Mitt Romney's Unfortunate Analogy

"Driving is privilege, not a right."

It's likely the first thing you remember hearing in your high school drivers' ed class. And it's meant as a warning. You'd better be a safe driver, because if you screw around that privilege will be taken away.

So when I heard Massachusetts Governor Mitt Romney say that his proposed law requiring every resident to have health insurance even if their employer doesn't provide it was similar to the law requiring you to have auto insurance before you're allowed to drive, all I could think was: In America we view health insurance -- and therefore quality healthcare -- as a privilege, not a right.

Don't get me wrong, I applaud Romney and the Massachusetts legislature for trying to come up with an innovative near universal insurance plan and do something to address our country's staggering health care problem.

I strongly agree that every citizen should have health insurance. But I disagree with the philosophy behind Romney's solution.

Under the Massachusetts law every state resident will be required to get health insurance by July 1, 2007. If you can afford insurance and don't buy it you'll be penalized on your taxes. Businesses with more than 10 employees that don't provide insurance also will be penalized. And through government assistance the state hopes to make insurance more affordable for the working poor and broaden the program offering free coverage to children.

Massachusetts officials expect that by 2010, 95 percent of the state's uninsured population, about 515,000 people, will have some form of coverage. Of course, as this skeptical column from the Boston Globe shows, there are the usual concerns about cost over-runs and funny numbers in the plan. In other words, we're going to have to wait a little while to see if this really works.

Regardless, it's a bold step. But it still doesn't address the fundamental unfairness of the American health care system. That is, for whatever reason, we continue to allow the quality of our health coverage to be dictated by the vagaries of our employment status, rather than establishing it as a basic "right" we guarantee to every taxpaying U.S. citizen. This makes us unique throughout the developed world.

Of the 30 countries in the Organisation for Economic Co-operation and Development, or OECD, only the United States doesn't offer a national health insurance program to its citizens. As of 2003, the most recent year for which these figures were available, there were roughly 45 million Americans without health coverage. And it shows in our comparative "big picture" health statistics.

To be sure, at the highest, most sophisticated levels, parts of the U.S. health care system represent the best the world has to offer. But when it comes to the basics we really don't get it right. For instance, as of 2003 life expectancy in the U.S. was 77.2 years, below the OECD average of 77.8. Australia, Iceland, Japan, Spain, Sweden and Switzerland all had life expectancies of over 80 years. Infant mortality was another area where the U.S. lagged, suffering seven deaths per 1,000 live births in 2003 compared to the OECD average of 6.1 deaths per 1,000 live births. Finland, Iceland, Japan, Norway and Sweden each had below 3.5 deaths per 1,000 live births.

There are many other similar statistics -- such as the numbers of doctors, nurses, critical care facilities, and so on -- all showing how the idea that America offers the best health care in the world is a myth.

But what's most bizarre here is that we continue to ardently stick with our program despite the fact that the one thing it's proven to be is the most expensive in the world. No matter how you look at it, of the 30 countries in the OECD the U.S. pays far more than anyone else for its health care, meaning we're really lagging in the "bang for your buck" category.

In 2003, 15 percent of our gross domestic product went to health care expenses, compared to the OECD average of 8.6 percent. The next closest country, Switzerland, allocated 11.5 percent of its GDP to health care, followed by Germany at 11.1 percent. Japan's health care expenses were roughly 7.9 percent of its GDP.

We also spent an obscene amount in pure dollar figures. Adjusting for different currencies, the average OECD country spent $2,037 per person on health care in 2003. The United States spent $5,635. Norway was next at $3,807, followed by Switzerland at $3,781. Japan spent just $2,139.

Clearly something's broken here beyond the point where the actions of a single governor or a state legislature can fix it. To get to the root of the problem we really need to start by asking ourselves where our priorities lie as a society.

In essence, it all comes down to this fundamental question: Is health care in America a privilege, or a right?