Newfoundland and Labrador Premier Danny Williams is set to undergo heart surgery this week in the United States.
CBC News confirmed Monday that Williams, 59, left the province earlier in the day and will have surgery later in the week.
The premier's office provided few details, beyond confirming that he would have heart surgery and saying that it was not necessarily a routine procedure.
Deputy Premier Kathy Dunderdale is scheduled to hold a news conference Tuesday morning.
Seems to me that when our Premier goes to the US for heart surgery, the analogy that comes to mind would be if the President of General Motors said 'Our GM cars are fantastic, but myself -- I own a Ford.'
Where U.S. Health Care Ranks Number One By Paul Hsieh, MD @ 12:15 AM
The January 7, 2010 Wall Street Journal published the following OpEd by New Hampshire surgeon Dr. Mark Constantian on the quality of medical care in the US.
...The Nobel Prizes in medicine and physiology have been awarded to more Americans than to researchers in all other countries combined.
Eight of the 10 top-selling drugs in the world were developed by U.S. companies.
The U.S. has some of the highest breast, colon and prostate cancer survival rates in the world. And our country ranks first or second in the world in kidney transplants, liver transplants, heart transplants, total knee replacements, coronary artery bypass, and percutaneous coronary interventions.
We have the shortest waiting time for nonemergency surgery in the world; England has one of the longest. In Canada, a country of 35 million citizens, 1 million patients now wait for surgery and another million wait to see specialists.
Yes, the US health system has problems. But any kind of government takeover will simply make things worse, not better.
8 out of 10 Americans are happy with the quality of the care they receive. Let's not destroy our current system by a headlong rush to "universal health care".
...Democratic politicians, liberal leaders, and the mainstream press are fond of criticizing America for spending a greater share of GDP on health care -- 16 percent -- than other countries do. Their remedy for "fixing" our country's high-cost system is more government control.
Yet they rarely disclose the high nonmonetary costs posed by government-controlled healthcare systems. Countries like Canada only spend less on health care by consigning their citizens to waiting lists and depriving them of access to effective cutting-edge treatments.
As of this year, 694,161 Canadians are on a waiting list for medical procedures. Assuming one person per procedure, that means 2.08 percent of the population is queued up for "free" care, according to the Fraser Institute's annual survey on wait times.
These Canadians pay for their health care in both taxes and the hard currency of pain, anguish, and lost wages.
She notes:
...[A]n incredible 16 percent of the population -- five million people -- is waiting to get a primary care doctor.
Once they get one, they have to wait yet again. On average, Canadians waited 16.1 weeks from the time their general practitioner referred them to a specialist until they actually received treatment in 2009, according to the Fraser Institute. That's 73 percent longer than the wait in 1993, when the Institute first started quantifying the problem.
Some specialties fare particularly poorly. Seniors should take note. In the United States, the average wait to see an orthopedic specialist is 16.8 days, according to a survey by medical consulting firm Merritt Hawkins and Associates. Canadians wait 17.1 weeks for the same appointment.
Under universal health care, governments only promise theoretical "coverage", not actual health care. And the policies they adopt actually worsen the ability of patients to seek and receive actual care.
Canadians have already learned this lesson the hard way. Will Americans be next?
In Canada, health care is never truly a "right". She was repeatedly told that she hadn't suffered for long enough to receive the surgery she needed, and that older patients were ahead of her on the waiting list.
Do Americans really want this kind of medical system?
...More than 70 private health providers in British Columbia now schedule simple surgeries and tests such as MRIs with waits as short as a week or two, compared with the months it takes for a public surgical suite to become available for nonessential operations.
"What we have in Canada is access to a government, state-mandated wait list," said Brian Day, a former Canadian Medical Assn. director who runs a private surgical center in Vancouver. "You cannot force a citizen in a free and democratic society to simply wait for healthcare, and outlaw their ability to extricate themselves from a wait list."
At a time that more Canadians are recognizing the merits of private health care over the public system, too many American politicians are trying to push our country towards a "public plan".
Do Americans really want to give their lives over to the government like that?
Sloan Compares Canada and the US By Paul Hsieh, MD @ 12:05 AM
In the August 26, 2009 Grand Junction Free Press, former Canadian resident Kelly Sloan compares the health care systems of Canada and the US.
When Tommy Douglas, architect of Canada's government-run health care system, (and head of North America's first socialist government) nursed his pet project to fruition in the early 1960s, he envisioned a medical utopia, where contented citizens, freed from the ravages of market forces, heartless insurance companies, and greedy doctors (sound familiar?) would receive timely, quality medical care on demand, provided by an army of cheery yet determined practitioners whose only concern in the world was to advance the general welfare of their fellow man. Paradise in a lab coat.
