*Shortly after columnist Deroy Murdock came to Stanford to talk about universal health care, Dr. Scott W. Atlas in the School of Medicine and the Hoover Institution sat down with The Stanford Review to share his experience and opinions on health care policy in the United States. *
The Stanford Review: You share appointments as professor and chief of neuroradiology in the School of Medicine and also at the Hoover Institution, where you research public policy related to health care. What do you research and what have you discovered?
Dr. Scott W. Atlas: At Hoover I have been working on several ongoing projects tied to the influence or the availability of advanced medical technologies in health care systems domestically, and I also participate in international health care policy work both through Hoover and through the Freeman Spogli Institute for International Studies, where I also hold an appointment. I have worked with the World Bank commission on how economic development is a secondary result of good health care as opposed to wealthy nations secondarily achieving good health care. The goal of the World Bank commission was to determine primary factors that facilitate economic development and one of those is health care. And I also work with health care policy and design for emerging countries, with some particular interest in China, which has a very complex set of issues to deal with, but every countries has their similarities and also some issues.
In fact, I’m going to China as part of the Stanford University entourage with President Hennessy, because we’re forming a more formalized relationship with Peking University. I’m going as a representative of the School of Medicine and in addition to the formal events that are going to link Stanford and PKU, I’m participating in a panel discussion about health care in China where I’m specifically talking about trends in the emerging nations in health care, in Asia specifically, including China and also India which again has a very different set of issues.
I think what’s interesting and fascinating to understand is that no matter what your ideas are on health care access, quality, and improvement, every country is grappling with these issues, whether you are in the most government controlled system or the least government controlled system. As health care has progressed, the fact of the matter is that things are expensive, and that somebody’s got to pay for these things. And I’m talking now affordable diagnostic as well as therapeutic delivery of quality health care, so there is no easy answer or it would have been done.
TSR: Do you agree with statements that our country has never been closer to enacting a universal or a government-mandated health care system?
SWA: Yes, because it seems true that it’s never been as frequently discussed, as front and center as it is now in this election cycle. Health care is clearly an issue that is very important to the American people. It’s also an issue that brings out a lot of emotion, often not based on fact. Along with the growth of other so-called entitlement programs, the degree of government control in health care is actually underestimated in the United States. It is not minimal at all; it’s not a free market system. But yes, I agree that it in a sense we have never been closer because it’s been talked about so much. How close we are remains to be seen. We’ll see what’s really enacted by Congress.
TSR: How do you see health care changing under a Clinton, Obama, or McCain presidency?
SWA: First of all, I’m not sure that the president will specifically determine what sort of health care system will actually be enacted. Certainly there’s a huge amount of power in the position, and they all have their proposals. The basic thrust of the difference I would summarize is that on the Democratic side, you have government being the determiner of what health insurance should be and having a huge say in what health care itself will cost, rather than what the Republicans say, which is even the playing field with tax reform, give American consumers adequate information as to make appropriate decisions, including information on prices and quality, so people can actually determine and buy whatever coverage they want, reduce the number of mandates so that you don’t force people to buy insurance for things like massage therapy and acupuncture and other things they may not want, and make prices come down based on competition. McCain talks a lot about allowing cross-state purchasing of health insurance, things that in other industries time and time again have been shown to reduce costs. Costs come down in the American economy by supply and demand, competition for business, and in the current health care system, the fact is that the American consumer has totally been shielded from even considering value or cost because they don’t pay directly and they think that someone else is paying, even though it’s their own taxes paying for it.
TSR: You were talking before about how the lack of transparency in information and the middleman between the American and their medical expenses and how we have a push toward government control. Why is health care, as opposed to other industries providing essentials for living, unique to receiving this kind of special attention?
