Myth: Healthcare Is Free in Canada, Germany, England, France
Fact: People in other health care systems often pay more than Americans do, sometimes in the form of taxes. And they may also incur high costs if they need a drug that is not covered by their health system or want to see a specialist.
In the US, a family of four with an employer-based PPO will have around $15,609 total this year in health care costs. Of this amount, $9442 will be paid by the employer and the employee will contribute $3,492 in premiums and $2,675 on copays, etc. [1] That's about 6 percent of average family income. [2]
In Canada, while the percentage of taxes used to provide health care varies, it is estimated that 22% of taxes collected went to the health system in 2004.[3] Several provinces, including Quebec, Ontario, Alberta, and British Columbia, also charge additional premiums.[4] Canadians also may spend money to receive private treatment for procedures or drugs that are not covered by the government system.
Citizens of the UK pay 11 percent of each pound they make in weekly income between £100 - £670 for the NHS, plus an addition 1 percent of income over £670 a week.[5] Though the copay for drugs is low, many drugs are not covered, often because they not considered cost efficient. And anyone who uses their own money to buy powerful but expensive drugs not paid for by the NHS finds him or herself shut out of the NHS for having gone outside the system.
In Germany, coverage from a public sickness fund currently can range significantly in cost, from around 12.2 to 16.7 percent of income, with the employee paying a bit under half. As of fall 2008, premiums are to be standardized from the federal level and health care experts anticipate that they will be set around 15.5 percent.[6] Private patients can generally expect to pay more than they would in the public system.
In France, employees contribute only to 0.75% of their salaries towards medical care, but also pay a 7.5 percent General Social Contribution, the majority of which is earmarked for the health system. This base coverage reimburses people for the majority of costs for doctors visits and for a portion of the costs of medications.[7] On top of the government coverage, almost all French residents have supplementary coverage from a mutuelle, costing approximately 2.5 percent of salary.[8]
References
[1] "Average 2008 Employee Out-of-Pocket Costs for Family Health Care to Increase 10.5%, According to Milliman Index," Medical News Today, 16 May 2008, http://www.medicalnewstoday.com/articles/107699.php.
[2] Kevin Sack, "Clinton Details Premium Cap in Health Plan," The New York Times, 28 March 2008.
[3] Jay Lehr, "Canadian Health Care is No Model for US: Claims That Canada's Single-Payer Health System Is More Efficient or More Compassionate than Ours Are Just Plain Untrue," Health Care News, 1 June 2004, available at http://www.heartland.org/Article.cfm?artId=15034&CFID=4911814&CFTOKEN=64059852
[4] OECD, "Taxing Wages 2006/2007: Special Feature: Tax Reforms and Tax Burdens," (2008).
[5] OECD, "Taxing Wages 2006/2007: Special Feature: Tax Reforms and Tax Burdens," (2008).
[6] "Beiträge können kräftig steigen," Süddeutsche Zeitung, 7 January 2008, http://www.sueddeutsche.de/wirtschaft/artikel/401/151024/.
[7] David G. Green, Ben Irvine and Ben Cackett, "Health Care in France," Civitas, (2005), http://www.civitas.org.uk/pubs/bb2France.php.
[8] David G. Green, Ben Irvine and Ben Cackett, "Health Care in France," Civitas, (2005), http://www.civitas.org.uk/pubs/bb2France.php.
As always, these sorts of economic facts are tremendously helpful in reinforcing the underlying moral point that health care is not a right. Health care is a commodity that must be created by the thought and work of a rational mind. There is no such thing as a "right" to something that must be produced by another.
When a government attempts to guarantee health care as a "right", it can only do so by violating the actual rights of doctors and other health care providers, who are forced to provide that service on the government's terms and for the government's prices, rather than on their own terms in a free market.
The results we see in Europe and Canada are the result of this idea put into practice.
1) The fact that patients are willing to pay you directly for your services means that you have a good reputation in the community. We know that lousy doctors cannot sustain a concierge practice.
2) Concierge practices are smaller than traditional practices. By sheer number, the risk of lawsuits is smaller. You have several hundred patients as opposed to several thousand.
3) You have more time to spend with each patient. You are less hurried. You are able to be more meticulous and pay greater attention to detail. This lowers your risk of human error.
