Paul Krugman attributes "America's Failing Health" to the lack of Canadian-style socialized medicine and thus to the persistence of a free-enterprise sector in American medicine (New York Times, August 27).
Because "interest groups are too powerful, and the antigovernment propaganda of the right has become too well established," his prescription is a "modest step in the right direction," rather than a one-step enactment of a Canadian system.
Let's see now: the United States has been taking such "modest steps" toward socialized medicine since the 1940s. There was Hill-Burton, or federal aid to build hospitals, in 1946; Kerr-Mills, to provide federal aid to elderly who couldn't afford needed medical care, in 1960; then Medicare in 1965, and Medicaid.
In the Clinton years, there were additional modest steps, notably the State Children's Health Insurance Program (SCHIP). And George W. Bush brought us another try at a Medicare prescription-drug benefit, which is to he implemented in 2006-unless there's a replay of seniors' reactions to the last attempt to introduce a prescription-drug benefit in 1989, when the seniors assaulted Rep. Dan Rostenkowski's car.
What has been the result of these incremental intrusions into American medicine? An ever-increasing number of uninsured? A noncompetitive automobile industry? An overall drag on the economy?
Why, no. Those are mere temporal associations. Correlation doesn't prove causation. The real explanation is that there hasn't been enough federal intervention, in Krugman's view. The remnant of a private sector competing with the government for those scarce resources is, paradoxically, the cause of the problems.
Scarce resources? Not exactly. In the United States it is said we spend coo mwch on medical care, hut there is a misallocation of the resources. That's because selfish people want too much medical care for themselves and their families, and greedy doctors and hospitals want to provide too much treatment to those who can pay for it.
What we need, Krugman apparently supposes, is an infallible government planning mechanism to divide up the resources and to put a rigid ceiling on spending, and nongreedy doctors and hospitals to allocate the available care in the fairest possible way. Public-spirited doctors and hospitals will replace the ones we have now as soon as all their checks start coming from the government.
And of course the government will allocate a lot of resources to providing health care to healthy people, whether they want it or not (especially mental-health care), to keep them healthy. If some people get sick before all ill-health is prevented and end up circling emergency rooms in an ambulance or parked in a corridor, that will keep the pressure on for more spending.
When the effects of socialized medical programs are measured in a way that controls for confounding variables (like educational level and drug abuse), it is hard to show any effect on any health outcome, such as low birth weight. If one compares infant mortality in Canadian and American Indians of the same genetic stock, however, the Americans do better.
But the big picture, Krugman claims, is lower infant mortality and longer life expectancy in a number of countries that have socialized medicine. In this case, correlation does prove causation, Krugman implies-even if the statistics aren't comparable. (Since very low-birth-weight babies are considered stillbirths in some socialized countries, whereas they are counted as live births here, the United States looks worse-even though many more tiny preemies survive here.)
Krugman may call his proposal a "modest step." But the incremental march toward socialism is the way to bring about revolutionary changes. It is hardly less modest than Jonathan Swift's proposal to solve the Irish famine problem by eating babies. …