The Coming Health Care Debate

LOS ANGELES -- Uwe Reinhardt is a professor of economics at Princeton and one of the wiser scholars of health care in the developed world. But he was not always a professor with a string of fancy titles and a gold-standard Ivy League health plan. He grew up poor in Germany, and this is part of what he says about that:

"I grew up in a tool shed, and I know how good it was that when we were paupers, my family, we had health insurance like everyone else in Germany. I've never forgotten that, and I would like the American people to have what I had, and my mother had as a kid. So that is why I care."

"I remember my own mother giving me a lecture once when she had to wait in Germany two weeks for the neighboring hospital to have a bed. And I said, 'Oh, I can make a phone call and get you in earlier.' And she said I was asocial. She says, 'Then some other lady has to step back. How could this be decent?'"

Dr. Reinhardt, whose work I have followed for a while, was questioned last Wednesday on "Fresh Air" by the estimable National Public Radio host Terry Gross. He also said this:

"What kind of country would you want to live in? Do you want to live in a country where someone who loses their job loses their health insurance? Is that what you want?

"Do you want a system where kids come out of college, and for the next 10 years, they can't get insurance? You want people who have family members struck with cancer to lose their house or their car? I mean, ask yourself what kind of country do you want to live in. And all of these things I mentioned, we have now. You lose your insurance with your job. You can lose your house and go bankrupt over a health care bill."

"The typical Canadian or German or Englishman understands that they have to pay taxes or premiums to be insured because you're all in this together, because you also expect society to save your life when you get in trouble. And they understand tit for tat."

The comparable American phrase for that would be: "You get what you pay for!"

But we don't. Americans pay more for health care than anyone else in the world -- close to $7,000 a year per capita compared with $3,000 in Germany -- and 47 million of us have no coverage at all. Our life expectancy is 29th in the world.

It is not so much that our system is worse than others. It is that, for many practical purposes, we have no system. Dr. Reinhardt, in heading a New Jersey Health Care Task Force, has reported that at one Jersey hospital the same procedure, a colonscopy, with the same doctor and equipment can cost anywhere from $400 to $3,000. The difference is not in the procedure; the difference depends on contracts and haggling with different insurance plans over coverage.

One other number he has used is 900; that is the number of people in the billing department at Duke University Hospital. "These people push paper," he said. "They do not treat patients."

Unfortunately, though I, too, have gold-standard coverage, I know that what Reinhardt is saying is true. Because of horrendous health problems in my family, I have been haggling with insurance companies in the United States for more than seven years -- and so have the doctors involved in those treatments. Some of the operations and procedures we needed were done in France -- and those treatments were generally haggle- and hassle-free. French health care costs per year are about the same as Germany's, $3,000 per capita.

As for Reinhardt, he believes it's now or never for American health care reform. New problems, new attitudes and a new president may be coming together at the right time. His guess is that President Obama will win a compromise victory on health care:

"The big battleground in the forthcoming health reform debate will be this idea of having a public plan. And my gut tells me that maybe President Obama will possibly give up on that idea if, in return, the insurance industry comes to the bargaining table and gives him what he wants, which is that any insurer must serve everyone who comes to them, and the premiums cannot reflect the health status of the individual applicant for insurance."

In other words, we will have universal government-mandated health care. And fools will attack it as socialism -- as long as they don't get sick.