Hot Air’s Haphazard Healthcare Howlers

I don’t mean to keep picking on Ed Morrissey. But he really has a knack for hunting down unrepresentative anecdotes, trying to link them to partisan narratives, briefly realizing that the larger implications make no sense, and then brushing past this problem with the sorts of brusque pronouncements that only sound convincing so long as you don’t think them through.

Case in point is his recent Hot Air piece on a Canadian patient who was denied surgical treatment and then went to the Mayo Clinic in the US. He and his friends then paid for the treatment themselves.

All in all, the ordeal sounds awful for Pankow. He was denied a surgery he believed he needed to save his life, went and paid for it in the US, and then was denied follow-up medications because they hadn’t been approved in Canada for use with his type of tumor-site. That’s awful. But as an indictment of the entire Canadian system as compared to the US, it falls far short, as Morrissey himself briefly acknowledges:

Some will say that the runaround happens in America, too, with private insurers. And they’d be right. However, people in America have the ability to move to different insurers when they get lousy service, and still get treatment in their own country. They don’t have to flee across an international border to get medical attention.

The first part of this bit of subject changing is patently ridiculous. If you want a treatment in the US and your insurance company refuses to pay for it, you don’t have the option of then simply switching to an insurance company that will. No insurance company in its right mind would take on a dying cancer patient as a new client. Not because they are evil, but because selling an insurance plan to someone who already has enormous expected medical costs is like letting someone buy fire insurance after their house has already burned down. It’s not “insurance” at all. It would be the insurance company simply handing over hundreds of thousands of dollars to someone like Kent Pankow because Kent Pankow asked them nicely. While that would be awfully charitable, it wouldn’t have anything to do with the business of selling health insurance.

It’s true that, at least in Canada, Pankow couldn’t have simply gone outside his insurance company and paid for his surgery himself. But that’s an aspect of Canadian law that no one is proposing should happen here in the US. And if Pankow were simply an American citizen to begin with, he would have had to do exactly the same thing if his insurer denied him coverage for the surgery he wanted: pay out the Mayo clinic of pocket. Only with Obama’s proposed reforms would something like an already sick person shopping around for different coverage become possible, and then only because coverage would be universally required.

In fact, that’s what trips Morrissey up in another of his arguments:

Let’s see if we can’t tally up the scandals in this story. First, instead of rushing Pankow into surgery, doctors waited more than two weeks to decide whether he was “surgery worthy.” Obviously, this was not a medical decision, as the Mayo Clinic didn’t take two weeks to make a medical decision on Pankow.

There’s nothing “obvious” about this: Pankow paid Mayo to perform a surgery, and they did. And, from the sound of it, it wasn’t that successful, since they couldn’t fully remove tumor. That might have been because his Canadian doctors waited too long, but it also might have been because they were correct about it being mostly inoperable from the get go.

Contrary to what Morrissey implies, doctors in the US don’t immediately rush every single patient into surgery the second they have the option (nor does their failure to do so prove that they are “lousy”: sometimes surgery is not the best option). A lot of them DO have to make tough decisions based on uncertain circumstances, balancing different patient interests against getting more information, and so on. When patients pressure them to do so, doctors in either system will sometimes choose surgery over some other course of treatment: sometimes even when it doesn’t seem to be the most medically viable course. But again: only if someone will pay for it. And that’s exactly what happened with Mayo. Someone paid for it.

The larger fact of the matter is that every single health care system in which patients have any sort of insurance coverage, whether it be provided entirely by the government or the private market, is going to have lots of cases in which a patient wants more care than the insurer is willing to pay for. That’s the basic function of insurance as a means of cost control: preventing people from spending other people’s money on unlimited amounts of healthcare (something that would ultimately bankrupt everyone). When you’re sick you of course want the best treatment money can buy. But insurance systems can’t afford to provide that level of care for everyone, and trying to do so is part of what’s making health insurance costs spiral out of control here in the US.

That inevitability means that if all someone like Morrissey is going to offer are anecdotes of this happening in one system while then offering no examples of it happening in another (let alone any actual statistics), that’s flatly disingenuous as a way of comparing two systems.

Of course, that’s not even addressing the fact that Morrissey is essentially arguing that the US shouldn’t pass a health reform bill that doesn’t set up a Canadian-style system because of something he doesn’t like about the Canadian system, simply because Obama and Democrats have praised SOME aspects of the Canadian system. For Morrissey, the actual details of the bill (and all the compromises made necessary by a politically divided system) just don’t seem to matter very much.

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~ by Drew on 2010/03/11.

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