The Treatment

Reformers: Meet Public Enemy Number One

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Richard Scott became famous, and infamous, for his management of the Hospital Corporation of America during the 1990s. More than almost any other individual, he is emblematic of everything that's frequently wrong with corporate, for-profit medicine--and how it can twist the principles of well-intentioned reforms like managed care, designed to refocus medicine on prevention and efficiency, into a crude tool for cost-cutting and profiteering.

Scott left, or was forced out, from HCA just as it became mired in scandal in 1997, although Scott never faced any criminal charges. One might think that would be the last we'd hear from him, at least on this topic.

Well, guess who's decided he has something to say about health care reform?

Politico's Jonathan Martin has the goods today about Scott and his latest endeavor: A mutli-million dollar publicity effort to quash health care reform. It's going to hit all the familiar points--government will be making your decisions for you, medical care will become unresponsive and shoddy, etc. In short, it's the new Harry and Louise.

The new group's name? Conservatives for Patients' RIghts

The good news is that the progressive community isn't being caught flat-footed this time. At pro-reform groups like FamiliesUSA and Health Care for America Now, activists have been buzzing about Scott's coming onslaught--and strategizing on how to combat it. He'll make his arguments, yes, but they'll be making theirs, as well.

Here at the Treatment, naturally, we're primarily interested in establishing the facts. And while this week's avalanche of news means I can't dwell on Scott's arguments now, I did want to spend just a minute on the claim--which, trust me, you'll be hearing again--that universal health care means necessarily long waiting lines because that's what happens in Canada and England. I've dealt with this particular argument before, among other places my book Sick:

The stories about Canada are wildly exaggerated. And the pinched access to services in Britain, at least, isn't a product of universal health care. It's a product of universal health care on the cheap. The British spend just 7 percent of their national wealth on health care, less than half of what Americans spend. It's possible to spend more than that--and get more--while still spending less than the United States does. A perfect example is Japan. Relative to the United States, Japan spends about 60 percent as much of its wealth on health care. But the Japanese don't wait for medical services. And they have more 'stuff.' In fact, Japan leads the world in the availability of technology such as CT scanners and MRI machines

The full answer to Scott's charge is more complicated, but no less devastating to its merits. And I hope to get to it soon. Among other things, over the summer the Commonwealth Fund was kind enough to underwrite two research trips to Euorpe, where I got an up-close look at a pair of high-performing universal health care systems--in France and the Netherlands.

No system is perfect and that's true of those countries, as well. But both have very real, if somewhat different, strengths. On balance, both outperform the American system--by leaps and bounds. (For the record, Britain and Canada actually do a lot of things well, too.)

Again, more on this soon. In the meantime, for those who can't afford to wait, I'd highly recommend Ezra Klein's still-classic rundown of health care systems abroad or PBS Frontline's "Sick Around the World."

Update: Over at Wonk Room, Igor Volsky reports that "it appears that the group’s public
relations guru Brian Burgess, is from the same PR firm that managed the Swift Boat Veterans For Truth; launching concocted right wing fairy tales onto the airwaves is something of a cottage industry for these guys."

--Jonathan Cohn 

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