4) Though you are capable of making a mistake, you actually have a relationship with your patients. You know them personally. You spend a great deal of time trying to do the right thing for them. Even if you make a mistake, your patients will be more likely to forgive you for human error.
5) Finally, we have looked at over 200 practice years of concierge physicians. To date, we have been unable to identify a single judgment against a concierge physician.
This is yet another example where a free market approach benefits both doctors and patients. I recommend reading his entire blog post.
I've listed the main points, but I recommend reading the whole thing because the essay elaborates on each point in greater depth:
1. Think About Your Health 2. Think About How You Use Health Care 3. Know the Doctor 4. Know How the Doctor Is Paid 5. Study the Health Plan 6. Know How the Health Plan Is Paid 7. Save Money 8. Ask for Cash Discounts 9. Recognize That Health Care Is Not a Right 10. Be Personally Responsible for Your Health Care
Private surgical centres are an essential relief valve for our overburdened public health care system. To see how, let's follow the case of 82-year-old Mrs. Green from Vancouver. She needs knee surgery and has been on an orthopaedic surgeon's waitlist for over two years. In our rationed health care system, her surgeon is "allowed" only six hours of operating room time per week, and he has 129 people on his list ahead of Mrs. Green.
In desperation, she contacts us. Two weeks later, Mrs. Green gets her new knee, in Quebec. Her surgeon there, Dr. Jones, operates at a public hospital but has used up all of his allotted time in the public system. But happily, he also operates in a private Quebec surgical centre every week, after completing his time "quota" in the public hospital. The extra money he earns for this work keeps him from moving to the United States.
When Mrs. Green travelled to Quebec for her new knee, Mrs. Brown moved up one slot on the public waitlist and will get her surgery a week earlier.
To summarize, by being able to operate in a private surgical centre as well as a public hospital, Dr. Jones has the incentive to stay in Canada, Mrs. Green has cut her wait time down to two weeks from 51 and Mrs. Brown will get her surgery in the public system one week sooner.
What part of this scenario do the apologists for our Canadian public health care system not understand?
Rick Baker, Timely Medical Alternatives Inc., Vancouver.
Here's more information about Rick Baker's service. Were it not for the small amount of private medicine permitted in Canada, things would be much worse for Canadian citizens, who would otherwise be forced to rely on the state-run medical system for their care.
It's eerily reminiscent of the small private farms in the former USSR which only occupied 3% of the land compared to the state-run collective farms, but produced over 25% of the crops.
Re: "Guaranteed health care is best for America," Aug. 13 letter to the editor.
Kristen Hannum's letter propagates the myth that government-run socialized medical systems can actually "guarantee" health care.
The British government has just told patients the exact opposite when it stated that the National Health Service should deny life-saving care if it is too expensive.
Whenever governments attempt to "guarantee" health care, they must also control it. Canada and England save money through rationing and wait lists. Rather than being "guaranteed," government-run health care becomes a privilege dispensed at the discretion of bureaucrats. Do we really want this sort of system?
Unfortunately, the facts of reality show the exact opposite. Recently, the British government has ruled that its National Health Service should deny medical care if the cost is too high:
Patients 'should not expect NHS to save their life if it costs too much'
The NHS should not always attempt to save someone's life if the cost is too much, the medical regulator has ruled...
[T]he regulator says: "There is a powerful human impulse, known as the 'rule of rescue', to attempt to help an identifiable person whose life is in danger, no matter how much it costs. When there are limited resources for healthcare, applying the 'rule of rescue' may mean that other people will not be able to have the care or treatment they need...
This is of course, classic rationing.
In reality, government "guaranteed" health care means that health care is dispensed at the government's discretion, rather than on the basis of what a patient and his physician decide is best.
Do we really want that kind of system for America?
A: Life expectancy in the U.S. compared with that of other countries is often cited to condemn the American healthcare system; the uninsured are dying from lack of health insurance and treatment, it is argued, while countries with universal coverage live longer as the result of their healthcare systems.
But is life expectancy primarily dependent on having health insurance? Is access to healthcare services the main determinant of longevity?
