Let's start with the fact that America's health care system spends more, for worse results, than that of any other advanced country.

In 2002 the United States spent $5,267 per person on health care. Canada spent $2,931; Germany spent $2,817; Britain spent only $2,160. Yet the United States has lower life expectancy and higher infant mortality than any of these countries.

What Krugman doesn't say is that its easy to hold down health care costs if you do what Canada does: withhold medical treatment from sick and injured people. The U.S health care system could save billions of dollars if we drastically reduced the number of doctors, hospitals, outpatient clinics, medical devices and diagnostic machines available. If we followed Canada's lead, we would severely limit each surgeon's allotted hours in the operating room so that they couldn't perform too many surgeries. Americans would wait months and years for critical medical tests and treatments - many would suffer greatly, become crippled, addicted to painkillers, go blind or die while waiting - however, the country would spend a lot less money on health care.

Paying More For Less?

For heart disease, cancer or any other serious health condition, there's no better place to be than the United States where more modern medical technology and expertise are available and accessible than anywhere else in the world. However, Krugman insists that the U.S is paying more than other countries and getting less health care as evidenced by 1) lower life expectancies and 2) higher infant mortality rates.

There are many factors that determine life expectancy averages and infant mortality rates which are beyond the control of the health care system. These include ethnicity, genetics, lifestyle, environment, education and cultural attitudes. In one column[2], Krugman does attempt to inoculate himself with some well-chosen weasel words:

It would be wrong to jump to the conclusion that this poor performance is entirely the result of a defective health care system; social factors, notably America's high poverty rate, surely play a role. Still, it seems puzzling that we spend so much, with so little return.

Well, yes "it would be wrong to jump to this conclusion" - however that's precisely what Krugman does - and what's really "puzzling" is that Krugman never offers any other proof for his assertion that we pay more and get less. In column after column, he monotonously cites these two statistics as clear evidence of the failings of American health care without offering any argument that an alternate health care financing method would make any improvement in these areas.

Life Expectancy Averages

While it may seem counterintuitive, there is very little correlation between the quality of a health care system and life expectancy averages. Many people die before encountering the health care system. Others would die prematurely regardless of the system - while some would live to a ripe old age anyway. Blacks have shorter life expectancies than whites, hispanics or asians. The black population of Canada is numerically insignificant while black Americans make up 13% of the U.S. population. Japanese females have the longest life-spans of all - regardless of whether they live in Japan or in America - i.e. regardless of the health care system they live under[3]. Thus, a good way for a country to raise the life expectancy average would be to import females of Japanese descent!

Instead of basing broad conclusions about the quality of the U.S. health care system on unreliable indicators - as Krugman does - why not judge our system by how well it prevents deaths from cancer, heart disease and other conditions that modern medicine can actually treat? Well, because the U.S. is better at these things than other nations - and that's not part of Krugman's message.

Consider breast cancer. In the U.S., the mortality ratio - the percentage of people with the disease who die from it - is 25%. The breast cancer mortality ratios for Canada, the U.K. and New Zealand are 28%, 46% and 46%, respectively[4]. The U.S. prostate cancer mortality ratio is only 19%. In Canada, its 25%, in France, its 49% - and in the U.K., over half - 57% - of men diagnosed with prostate cancer die from it[5]!

Infant Mortality Rates

The primary reason that the U.S has higher infant mortality rates than other industrialized nations is that we experience a higher incidence of low-birth-weight babies due to demographic factors beyond the control of doctors and hospitals[6]:

Several factors are known to increase the likelihood of low-birth-weight babies, but the most significant is race. African American women deliver very small babies at twice the rate of white American women, This is true even when controlling for the mother's age, income and education. It is even true holding constant the number of prenatal medical visits. Why some ethnic groups have disproportionate numbers of low-birth-rate babies is not fully understood.

Krugman's Choice: A "Single-Payer" Model

So which country's health care system does Krugman recommend [7] as a model for our own?

You guessed it:

Does this mean that the American way is wrong, and that we should switch to a Canadian-style single-payer system? Well, yes.

Hundreds of thousands of Canadians are suffering and waiting long periods of time for medical care that, for the most part, is quickly available in the U.S. The Canadian press consistently reports outrageous stories detailing the callousness and inhumanity of a system which intentionally limits supply and rations health care to its citizens. Krugman, however, merely glosses over this inconvenient fact[8]:

Yes, Canada also has waiting lists, but they're much shorter than Britain's -- and Canadians overwhelmingly prefer their system to ours.

Similarly, Krugman's assertion that Canadians prefer their system to ours is laughable. Most Canadians have no idea how the U.S. health care system works. They've been fed a steady diet of Anti-American propaganda for more than twenty years to the point that there's a perception among many that poor and lower-middle-class Americans are literally dying in the streets after have been denied health care. Younger and healthier Canadians - who have never been really sick - boast of their "free" national health insurance and love the perception that they are getting something at someone else's expense. Many of them change their tune later in life when they find themselves on painfully long wait lists for diagnostic tests or surgery - while others have merely become accustomed to the idea that waiting months for an MRI or even years for orthopedic surgery is a normal feature of any health care system. Since they have little knowledge of the American system, they have nothing else to compare their experiences to.

The Trojan Horse

Under the government-run health care system that Krugman advocates, Americans would suffer and die while waiting for rationed health care just as the Canadians and the British do. By making health care "free" at the point of delivery and making government the payer for all medical transactions, the advocates of a "single-payer" system would reduce both the quantity and the quality of health care in this country - for everyone.

Its therefore, reasonable to ask if Krugman and his ilk have motivations other than promoting better and more available health care. Here's a hint[9]:

In the long run, medical progress may force us to make a harsh choice: if we don't want to become a society in which the rich get life-saving medical treatment and the rest of us don't, we'll have to pay much higher taxes.

References:

[1] Pride, Prejudice, Insurance (registration required), Paul Krugman, New York Times, November 7, 2005 (Also, available without registration here)

[2] The Medical Money Pit (registration required), Paul Krugman, New York Times, April 15, 2005 (Also, available without registration here)

[3] Lives At Risk: Single-Payer National Health Insurance Around the World, John C. Goodman, Gerald L. Musgrave, & Devon M. Herrick, Roman & Littlefield Publishers, 2004, page 51

[4] Goodman, Musgrave & Herrick, page 72

[5] Goodman, Musgrave & Herrick, page 73

[6] Goodman, Musgrave & Herrick, page 53

[7] America's Failing Health (registration required), Paul Krugman, New York Times, August 27, 2004 (Also, available without registration here)

[8] The Medical Money Pit, Paul Krugman, New York Times, April 15, 2005

[9] Ailing Health Care (registration required), Paul Krugman, New York Times, April 11, 2005 (Also, available without registration here)