According to Mayor Giuliani, “we gotta solve our healthcare problems with American principles, not with principles of socialism.” (Basing policy on empirical data doesn’t seem to be an option.) In his speech, he then gives this rather bizarre evidence for the superiority of the American system: Europeans have asked him to get them into American hospitals, but no one has asked him to get them into a European hospital. His favorite example for the superiority of outcomes in the U.S. is a prostate-cancer comparison with the U.K., but he is simply wrong about the numbers. Nevertheless, it turns out that Americans are going abroad for healthcare. The term for this phenomenon is “medical tourism,” which connotes the rich and famous convalescing on the Riviera. But, it is actually a result of desperation for those who can’t afford treatment in the United States. And, although Mayor Giuliani likes to knock Sicko by including Cuba in his lists, many of these American "tourists" are going to third-world countries.

It’s not clearly all “bad” because people are able to get medical treatment for a lot less money. At some level, though, this is like satire: the free market is providing health care, but not the way you'd expect.  Instead, Americans, citizens of the richest country in the history of the world, must travel to Latin America or South Asia to get it. What’s odd about this as well is that the quality of care in foreign hospitals is evaluated based on “American standards.” In addition, the American tort system (i.e., the ability to sue for malpractice) is invoked as a standard of protection that patients can expect (or not) against negligence. Somehow I doubt that Mayor Giuliani will invoke this free-market example when he next ignorantly compares the market for iPods to insurance. (See my explanation here for the fundamental difference between markets for consumer goods and those for insurance.)

Within the U.S., a volunteer medical-relief corps, called Remote Area Medical (RAM), is beginning to provide treatment to Americans without health insurance. RAM, though, has historically gone to countries like Guyana, India, Tanzania and Haiti. It now works in animal stalls and makeshift tents in the United States. In July, President Bush said, “[T]he objective has got to be that America is the best place in the world to get healthcare.” This is right before he claimed, “People have access to healthcare in American, I mean, after all, just go to an emergency room.”) How is it that Republicans are considered “in touch” with Americans?

These stories are creating an incredible space for Democrats to take bolder positions on economic security. According to Mayor Giuliani, “each one of us can make a contribution [to fixing healthcare] by taking a little more control of our healthcare.” Right now, Americans are experiencing a “great risk shift” (see Jacob Hacker’s excellent book by that title) in which they feel ever less secure economically and feel ever more worry, anxiety, stress, and fear. Will Americans choose a President and Congress who will restore the American dream of middle-class security? I’m, unfortunately, not very optimistic. After all, let’s not forget how our elections are paid for.