THE PLANK JANUARY 31, 2008
Right after the debate, CNN decided to run an hour-long special on health care by their medical correspondent, Sanjay Gupta M.D.. I wasn't going to watch it, mostly because of low expectations. On those all-too-rare occasions when television spotlights public policy, they usually do a lousy job. It's either woefully uninformed or so beholden to the conventions of even-handedness -- which generally means letting people spew untruths without correction -- that they make reality impossible to discern.
But I ended up watching this anyway (probably because it was on while I was finishing my last web item). And, much to my (pleasant) surprise, this special was terrific. Gupta and his producers were scrupulous about giving both sides a hearing. But they also provided viewers with enough information to see through the spin and determine who is right.
At one point, for example, Gupta quoted Republican Senator Tom Coburn talking about one of his favorite causes: The need to create an interstate insurance market, so that anybody looking to buy an individual policy (as opposed to coverage through an employer) could buy from anywhere in the U.S.
As I've written before, this is a terrible idea. It would create all sorts of new opportunities for fraud, which is already a huge problem in the individual market. It'd also create a race to the bottom, as insurers quickly relocated to whatever state had the laxest regulations and began offering coverage from there. And while gutting reulgations might sound like a nice idea, a lot of those regulations guarantee coverage of important screenings and treaments -- or prevent insurers from discriminating against high-risk patients. The CNN script nailed this point, showing that Coburn's plan wouldn't help people with pre-existing conditions, the one who struggle the most to get insurance right now.
Gupta also noted that conservatives frequently tout "high-risk pools" as the answer for people with pre-existing conditions -- but that such pools have never worked very well. (The reason? States are generally reluctant to fund these pools and insurers are generally reluctant to participate in them unless they can continue to charge somewhat higher rates to the sick -- or exclude pre-exisitng conditions for a time.)
What about solutions? The special has showcased the French health care system -- always among my personal favorites -- as an example of a country that provides high quality care to everybody, for less money than we pay. It's even captured some of the nuances of the French system, like the fact that the system there eliminates cost-sharing for the chronically ill. Nor has it flinched from showcasing the strenghts of "government-run insurance." American politics may be afraid fo single-payer insurance, but CNN is happy to give it a fair hearing.
My two quibbles: First, the program was called "Broken Government: Health Care - Critical Condition." In fact, when I first heard it was airing, I prepared for another screed about the supposed evils of the public sector. (Like, um, this guy often argues.)
The content was nothing like that. While not excusing government's failures, it's mostly about the private sector's failures. I suspect most viewers will come away agreeing with Congressman John Dingell -- who gets a lot of air time -- that we'd be better off with more government. But, then, why the loaded title?
Second, Gupta just noted that the U.S. has significantly higher cancer survival rates for men than other countries. As I and others have written, that's a very misleading statistic. A huge part of the gap is due to prostate cancer, in which the evidence suggests we largely overdiagnose -- and overtreat -- the disease, curing a lot of slow-moving tumors that wouldn't kill people before something else did.
(Note, for example, CNN didn't show a similar statistic for women. That's because the numbers are much better there -- and when you really break it down, it looks like the U.S. is among the best, but countries like France and Switerzland are awfully close.)
Still, overall it's been a very solid program. CNN often rebroadcasts these shows, so check the listings if you missed it and want to watch. And if you can't find it, check out this CNN web page, which seems to have a lot of the material from the show.
-- Jonathan Cohn