Trauma
Motor vehicle fatalities are the leading cause of death for Americans aged 1-29. Driving under the influence of alcohol is the most common factor in fatal crashes. For every reported death related to a motor vehicle crash, it is estimated that thirteen individuals are injured severely enough to require hospitalization.
...Supporters of government-provided healthcare often attribute longevity to healthcare access without considering the impact of other factors. Healthcare access in the U.S. has less of an impact on mortality statistics than trauma.
She also discusses obesity, smoking and crime, concluding:
As you can see, comparing life expectancy in countries where government foots the insurance bill to our system here is like equating apples and oranges. Conditions relating to obesity, tobacco use, alcohol, and violence make America unique. Adopting a national health insurance model will not necessarily lead to a longer life.
ABC News reporter John Stossel makes a similar point in this article:
Many things that cause premature death have nothing do with medical care. We have far more fatal transportation accidents than other countries. That's not a health-care problem.
Similarly, our homicide rate is 10 times higher than in the U.K., eight times higher than in France, and five times greater than in Canada.
When you adjust for these "fatal injury" rates, U.S. life expectancy is actually higher than in nearly every other industrialized nation.
Using international life expectancy statistics as a justification for a government takeover of medicine is misleading and dangerous. Fortunately, some doctors and reporters know better.
The recent 40th anniversary of Medicare was observed in Pueblo by several doctors calling for a single-payer health insurance program for all U.S. residents.
Single-payer is a euphemism for government-controlled health care. If you are enamored of the Postal Service, you will simply love health care directed by bureaucrats in Washington, D.C.
The fact that Medicare already limits the payment for much of America's health care should tell the medicos something. It's that, when a finite number of tax dollars are going to pay for health care, there will be rationing.
One only needs to look north of the border, where health care is a government-run enterprise. People with serious ailments often must wait for months to get the treatment they need, and some die waiting. Canadians who can afford it often travel south to the United States to get the care they need when they need it.
The same can be said of government-run health care in Great Britain. The English may wait for care while keeping a stiff upper lip, but this ain't the United Kingdom. Ironically, less than a week after American "Medicare for all" was being touted, the Government Accountability Office reported that about 10 per cent of Medicare dollars for medical equipment such as wheelchairs are going to fictitious sellers. The government has been aware of these shenanigans for at least three years, but the bureaucracy has been slow to shore things up.
People say they want health care that's the highest quality, available to all and inexpensive. It's axiomatic that you can have any combination of two, but not all three.
Which one do the single-payer advocates want to do away with?
Myth # 1: The only ethical way to save our medical system is to create a universal health care system managed by the government and abandon private medicine.
Myth #2: Concierge Medicine doctors only see wealthy patients, abandoning the poor and middle class.
Myth #3: Health care is a right! People should not have to pay for their healthcare.
Myth #4: Concierge doctors are only concerned with money. There is no reason that they cannot care for complex patients with multiple medical problems in an eight-minute office visit.
I recommend reading the whole thing, because Dr. Knope provides a positive moral defense of his profession.
Concierge medicine is a natural consequence of the free market, where physicians and patients can voluntarily negotiate using their rational judgment according to their mutual interest. Patients receive quality care for a fair price, and physicians are able to practice good medicine according to their professional conscience. Both sides win as a result.
Tales From Canada By Paul Hsieh, MD @ 12:05 AM
One Canadian resident pointed out to me that socialist policies may seem successful in the short term due to the initial looting of taxpayers, but this is not sustainable in the long run. Economic reality then sets in, with the inevitable shortages and rationing.
Here's a slightly edited version of his e-mail, quoted with his permission:
...When Canada's Health Care System was nationalized, I predicted, to any who would listen, that in 15 years its initial flush of great service would decline from 'lack of funds' (1985). That is exactly what happened, but health care professionals took dozens of steps to mask or hide that effect. E.g., for the last decade, in the hospital where [a family member] works, an entire ward of ~25 beds has been used for storage, while patients lie on gurneys in the hallways. It is closed because the government will not provide enough funds for nurses to man it. Many staff in the hospital are unaware of this closed ward, even as they walk past it every day. Patients on those gurneys who die of heart failure or stroke, while awaiting for surgery, are not listed as having died from "waiting".
