'Sicko,' Health Care and SCHIP

Moore's many case histories poignantly illustrate this -- sick people being dumped on skid row by health care facilities, parents moving into their children's basements after being bankrupted by medical bills, children dying from minor illnesses because their mothers are refused urgent care at the nearest hospital. The administration's priorities are ... supply your own adjective here.

(A caveat: If SCHIP or some other program is effective, why not extend it to all Americans? One problem is that of scale. Programs that work for small groups don't always do so when scaled up to the nation as a whole. A prosaic instance of such nonlinearities occurred to me at a pizzeria recently where the small 8-inch pizza sold for $10 and the large 12-inch pizza went for $15, despite the fact that the larger one was more than twice the area of the smaller. More generally, scaling up can change the costs and payoffs of any policy significantly.)

Give Me Poverty or Give Me Death

"Give me poverty or give me death" doesn't quite have the rousing ring of Patrick Henry. It's heartless to give gravely ill and uninsured people the Hobson's choice of either dying or impoverishing themselves to pay for medical care. Of course, that's not quite right since, as Bush recently observed, "People have access to health care in America. After all, you just go to an emergency room."

As has often been noted, however, emergency rooms are expensive and inappropriate for routine care. It's better for patients and cheaper for everyone else when patients get care and preventive treatment at a doctor's office, the sort of medical care that the extension of the SCHIP program is designed to provide.

Providing needed medical care to all is a monstrously complex subject (expenditures on health care were $2 trillion in 2005, about 17 percent of GDP). As indicated, the present system suffers from inefficiencies, absurd administrative expenses, exorbitant prices, bad management, fraud and waste. There are countless ways to improve it and achieve universal coverage -- most consistent with a vibrant private sector.

The solution to the problem is technical requiring the combined expertise of doctors, actuaries, business people, operations researchers and policy wonks of all sorts. At its base, however, the crisis in health care is an ethical issue. Acknowledging its extent and not succumbing to ideological biases and economic special interests are two necessary first steps to resolving it.

Seeing "Sicko," a funny, but deadly serious movie, might help too.

John Allen Paulos, a professor of mathematics at Temple University, has written such bestsellers as "Innumeracy" and "A Mathematician Plays the Stock Market." His "Who's Counting?" column on ABCNEWS.com appears the first weekend of every month.

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