It's all about repetition. Does anybody remember former presidential candidate Bob Dole saying, "There's got to be some truth to the charges" by the Swift Boat Veterans for (Bush) -- not because there was any evidence, but because their claims were repeated so often? Repeat something often enough, and incredulity erodes.
In February 2006, pollster John Zogby, reporting on a poll of soldiers serving in Iraq, wrote, "Nearly nine of every 10 -- 85% -- said the US mission is 'to retaliate for Saddam's role in the 9/11 attacks,' while 77% said they believe the main or a major reason for the war was 'to stop Saddam from protecting al Qaeda in Iraq.'" President Bush famously said, "... fool me once, shame on -- shame on you. Fool me -- you can't get fooled again," but his entire administration has been based on the principle that you can fool some of the people all of the time, and if you do it right, it lasts four years.
Alongside "We can afford a tax cut," "Iraq has weapons of mass destruction" and "We need to privatize Social Security," you can hang "Health care is expensive because the vast majority of Americans consume it as if it were free. Health insurance policies with low deductibles insulate people from the cost of the medical care they use -- so much so that they often do not even ask for prices." That line appeared in an op-ed piece in the New York Times on April 3, written by (or at least written for) Allan B. Hubbard, assistant to the president for economic policy and director of the National Economic Council. Mr. Hubbard, as might be expected, holds degrees in law and business (he was president Bush's classmate at Harvard), but none in economics.
The reasons for the high cost of health care in the United States have been analyzed repeatedly. The Annals of Internal Medicine published a series of articles by Dr. Thomas Bodenheimer that included this conclusion: "Making patients responsible for the costs of their care can reduce expenditures for patients with low levels of expenditures; however, there is no convincing evidence that patient cost-sharing reduces expenditures for the 10% of the population that incurs 70% of health care costs."
The late comedian Henny Youngman had this idea: "A doctor gave a man six months to live. The man couldn't pay his bill, so he gave him another six months." And, "When I told my Doctor I couldn't afford an operation he offered to touch up the X-rays." And "Tell the ambulance driver to hurry up or you'll miss the early-bird special."
There are lots of reasons for the high costs of health care in the United States, but the notion that it's because people with insurance don't bother to shop around is absurd. By that logic, the costs of health care in those nations that have universal coverage and a single payer system should be much higher than US costs. They're not. According to the National Coalition on Health Care, in 2004 total United States healthcare spending represented 16% of the gross domestic product (GDP). In contrast, according to the Organization for Economic Cooperation and Development, healthcare spending accounted for 10.9% of the GDP in Switzerland, 10.7% in Germany, 9.7% in Canada and 9.5% in France. But these other countries offer health care to all their citizens, while the US has 46 million people without insurance.
One difference that has been well documented is the administrative costs of the US non-system. One analysis concluded that a key difference between Canadian and US costs was due to administrative costs, with a difference of $752 per person per year. Canadian physicians and hospitals don't have to employ large staffs to figure out who is paying the bill -- they already know. Administrative costs represent about 25% of the total United States health care bill.
The argument in favor of healthcare savings accounts is familiar to anyone who has paid attention to the Bush administration. Health care costs in the United States are higher than in any other developed nation, but the problem doesn't lie with the insurance companies and their duplicated bureaucracies and multimillion-dollar CEOs. Don't blame the pharmaceutical companies that charge whatever they can get away with. Don't blame the hospital executives who learned long ago that the answer to competitive pressures was to merge with or buy out all the local competitors. The fault is with people who don't ask for price lists before seeing physicians. The administration is kowtowing to corporations and blaming the citizenry.
It's nonsense. Worse, it's dangerous nonsense that threatens to destroy whatever shreds of a system we still have. But if you repeat the line often enough, someone may be convinced that it's true.
Sam Uretsky is a pharmacist living Long Island, N.Y.