The post in which I continue to attack the damn libertarians

Also pissing me off this week is the continuing nonsense from Cato’s anti-universal health care club which is suggesting that increasing health care coverage will lead to an increased number of deaths because of increasing medical errors.

Sack notes that “at least twice as many Americans are estimated to die each year from medical errors as from lack of access to care.” He quotes economists Helen Levy and David Meltzer’s conclusion that there is “no evidence” that expanding coverage would be the best way to improve health and save lives.

If there is no evidence that expanding coverage would deliver the biggest improvement in health for the money, then expanding coverage could actually increase death and disability compared to a superior policy. I’ll be debating Nichols tomorrow at a meeting of the National Association of Business Economists. Should be a good time.

Now, if you want to be a libertarian and think of no one but yourself all the time, that’s just freaking great, but it’s totally different if you’re going to start spreading around this crank nonsense about medical errors being a big bad killer. Inherent is this suggestion is that medical care is of net negative benefit, which is totally absurd. And the Institute of Medicine reports on medical errors are poorly understood as people fail to understand two critical aspects of the studies. For one, much of the medical errors resulting in injury have to do with inpatient care and an inpatient population is a really different beast from the types of medicine we’re talking about with universal coverage. People under universal healthcare won’t go into a hospital, lay in a bed for a few days and get a decubitus ulcer because they suddenly have free medical care. Much of the medical “mistakes” described in these reports aren’t really mistakes by doctors but represent fundamental problems with keeping people healthy in hospitals. Much of it has to do with nursing and support care, spread of nosocomial infection, and clerical errors (the last of which we’re improving on with increased digitization) and affecting a population which tends to be very fragile to start with. This stuff simply isn’t relevant to the type of outpatient care universal coverage seeks to provide.

The second idiocy here is that the type of medicine under a universal health system will hopefully be fundamentally different than what we have now. Currently, doctors are essentially penalized for providing more care, and rewarded by insurance companies for providing less care. There is also completely inadequate support for preventative medicine. Despite these measures to reduce cost we still manage to spend more per capita on healthcare than any other nation, are ranked almost dead last among industrialized nations for provision of care (mostly due to access problems), and have over 40 million uninsured. These facts make a prima facie case for the need to reform our medical delivery system. The current system is unjustifiably stupid economically, and the restructuring of healthcare delivery has the potential to gear medicine more towards better disease prevention, screening, and overall increased quality of care as people are less fearful of being dinged by their insurance company for the crime of getting sick or being diagnosed with a disease.

The third idiocy is to say the reason for universal healthcare is just improving patient outcomes. We’re also trying to prevent people from being bankrupted, whether they’re insured or not, because of medical problems. Even with insurance illness frequently leads to financial distress and even bankruptcy.

I want universal health care because I think it is the right thing to do medically, morally, and economically. Our current system is too expensive, poorly designed for delivery of good medical care, and ultimately is biased against people getting the care they need. If you can fix the system under a free-market approach that will prevent people from being financially ruined by health issues, will cover everybody, encourage the widespread adoption of preventative care and not cost five times as much per capita as any other country’s care, I’m all for it. As it stands what we have is too little care for too much money. The best Cato can do is make the absurd argument that more care = more mistakes. By this logic we should just stop all medical care from being provided if mistakes are such a net negative. If that’s the best the defenders of the free market can do, the free market is in trouble.