One of the great problems with Trumpcare is the fact that President Trump actively believes that it should be a goal of government to ensure that everyone in the United States actually has health insurance. Just two months ago, days before taking office, Trump stated that he wanted his replacement for Obamacare to provide “insurance for everybody.” He stated openly, “We’re going to have insurance for everybody. There was a philosophy in some circles that if you can’t pay for it, you don’t get it. That’s not going to happen with us.”
Then, naturally, Trumpcare didn’t fulfill that goal – instead, according to the Congressional Budget Office (CBO), fewer Americans will end up with health insurance than they would under Obamacare (or, for that matter, under repeal of Obamacare without Trumpcare). That’s natural, since millions of Americans would opt out of health insurance, and millions more would feel the impact of increased premiums based on healthy people failing to prop up the insurance market through forced mandates.
That’s why the Trump administration has been fighting back hard against the CBO report, suggesting that the CBO should be abolished or that their estimates must be wrong. And there are plenty of legitimate questions to ask about the CBO’s scoring, which was absolutely wretchedly wrong with regard to Obamacare.
But that doesn’t change the fact that if Trump believes that the metric of success for a government-involved health care program is securing insurance, the only real solution is nationalized health care. That’s because quality of care no longer matters; neither does the usefulness of the insurance. Only that one number – the number of people covered – matters. And you can ensure that everyone is covered just by making it a complete entitlement.
Of course, that shouldn’t be the goal of government.
First, government should not be in the business of telling you – or anyone – how to deal with their health care. Government-run systems are subject to rationing. They are subject to price and wage controls. They destroy medical innovation, deny and delay care, and blow out budgets. The goal of any health care system should be delivery of health care to the individual, not arbitrary government numbers about how many people are covered – if that were the metric, Cuba would indeed be a health care paradise. It isn’t.
Here are some actual metrics that should matter more.
1. Life Expectancy. We should be looking at average life expectancy in countries to determine how well they do in terms of health care delivery. And we have to compare countries with similar demographic breakdowns if we wish to actually compare apples with apples. Currently, the heavily-regulated but non-nationalized U.S. healthcare system provides an average life expectancy of 79.8 years at birth. That’s marginally lower than far more homogenous countries like Canada (81.9 years) or South Korea (82.4 years). The United States’ life expectancy declined last year for the first time in two decades under Obamacare.
2. Cancer Survival Rate. The 5-year cancer survival rate is an excellent measure of how well the health care system works – the fact is that insurance won’t matter all that much if you can’t access cancer treatment with it. When it comes to the U.S.’s net five-year survival rates 2005-2009 for stomach, colon, rectum, liver, lung, female breast, cervix, ovary, prostate, and leukemia, we outrank Canada on seven out of the ten types; we outrank the U.K. significantly on all ten, with massive differentials; we outrank Finland on seven out of ten.
3. Health Care Patents. The U.S. far outclasses other countries in terms of generating new devices, drugs and services – a fact from which other countries obviously benefit. That’s due to the privatized system, which prioritizes research and development and innovation – all of which were penalized by Obamacare.
There are other statistics, too, that are useful in analyzing the efficacy of a health care system. But they don’t include level of expenditure (private expenditure is nobody else’s business) or number of insured (that doesn’t answer the quality of health care question). All we should care about is whether people can get access to the health care they need if they so choose. Our current system isn’t the best – it’s an ugly mashup of the government-run systems prevalent in Europe and the privatized system that used to dominate here at home. But the answer isn’t more government. It’s less.