the U.S. can offer support to its Islamic friends in the region most threatened by ISIS, but it can't fight their war
updated 4:53 PM EDT, Tue August 26, 2014
America's painful struggle with racism has often brought great satisfaction to the country's rivals, critics, and foes. The killing of Michael Brown and its tumultuous aftermath has been a bonanza.
updated 3:19 PM EDT, Tue August 26, 2014
Rick Martin says the death of Robin Williams brought back memories of his own battle facing down depression as a young man
updated 11:58 AM EDT, Tue August 26, 2014
David Perry asks: What's the best way for police officers to handle people with psychiatric disabilities?
updated 3:50 PM EDT, Mon August 25, 2014
Julian Zelizer says it's not crazy to think Mitt Romney would be able to end up at the top of the GOP ticket in 2016
updated 4:52 PM EDT, Mon August 25, 2014
Roxanne Jones and her girlfriends would cheer from the sidelines for the boys playing Little League. But they really wanted to play. Now Mo'ne Davis shows the world that girls really can throw.
updated 5:04 PM EDT, Mon August 25, 2014
Kimberly Norwood is a black mom who lives in an affluent neighborhood not far from Ferguson, but she has the same fears for her children as people in that troubled town do
updated 5:45 PM EDT, Fri August 22, 2014
It apparently has worked for France, say Peter Bergen and Emily Schneider, but carries uncomfortable risks. When it comes to kidnappings, nations face grim options.
ADVERTISEMENT
ADVERTISEMENT
ADVERTISEMENT
ADVERTISEMENT