SWA: This really goes back, to my knowledge, to Milton Friedman’s writings on health care many years ago where he said there is no case for making health care different from other service product industries. This is restated in Mr. Murdock’s talk: why shouldn’t you say that the government should provide food, or clothing, or other essentials? Which of course the government doesn’t do, whereas it does give them money to help them purchase things they actually want.
It was an accident of history that health care was given this kind of benefit that was shielded from tax considerations. As it does with other entitlement programs in the United States, as the entitlement grows, the expectation of the entitlement grows, and in the process people think it’s free. And the fact of the matter is that they couldn’t be more wrong. They’re paying, but they think they don’t and therefore there’s no reason why not to just spend unlimited money in the American consumer’s mind. And the fact is that Medicare, Medicaid, these programs are unsustainable. That’s inarguable, they’re unsustainable. So all those people who say let’s have Medicare for everyone, which is essentially a stated position of many policymakers, it’s quite the opposite. The government should not be in the business of arbitrarily setting price controls for medical care, and they should not be the ones who are the insurers, in my opinion.
All these things are better done in the private world where free market economics and competition occurs, and the consumer benefits. That’s why we see prices of computers come down. Now do people have enough information to understand the exact workings of different CPU chips? No. But they know enough information to be able to make comparisons, shop around, and buy what they think is valuable. And so for all those who think that people aren’t sophisticated enough to make a decision about health care, I mean, that’s ludicrous, there’s no basis for saying something like that.
TSR: How can opposition to universal and government-mandated health care most effectively be framed?
SWA: My feeling is that the American people need to understand the facts. Having been the coordinator of the policy team of one of the major presidential candidates who’s not running now, one of the things that was obvious to me was that people don’t understand the facts. Facts need to be put forth about how government control has negative impacts on health care for the individual consumer, the negative impact of mandates on people who get insurance as well as the mandates that make up what needs to be included in insurance, the negative effects of government-controlled delivery where there is such limited access, the negative quality impact.
We look at the facts and it’s very easy to see that when you compare the United States system with all of its flaws to other systems, whether that’s in Canada where there’s almost a wholly government-controlled system, or in western Europe. There’s a lot of data out there that shows unequivocally that if you’re sick, you’re much better off to be in the United States. Now that doesn’t mean that the system is without its significant flaws, but the question is how to solve those flaws, and this is what the difficult task ahead is: to educate Americans on how it would better if you, the American public, has control over the dollar and make the decisions yourself and in consultation with your doctor.
Unfortunately, the easiest argument to make, which is a dishonest one, is to say that the government will cover it and it’s all taken care of. And that is very easy to accept as another “entitlement.” But the fact is that people really need to be educated about the downside of that.
It’s an attractive proposition to say to somebody that we as the government will just give that to you. But we see how well that works for the public schools in K-12 in the United States, as opposed to private schools and our secondary school system with all of its choices and competition. I think it’s a more difficult task, but we need somebody, a candidate a group of leaders who are going to be able to articulate the facts in a very clear and straightforward way to the American public, because in the end, the will of the people will be enacted, I believe.
TSR: Why is it that so many people who could articulate opposition to government-mandated health care just seem to run away from the issue?
SA: Well, I’m not sure that they run away from the issue, but it’s a difficult one, and it is not the only issue of importance in the campaign. There are other issues, and the media really is controlling the message. Let’s be honest here. You could watch those Sunday talk shows and 50% of the time they’re talking about what Geraldine Ferraro said or what Obama’s minister said and they never even get around to asking about the issues. Number two, there are other important issues. Iraq, and right now the economy is really front and center; health care is really important, but the real polling shows that only in the single-digits do people actually vote with health care as the number one issue. And the other reason is that health care is complicated. Like I said, it’s an easy argument to just state okay, we are going to give this to you. And people will say, okay, that sounds very good. It’s another level to go into why that’s bad and why you’d rather be empowered. So it’s a message of empowerment, and it takes somebody who knows the facts, who again can make the compelling argument. And it’s not an easy argument to make, although I think it’s the right one.