Commentary: U.S. healthcare reform faces the status quo

Many opponents of abortion consider those with opposing points of view as guilty of supporting the murder of thousands of unborn children. Some of them even condoned the recent assassination of a doctor in Kansas who provided late term abortions.

Taking that approach to public policy yields the conclusion that there are others with the blood on their hands. Given that way of thinking, the opponents of health care reform can also be considered responsible for the deaths of thousands of children.

Those uninterested in some basic facts would of course vehemently reject such an assertion. That would undoubted include all those who attempted to win the Republican nomination for president in the last election. One of the more memorable lines from the debates they held was the mantra that America has the best health care in the world. That is true only if you are wealthy, white and well insured like they all are.

One of the most basic indicators of the overall health of a nation's population is infant mortality. According to the CIA Fact Book, 44 of the 244 countries they list have a lower infant mortality rate than the United States. For every 1000 live births in this country, 6.26 infants do not live to see there first birthday.

If reform of the health care system resulted in dropping the infant mortality rate to that of say France, where it is 3.33, the lives of some 13,000 children would be saved each year. If the United States was able to emulate socialist Sweden, the rate would fall even further to 2.75 and the lives of 15,000 babies would be saved.

Some would be quick to counter that the governments of those countries are more involved in health care and therefore must spend much more than the United States does. Once again the facts intrude. France devotes 11.0 percent of its economic output to health care and Sweden a mere 9.1 percent. This country, on the other hand, spends 16.0 percent, which is nearly twice the average for other industrialized democracies.

The fact that the United States devotes a higher portion of its economy to health care than any other country in the world is the main reason the resistance to reform is so great. The status quo always exists not simply because of the absence of a bright idea about how to do things better. It exists because there are always powerful interests who profit from the way things are and they invariably see change as a threat.

That is why in the current health care debate every interest group says it supports reform, but only if it means their slice of the health care pie is made bigger or at least not diminished in any way. That can't happen of course without increasing the percentage of our economy consumed by health care to an even higher level.

Americans pride themselves on having a country with a market economy. But for a market to function, the buyers and the sellers have to have information. When you last entered a doctor's office, did you know how much it was going to cost? Did you discuss the cost of alternative treatments? And after the office call was over did you know what the total bill was? Health care is perhaps the only thing people buy without any idea of what the price is and with almost no capacity to negotiate what the ultimate cost will be. So the idea that the market should just be left to decide is another way of saying the 47 million Americans without insurance can just eat cake.

One more thing about our market based economy makes the prospects for real reform dim. The more money involved, the more powerful the protectors of the status quo will be and the harder they will work to protect the system that has enriched them even if it has failed to serve others. And where there is money, there are pliable politicians because legislation is just one more commodity that is traded in the Washington marketplace. So if you can't afford a lobbyist you can forget your voice being heard.

Voices that will be heard, however, and make a rational debate even less likely are those of the media stars and Astroturf activists who are willing to profit themselves by inflaming and exploiting the fears and uncertainties about change.

So if anything comes out of the current health care debate, the amount of reform is likely to be truly small. But even a little bit of change could help. If reform resulted in lowering the U.S. infant mortality rate to only that of Cuba, it would save the lives of 1900 infants every year.


Dennis Jett, a former U.S. ambassador to Mozambique and Peru, is a professor of international affairs at Penn State's School of International Affairs. His most recent book is "Why American Foreign Policy Fails: Unsafe at Home and Despised Abroad."

McClatchy Newspapers did not subsidize the writing of this column; the opinions are those of the writer and do not necessarily represent the views of McClatchy Newspapers or its editors.