President Donald Trump praises a “strong, sharp and powerfully focused” Chinese President Xi Jinping for his handling of the coronavirus outbreak. “President Xi strongly leads what will be a very successful operation,” Trump said.
This offended some Americans. At a time when many Chinese are criticizing Xi for initially covering up the outbreak, should America’s president really side with a dictator who punished doctors rather than listening to them?
Still, focusing on China’s failures or on Trump’s praise risks distracting from our own failures in health care — and this is where Trump’s actions have been more destructive than his words. He has proposed enormous budget cuts for Medicaid, the National Institutes of Health and the Centers for Disease Control and Prevention; if carried out, these would leave the U.S. more vulnerable to a pandemic.
But whatever happens with the coronavirus, America’s health system is a mess. That is a consequence of failures that go way back, and Trump is compounding them. In particular, his lawsuit to destroy Obamacare without offering anything to take its place is the height of irresponsibility; it’s not policy but vandalism.
Already, Trump’s policies have led to the loss of health insurance for 400,000 children. Imagine that your child is crying from an ear infection or a toothache and you have no doctor to go to. Or you’re worried that your daughter is slow to speak or your son isn’t growing properly. What are you supposed to do?
Xi’s bungling of the coronavirus outbreak deserves scathing criticism, but we Americans live in a glass house. A newborn in Beijing has a longer life expectancy (82 years) than a baby born in Washington, D.C. (78), or New York City (81).
Democrats’ internecine battle over so-called “Medicare for All” is largely irrelevant, because the plan won’t get through Congress. What’s imperative is simply achieving universal medical and dental coverage, either by a single-payer system (like Britain’s) or a multipayer system (like Germany’s); both work fine. What matters is the universal part.
In some ways, America’s health care is outstanding. Specialized anti-cancer treatments are saving lives. But overall, our system has two fundamental flaws.
First, outcomes are mediocre and inequitable. Rich Americans live 20 years longer than poor Americans, and low-income American men have approximately the longevity of men living in Sudan. Several American counties have a shorter life expectancy than Cambodia does.
We’re bad at simple things, like vaccinating children. Rwanda has a higher share of girls vaccinated to prevent cervical cancer than the United States does.
One study found that 21,000 American children’s lives would be saved each year if we only had the same mortality rates as the rest of the rich world. So two American kids die each hour because we have worse child survival rates than our peer countries.
In my reporting, I’ve been struck by how much more widespread dental pain is in America than in other countries. Some 74 million Americans don’t have dental coverage, about four times as many as lack medical insurance. When their teeth rot, they suffer constant excruciating, debilitating pain that should be unfathomable in a country as rich as ours.
Health care in the United States is “a moral morass,” a question of our “soul,” Uwe Reinhardt, a brilliant health economist at Princeton wrote in “Priced Out,” a book recently published posthumously.
The second fundamental problem with our health care system is that it delivers these second-rate outcomes at enormous cost. “Prices for virtually any health care product or service in the United States tend to be at least twice as high as those for comparable products or services in other countries,” Reinhardt wrote.
We spend an average of more than $10,000 per person on health care each year, more than twice what France, Canada and Japan each spend (even though the French, Canadians and Japanese all live longer). An excellent forthcoming book by Anne Case and Angus Deaton, “Deaths of Despair and the Future of Capitalism,” argues that this discourages hiring of low-income workers. The average cost of a family health insurance policy is $20,000, which is a reason for a company not to hire a junior employee and assume insurance costs.
“Unless costs are somehow reined in, the long-run prospects for less-educated Americans remain bleak,” Deaton warns.
Sadly, health professionals are part of the problem. Dentists have fought the licensing of dental therapists, who can perform simple procedures more cheaply. And doctor groups limit medical training and qualified foreign physicians to keep prices high; that’s why there are fewer doctors per capita in the United States than in peer countries. As Case and Deaton write: “The industry that is supposed to improve our health is undermining it.”
This year’s election should in part be a debate about all these issues, and the coronavirus anxiety should remind us of the dysfunction of our own health system. Let’s hold China accountable — but we should also look unflinchingly in the mirror.
Nicholas Kristof is a columnist for The New York Times.