Similarly, emergency-ward wait times have been increasing. I used to hear of people waiting as much as twelve hours, but recently spoke to a man in who had to wait 36 hours while in considerable pain (a new record for my mental tracking of wait times). Meanwhile, an architecturally stunning new cancer wing has been built with private funds provided by local construction magnate... Outside there are gardens and statues of ordinary looking people 'leaving the building'. A sign tells us they are "Survivors". The wing has received a great deal of positive media attention and garners lots of oohs and aahs, but elsewhere there are still ~25 beds unavailable for other patients.
The hospital president is good friends with [a local politician]. When that friend became the province's Minister of Health the president was very excited that, with a little "schmoozing" (his word) he would now be able to get money for the hospital. Yes, that's how it's done!
More American politicians should learn what medical care is really like in Canada, before advocating a similar system for the US:
If citizens of these other wealthy countries have guaranteed care, can Dr. Krugman explain to me to following instances of people in these countries not getting needed medical care:
The British National Postreports on “How the NHS is letting my father die - by a top hospital consultant.”
The Globe and Mailreports that “More than 100 Canadian women with high-risk pregnancies have been sent to United States hospitals over the past year – in what a doctors’ group attributes to the lack of a national birthing plan.”
The Canadian Medical Association Journal reports that in one year, 71 Ontario patients died while waiting for coronary bypass surgery and over one hundred more became “medically unfit for surgery.”
The Canadian Broadcasting Corporation reports that “109 people had a heart attack or suffered heart failure while on the waiting list. Fifty of those patients died.”
The Globe and Mail also reported that “More than 400 Canadians in the full throes of a heart attack or other cardiac emergency have been sent to the United States because no hospital can provide the lifesaving care they require here.”
A Daily Telegraphheadline reads: “Sufferers pull out teeth due to lack of dentists.” “Doctors are calling for NHS treatment to be withheld from patients who are too old or who lead unhealthy lives,” reports another article.
My own thoughts: This is the consequence of "universal health care".
Whenever the government attempts to guarantee a good or service such as health care, it must also control it. The inevitable end result of attempting to make health care a "right" is this sort of rationing and waiting lists. Far from being a "right", government health care then becomes a privilege dispensed at the discretion of bureaucrats who control those lists. Ask any Canadian who has waited 8 months for his knee MRI scan, while the son of a well-connected politician jumps to the front of the line.
The flawed premise behind "universal health care" is regarding health care as a "right". Health care is a need, but not a "right", and that's a critical difference. A right is a freedom of action, such as the right to free speech or right to contract. It is not an unearned automatic claim on the goods or services produced by another person -- that's just state-sanctioned theft or slavery. Just because my neighbor is hungry, it doesn't give him the right to take a can of soup from my pantry.
Rights only impose negative obligations on others -- for instance, my right to free speech only means that someone else (my neighbor or the government) can't stop me. If someone chooses to leave me alone, then he hasn't violated my rights.
In contrast, the various entitlements (such as an alleged "right" to health care) imposes a positive obligation to provide something to someone (e.g., an appendectomy). One of the biggest problems with modern-day America is the proliferation of positive "entitlements" which are mistakenly called "rights".
Any alleged "right" to health care can only be implemented by violating the actual rights of doctors and other health care providers. This is why "universal health care" is such a grossly immoral policy, and should be opposed as such.
When part of a building is on fire, panic has been known to drive a crowd directly into the fire.
Such is Froma Harrop's call for even more government interference in the health care industry.
She likes the insurance mandate in Mitt Romney's Massachusetts health plan:
"Everyone must get coverage. Those who don't, pay a penalty. The uninsured holdouts tend to be young, male and in good to excellent health. They figure that if something goes wrong, they can report to the emergency room where they'll get free care. Such people are called 'free riders.'"
The problem is real, but what is the cause? Why do people get free emergency room care? It's because of existing government mandates!
So we are to solve the problems caused by one government mandate with another government mandate? Where will it all end?
We are fast approaching the point where every aspect of life will be either mandatory or prohibited.
Clarence Manion, Lyons
For more information on why mandatory insurance has failed in Massachusetts, the home state of Mitt Romney, see our collection of links here.
