Madeline in the US?

March 19, 2013
Posted by Jay Livingston
Reposted (with more graphs but no Madeline) at Sociological Images

Readers of Madeline by Ludwig Bemelmans may remember the title character’s emergency appendectomy.  It is, after all, the central plot point.  Madeline is whisked away to a hospital, where she later shows her scar to her housemates. 

Ludwig Bemelmans came to the US at age 16 and became a citizen four years later.  He lived in New York. Yet he set this tale in France. 

And soon after Dr. Cohn
came, he rushed out to the phone,
and he dialed: DANton-ten-six -
"Nurse,” he said, “it’s an appendix!”
Everybody had to cry -
not a single eye was dry.

In a US version of the story, the tears might be caused when the bill comes.*

The Washington Post (here) has provided some data on medical costs showing why there might never be a US version of Madeline. The tab for an appendectomy here runs to $13,000, four times what it costs in France.

(Click on the chart for a larger view.)

No wonder the US spends twice as much as France on health care.  In 2009, the US average was $8000 per person; in France, $4000.  (Canada came in at $4800). Why do we spend so much?  Ezra Klein (here) quotes the title of a 2003 paper by four health-care economists: “it’s the prices, stupid.”

And why are US prices higher?  Prices in the other OECD countries are lower partly because of what US conservatives would call socialism – the active participation of the government.  In the UK and Canada, the government sets prices.  In other countries, the government uses its Wal-mart-like power as a huge buyer to negotiate lower prices from providers.  (If it’s a good thing for Wal-Mart to bring lower prices for people who need to buy clothes, why is it a bad thing for the government to bring lower prices to people who need to buy, say, an appendectomy? I could never figure that out.)

There may also be cultural differences between the US and other wealthy countries, differences about whether greed, for lack of a better word, is good. Is it an unlimited good? Are there realms, medicine perhaps, where it is not good?  Klein quotes a man who served in the Thatcher government:

Health is a business in the United States in quite a different way than it is elsewhere.  It’s very much something people make money out of. There isn’t too much embarrassment about that compared to Europe and elsewhere.

So we Americans roll along, paying several times what others pay for medical procedures, doctor visits, and drugs.**

Ludwig Bemelmans died a half-century ago, but Madeline lives on.  If publishers are considering an American version – like what Hollywood did in “The Birdcage,” “Dinner for Schmucks,” and other Americanized remakes of French movies – I’ve finished the first draft of my manuscript (rough and in need of editing, I admit).  Here’s the ending.

And all the little girls cried, “Boohoo,
we want to have our appendix out, too!
We want a real scar
Not just some tattoo.”

“Good night, little girls!
Let this fantasy drop.
Appendectomies here
Cost thirteen g’s a pop.

“And that’s not including
The hospital stay –
The US average:
Sixteen big ones a day,

“And that pretty penny
For hospital care is
Four times as much
As the price back in Paris.

“So please go to sleep!
Let’s have no more drama. There
Might be improvement ahead
With Obamacare.”

-------------------------------------------
*  See Steven Brill on the bitter pill of the medical bill - here.)

** The most viewed SocioBlog post ever was this one from 2009.  It consisted mostly of four graphs on health care costs.  It got Boinged because of one line: “Our Lipitor must be four to ten times as good as the Lipitor that Canadians take.”