Once again, I found myself surfing the webs and eating ice cream last night, when I stumbled upon an article from Eduardo Porter in the New York Times. Porter promises sage advice for Republicans burdened by their “repeal and replace” proposals. “Hot Dog!” I exclaimed, elbowing the TV remote off the arm of the couch. How exciting! Finally we have someone attacking the issue. Republicans aren’t sure what’s going on and Democrats want single payer but are too afraid to admit it completely. Nobody is offering any real solutions. Well, no one but Mr. Porter…
“As you regroup after the collapse of your bill to repeal the Affordable Care Act, hoping to figure out some new approach to dismember it, you might want to think not about Denmark, but about Rwanda.”
Of course… Why didn’t I think of that?
The U.S. versus Denmark comparison has been soundly debunked. For leftists, it must be time to move on to a new faulty equivalence. What better a place to start than Rwanda, the epicenter of quality medical care and research on the planet. It just makes sense. Come on GOP! Put two and two together already!
Putting jokes aside (hard to do when reading the article), Porter is actually pushing the idea that the United States could improve our health systems by emulating the healthcare market currently enjoyed by Rwandans. What’s scary, is that this piece wasn’t written by a college kid scribbling away in a dorm somewhere. Eduardo Porter is a former member of the NYT editorial board; a proper Democratic mouthpiece. Here, it seems he is actively floating a trial balloon for democratic talking points.
Throughout the article, he offers quite a bit of evidence he claims supports his case. Porter starts by saying:
“Over the past 15 years or so, Rwanda has built a near-universal health care system that covers more than 90 percent of the population, financed by tax revenue, foreign aid and voluntary premiums scaled by income.”
Wow, that’s great! Over 90% of Rwandan’s covered! It makes more sense now that he’s expla… hey wait, hold up a second. What was that foreign aid bit?
A little digging shows that, according to the World Bank, Rwanda’s budget is comprised of roughly 30-40% foreign aid. In 2016, the United States gave Rwanda more than $128 Million, part of which went directly to programs like “the President’s Emergency Plan for AIDS Relief (PEPFAR)” and “The President’s Malaria Initiative (PMI)”, according to USAID. Rwanda’s annual GDP expenditure on healthcare averages around 7.5%, so with a total GDP of $8.376 Billion, that works out to about $600 million a year in annual healthcare expenditure. Not all of the $128 million given by the U.S. was directly funneled into their healthcare system but dollars are fungible. Rwandan healthcare benefitted from that money whether it was directly appropriated to the healthcare budget or not. It turns out Socialist medicine works quite well when someone else is paying for it, but while we are graciously helping to foot the bill for Rwandans, who’s going to foot the bill for us?
It gets better.
“It is not perfect” says Porter. “ A comparative study of health reform in developing countries found that fewer than 60 percent of births there were attended by skilled health workers.”
Quite the concession that it’s “not perfect”. It’s actually not even decent. We’ve been hitting better numbers in the U.S.A. since the 1950’s. According to Hektoen International, American in-hospital births increased “to 56% (non-white) and 88% (white) by 1950”.
Porter goes on:
“Rwandan lives may be short, but they are 18 years longer than they were at the turn of the century — double the average increase of their peers in sub-Saharan Africa”
The average life expectancy in Rwanda is 60.1 years, placing it at 200th of 224 countries world-wide. The average life expectancy in the United States, is 79.8 years. So yes, it may be true that Rwandans’ life expectancy has increased comparative to other African nations but here in the U.S. we still outlive them by almost twenty years.
His next point is my favorite.
“Its infant mortality rate, for one, dropped by almost three-quarters since 2000, to 31 per 1,000 births in 2015, vastly outpacing the decline in its region. In the United States, by contrast, infant mortality declined by about one-fifth over the period, to 5.6 per 1,000 births.”
So, just to be clear, he’s saying that we should model ourselves after a healthcare system that has an infant mortality rate five and a half times that of our own. Ok? I’m not sure I’m smelling what he’s stepping in here. As Porter undoubtedly knows, malaria contributes substantially to Rwanda’s sizable infant mortality rate. Perhaps, President Kagame’s Malaria Initiative that also strongly addresses non-healthcare malaria prevention focused on treated mosquito nets and indoor insecticide spraying has something to do with this. Rwandans can thank Bill Gates and mosquito nets for this result as much as socialized health care.
Porter writes that the example of “Rwanda may impress upon you an idea that has captured the imagination of policy makers in even the poorest corners of the world: Access to health care might be thought of as a human right.”
Well, not quite. What Rwanda has impressed upon me is that their healthcare may be improving but it’s still abysmal compared with our own.
Before the online version of Porter’s article was edited yesterday, he cited Rwanda’s HPV vaccination program which has covered over 93% of the young girls living in the country and compared it to US numbers which are lower. According to the CDC, our vaccination rate is about 63% (contrary the 40% number Porter gave in his article). First of all, remind me again who is paying for Rwandan vaccines? Second, Porter omits discussion of the real epidemic in Rwanda: HIV, which infects roughly 2.82 percent of the people that live there. In the U.S. that number is 0.34%.
The author goes on to further examine the growing healthcare coverage in countries like Ghana, Peru and Vietnam. He must have just forgotten to include other socialist medicine success stories, like peaceful Venezuela, utopian Cuba and the ever-free, quality care that was provided by the Semashko system of Soviet Russia.
Unfortunately, according to Porter, there are still hurdles preventing us from embracing Rwandan healthcare values:
“One is that it is hard to finance a universal system with voluntary payments. The young and the healthy will be reluctant to pay, leaving only the sick in the insurance pool, which would push the cost of premiums to unaffordable heights and ultimately cause the system to collapse.”
Ok, now you’re speaking my language.
“Several developing countries that initially leaned on voluntary premiums to finance their push toward universal health care have turned increasingly to direct government funding, either from earmarked taxes or general budget revenues.”
Nope, you’ve lost me again.
In true form, he finishes with this gem:
“Want to propose a single-payer health care system financed with higher taxes, maybe one that pays doctors a wage instead of a fee for service? It probably won’t take long for the American Medical Association to call you a communist.”
What! How dare they call single-payer advocates communists. Doesn’t the AMA know that communist health care systems were… uhh, well they.. um… ok yeah, Porter has pretty much advocated for communist medicine here. In reality, I highly doubt the AMA, which supported Obamacare, has ever called any proponent of socialized medicine a communist. A bit sensitive, no?
Well, that was enlightening! Rwandan healthcare in the States should work beautifully. We’ll just gloss over the fact that the population of the United States is roughly twenty seven times that of Rwanda, a country which is about the size of West Virginia. We’ll ignore that there are only 48 district hospitals in the entirety of the African nation, while in the U.S., there are 4,749, with 407 in Texas alone. Comparing these countries is not like for like and it’s intellectually dishonest to even make the reach.
Look, it sounds crazy to Conservatives in this country, but what Eduardo Porter is advocating is what leftist Democrats want. They’ve decided, for you, that Capitalism is simply too unfair to the poor and hapless, and their solution is to redistribute the unfairness and bad fortune to everyone. We don’t have first rate doctors, the newest medical technology and world class medicinal research in spite of Capitalism, we have it as a direct result. This is one trial balloon that should quickly succumbed to its own weight.
So here’s some better advice for Republicans: Repeal Obamacare. You know, like you said you would? The closer we get to socialized medicine, the more our healthcare system will look like Rwanda’s and Venezuela’s. If you ask me, that’s not such a good thing after all.