In trying to quell the uproar over the government takeover of medical care in the US, Obama made a point that I think is really worth exploring. He said:
[I]f the private insurance companies are providing a good bargain, and if the public option has to be self-sustaining — meaning taxpayers aren’t subsidizing it, but it has to run on charging premiums and providing good services and a good network of doctors, just like any other private insurer would do — then I think private insurers should be able to compete. They do it all the time. I mean, if you think about — if you think about it, UPS and FedEx are doing just fine, right? No, they are. It’s the Post Office that’s always having problems. (emphasis mine)
This argument really breaks down on a number of levels, and it’s worth a look at all of them.
First, let’s start with the fact that Obama’s comparing the most advanced medical care system in the world with the job of moving a package from Point A to Point B. Any schmuck can take a package – which has your name and address right on it – and get it from here to there. If I gave anyone reading this post an addressed package, you could jump in your car and drive it to the destination with minimal failure (allowing for flat tires, the recipient having moved and left no address, random explosion of the house, whatever).
The fact is, shipping isn’t a teribly complicated business. Yet even Obama admits that the Government option is the one that gets it wrong. He points out that FedEx and UPS are doing it right, but the USPS isn’t.
So that raises the next point of failure in his argument. It’s not like FedEx and UPS were doing it first, and the government created a new mail delivery vehicle to force FedEx and UPS to lower their costs. FedEx and UPS, to the contrary, sprung up in response to a near complete failure of the government option. They arose from the ashes of countless lost packages, and inefficient government bungling. They recognized a market for reliable package delivery.
Let us imagine, however, that we treat package delivery the way we treat medical care. In the package delivery business, you must a) declare the value of your package, and b) acknowledge that should it be lost or damaged, you will be entitled to only that amount.
In May of 1996, a man cut off his own hand believing it to be evil. He refused to let doctors reattach the hand, then sued them for not doing so. He claimed they should have known he was nuts and forced him to accept the reattachment of the hand. While this is an extreme example, this sort of frivolous suit is filed every day. Malpractice suits and insurance contribute a staggering amount to the costs of health care. The total amount can be debated, but a Congressional Budget Office Brief looking at malpractice insurance premiums paid by doctors rose twice as fast as medical spending between 2000 and 2002 – roughly 15%. For general surgeons the hike was even greater running at 33%.
In package delivery, the cost of package breakage doesn’t rise dramatically year over year. If it did, the companies would look at ways to reduce breakage and loss. Yet our government has ignored the skyrocketing costs of malpractice and malpractice insurance as a part of the reform debate.
Costs are a huge problem. We get that. But that raises another key difference between the healthcare debate and the President’s chosen analogy of package delivery. Research into package delivery technology isn’t a dramatic portion of the package delivery costs. Do they buy equipment? Yes. Do they invest in dfferent ways to scan barcodes and create shipping labels? Of course. Are they handwritten package slips a huge pain in the ass versus the barcoded, Internet-generated slips? I imagine they are. But unlike, for instance, pharmaceutical companies, the amount they spend on R&D is fairly constrained. They don’t spend a decade or longer trying to figure out a way to move ONE particular size and shape of package.
As a result, comparing the amount of money invested in drug research and clinical trials to the box moving industry is probably a silly thing to do. Yet their was POTUS, telling us that the two are somehow equivalent.
Looking at his argument, the one part of the example the President got right was when he said, “It’s the [Government] that’s always having problems.” If you think the same people that brought you Katrina, the US Postal Service, the missing $400 million dollar Mars Global Surveyor, the $600 hammer and the $900 toilet seat, and countless other blunders will do a better job with health of every American, look no further than the countless stories of Medicare and Medicaid fraud and abuse.
The fact is, Obama’s example probably gives us more to think about as an example of why we shouldn’t let government manhandle our health care system. As Obama points out, and as the famed economist Milton Friedman said, “The government solution to a problem is usually as bad as the problem.”