“Can i suggest that before attacking my article, you first read it? I never once say that I’m in favor of dental insurance. I merely point out that people without general medical coverage can’t afford to pay for preventative dental care. And nor do I saw that the health care system is an efficient free market. I say–quite the opposite–that the amazing thing is that a country that is otherwise committed to economic efficiency would tolerate such a grossly inefficient health care system. Trust me. It’s not that hard to read a 4000 word article.”
I am certain that Mr. Gladwell is not seriously suggesting I had not read his article, but rather uses this cute device to imply that my interpretation was so far afield from his intent, one could only assume the critic (that is, I) had not in fact read the piece at all.
But it was indeed read, and several times, mostly in astonishment that such a slightly argued discussion was published in a major magazine. It appeared to contain virtually every canard supporting nationalized health care I have ever seen in print.
Others have, as I had noted, already critiqued several of its deficits. My main concern was that the initial argument introduced in that article, that:
“People without health insurance have bad teeth because, if you’re paying for everything out of your own pocket, going to the dentist for a checkup seems like a luxury.”
was never in fact demonstrated in the article.
Is it true that people without health insurance have bad teeth because of health care spending?
First, he repeats the unverified-but-now-canonical statement: “The leading cause of personal bankruptcy in the United States is unpaid medical bills.”
This Health Affairs article he references was debunked by Gail Heriot in the National Review. It was similarly refuted at Volokh.com by Todd Zywicki here and here.
In short, a rather expansive if not dishonest definition of ‘bankruptcy due to medical bills’ permitted two longtime leftist authors to introduce a meme that has held firm, despite its weak evidence. David Himmelstein and Steffie Woolhandler, authors of the 2003 Proposal of the Physicians’ Working Group for Single-Payer National Health Insurance and co-founders of Physicians for a National Health Program (1989) have long pushed for nationalized health care. Their studies’ conclusions are both biased and questionable, to put it mildly.
Even if that claim were true, it does not follow that people do not get their teeth fixed because they spend their income instead on health care. The poor already have health care covered by Medicaid, so he cannot mean that group (one hopes). If he means the uninsured but non-poor, he does not say so, or prove that either. His anecdotes suggest the working poor as well as those on the dole were interviewed, but we must assume their self-reported status of non-insurance is accurate (which is not often the case, as any social worker could confirm). Undoubtedly this group finds dental care too expensive, but why? Their spending choices? Other fixed costs? Preferences? That answer is simply unknown. He is not permitted to assume that because (a) one is uninsured that (b) one’s teeth go uncared-for as a result.
In the comments, Mr. Gladwell takes issue with other things:
“I never once say that I’m in favor of dental insurance. I merely point out that people without general medical coverage can’t afford to pay for preventative dental care. “
Well, no. In fact, he quotes outright from the book:
“Almost every time we asked interviewees what their first priority would be if the president established universal health coverage tomorrow,” Sered and Fernandopulle write, “the immediate answer was ‘my teeth.’ ”
So he meant national health care, but no dental care? Something else? Then why that quote? And how were we to draw any other conclusion than that a national dental plan was needed?
And he comments further: “And nor do I saw that the health care system is an efficient free market. I say–quite the opposite….”
From the New Yorker again (ellipsis mine):
“A country that displays an almost ruthless commitment to efficiency and performance in every aspect of its economy … has loyally stuck with a health-care system that leaves its citizenry pulling out their teeth with pliers.”
I see. Was he instead saying that we should promote a “ruthless commitment to efficiency” for health care? Is it insufficiently ruthless? Or simply inefficient?
It appears that his comment (“nor do I sa[y] that the health care system is an efficient free market”) means that it IS a free market, just an inefficient one. I think. Or not; it’s hard to tell. (Unfortunately for us, the fact that nationalized industries are among the most inefficient of economic arrangements, marked by historic failures across the globe, seems to have escaped Mr. Gladwell’s research.)
The original argument, then, that poor dental care results from a lack of funds caused by a lack of health insurance, remained unexamined and unproven. A long trip through the talking points for Himmelstein’s national health care proposal is not proof thereof, but is itself another uncritiqued proposal (look it up: there has never been a follow-up article in JAMA rebutting her proposal.) A wish list is not evidence.