DeLong and DeShort of It

Brad DeLong at The Health Care blog makes these assertions:

  • Bismarck created the world’s first national health insurance system 130 years ago because he wanted to make the German people healthier.
  • The rationale for national health insurance in the U.S. today is the same as it was for Bismarck.
  • People can’t pay for expensive care without health insurance and without health insurance they can’t get health care.
  • “So, unless we adopt the view that those without ample savings who fall seriously ill should quickly die (and so decrease the surplus population), a country with national health insurance will be a wealthier and more successful country.”

Hmm. It’s hard to know where to start.

Comments (17)

Trackback URL | Comments RSS Feed

  1. Buster says:

    Bismarck created the world’s first national health insurance system 130 years ago because he wanted to make the German people healthier.

    Health status isn’t a condition that’s dependent on doctor visits in the same way your car wears out and needs periodic maintenance. My car does not regenerate parts, whereas my body does. My car works much better when old, worn out parts are replaced. There is a limit to replacing body parts.

    Basically, medical science couldn’t provide much benefit back then. This suggests national health insurance was little more than a empty gesture.

    • Sandip says:

      Interesting analysis. There is no doubt that health policy is quite complex and it is hard to make anything universal out of it since so many factor affect health.

    • Nathanael says:

      Bismarck’s national health insurance really did make people better off. Doctors already knew how to perform surgery cleanly by that point (Lister predates Bismarck’s system).

      Bismarck’s system partly got people proper care when they had industrial accidents (or injuries fighting for the Kaiser!) and needed surgery. But it did get people care under those circumstances *which they had not had before*.

      Bismarck’s system also got people vaccinations (yes, those had been developed by this time too) which they had not gotten before.

      Make no mistake: Bismarck’s system improved the health of Germans of the time. You’ve overstated your case due to not knowing the actual history of medicine.

      Yes, Bismarck’s goal was probably to have a fitter fighting army.

      • John R. Graham says:

        But it fits in very well with a casual theory which I hold. It answers the question: “In democracies, why do citizens allow politicians and bureaucrats to control their access to health care, which they would never do for clothing, food, or shelter?”

        The answer, I think, is that clothing, food, and shelter have been made and used by mankind since prehistory. Every generation sees improvements, but everyone can see that people were able to feed, clothe, and house themselves through voluntary market transactions before the central administrative state arose.

        So, a politician who promised universal food, clothing, or shelter would be seen my most citizens as ridiculous – proposing to solve problems that people can largely solve for themselves.

        Medical and surgical care, consistent with any sensible definition, did not exist before about 130 years ago. It’s rise was concurrent with the central administrative state.

        So when politicians say that only they can guarantee universal access to care, many people will tend to believe them. They cannot imagine an alternative unobserved in history.

        (This implies, of course, that health care is not a necessity, because homo sapiens existed for about 150,000 years before “health care” existed!)

  2. Joe Barnett says:

    Most of the improvement in longevity over the past 130 years came from infrastructure improvements — especially clean water and sanitation — that reduced premature mortality from disease; public health measures against viral and bacterial diseases.

  3. Greg Scandlen says:

    Don’t these people ever get embarrassed by their own ignorance? There were plenty of ways to pay for needed health care at the time, including mutual aid societies, charity, and installment plans. In fact the cost of the care was less of a burden on people than the lost wages when they were sick.

  4. John R. Graham says:

    I hereby pledge to stay healthy in order to glorify the Kaiser.

    But seriously, even Wikipedia tells us that the plan was designed to give the federal government more power over the states (to use American lingo). Thus, it should be seen as a micro symptom of the macro phenomenon of the Prussian consolidation of government over the entire German people.

    States and employers were unhappy with Bismarck’s original plan, which failed twice in the Reichstag. It only passed when the premiums were funded by employers and not the federal government though general revenues.

  5. Afton says:

    Nationalism can be a difficult force to contain.

  6. Qwerty says:

    The article mentions vaccines. How do they fit into insurance?

    • Beth says:

      They probably pick certain common vaccines to put into insurance packages, and leave out obscure vaccines.

  7. Linda Gorman says:

    Gosh, that friend of mine who doesn’t have health insurance and paid cash for back surgery must not exist…

  8. Vicki says:

    Clever title.

  9. Bob Hertz says:

    At least part of the impetus for national health care in Germany was to create healthier soldiers.

    In America, the number of young men rejected for Army service was very large, in the millions, in World War II for sure. This occurred right after The Depression, and there were many cases of horribly bad teeth and various diseases that come from poverty and bad diets.

    I am saying that Prof Delong has over-reached here. There is nothing much in common between Bismarck trying to make young men strong, vs Obama adding coverage for mental health and contraception. Both are called national health insurance, but that is misleading.

  10. education says:

    hey there and thanks on your information ? I have certainly picked up something new from right here. I did on the other hand expertise a few technical points the use of this website, as I skilled to reload the website a lot of occasions previous to I may just get it to load correctly. I had been considering if your hosting is OK? No longer that I’m complaining, however slow loading cases times will often affect your placement in google and could injury your high quality score if advertising and marketing with Adwords. Anyway I’m including this RSS to my e-mail and could glance out for a lot extra of your respective exciting content. Make sure you update this once more soon..

  11. Health Insurance in Germany says:

    It’s hard to know where to start.