Some 40 years later, the reality bears little semblance to the idealistic vision of Kiefer Sutherland's grandpa. Skyrocketing costs, crippling tax rates, chronic doctor shortages, months-long waits for routine tests, (years for many specialized services), and oftentimes outright denial of procedures are the norm. Governments, desperate to control costs and prevent a total collapse of the system, are continuously de-listing previously covered procedures, and seeking new taxes or even, (heaven forbid) user fees.
As a Canadian, I can testify to the elongated waits for tests that often result in additional and more costly treatment, when you do finally get around to being treated. Those who can afford it flock south for their medical care.
So what went wrong?...
Sloan also offers some positive recommendations to improve the current American system:
This is not to say that improvements can't be made. America has been in the business of improving things since its inception more than 200 years ago. Few would deny there are costs associated with the system that can be controlled. Tort reform (it is somewhat ironic that under President Obama's plan, the only segment of the health care industry who would not be making great financial sacrifices are the trial lawyers), addressing the issue of portability, easing mandates on insurance companies, and Health Savings Accounts would all go a long way toward creating real competition, lowering costs, and helping solve the problem of dropped coverage associated with job loss and pre-existing conditions, as individuals took ownership of their insurance. Many of these common sense reforms were, incidentally, voted down by previous Congresses, which included then-senator Obama in the "nay" column.
These would be excellent steps in the right direction -- and would constitute real reform.
The incoming president of the Canadian Medical Association says this country's health-care system is sick and doctors need to develop a plan to cure it.
Dr. Anne Doig says patients are getting less than optimal care and she adds that physicians from across the country - who will gather in Saskatoon on Sunday for their annual meeting - recognize that changes must be made.
"We all agree that the system is imploding, we all agree that things are more precarious than perhaps Canadians realize," Doing said in an interview with The Canadian Press.
Americans should not wish to emulate this failing system.
Your headline got my hopes up, but what's being discussed is not the kind of fundamental change that's needed. Patients and doctors need to be allowed to obtain and offer services without the interference of government. That someone must wait months for services that they are willing to buy and which would be offered if government didn't outlaw it in the name of "equity" is wrong. That this state of affairs is allowed to persist in the life-and-death field of medicine is outrageous.
Canadian Cost Controls By Paul Hsieh, MD @ 5:05 AM
As health costs continue to rise, Canadian government authorities impose yet further controls which amount to rationing.
...To keep expenses down, Quebec's Ministry of Health imposes surtaxes on physicians who make more than about $200,000 a year -- gross of expenses. What with swine flu and all, it's been a busy year for pediatricians. Some of those running the Tiny Tots Clinic apparently have already bumped up against their maximum income. As a result, they're now going to be paid at 25¢ on the dollar for all the services they provide between now and the end of the year.
Think of it as a kind of Tax Freedom Day in reverse. Tax Freedom Day is when you've earned enough in the year to pay all your taxes and can then start working for yourself. But if you're a Quebec doctor, it works the other way around: As early as June, depending how hard you worked the first part of the year, you may start working almost entirely for the government.
Trouble is, 25¢ on the dollar doesn't pay the clinic's overhead. So the clinic has been restricting its hours while the doctors petition the Minister of Health for permission to be re-classified so they can keep working with full remuneration for the services they’re providing.
What a bizarre country we live in. A doctor wants to treat a child. That child's parent wants the child treated. But if the doctor is to be paid for providing treatment, they have to await permission from the Minister of Health.
Pipes on Canada By Paul Hsieh, MD @ 12:05 AM
Sally Pipes has two-part editorial in the Washington Examiner on the problems with Canadian health care (and the problems Americans will soon face if we adopt our own "universal health care" system). I highly recommend reading both parts:
...In a 2000 assessment of the world’s health systems, the World Health Organization (WHO) ranked the U.S. system thirty-seventh -- lower than even that of Colombia. In Sicko, Michael Moore’s 2007 documentary comparing health care systems, the U.S. system is portrayed as broken and cruel. A Commonwealth Fund study published in early 2008 surveyed nineteen nations in terms of preventable death and ranked the United States last.
This unrelenting stream of negativity has shaped the debate over U.S. health care reform. Consumers are souring on U.S. health care; policymakers are weighing the political and economic costs of changes to the system; and, according to one recent poll, even doctors—historically the most vocal opponents of socialized medicine—now support the idea of government-run health care.
...Ask yourself a simple question: If your daughter had a bad cough, would you call your pediatrician -- or get her on a flight to Bogota, Colombia?
While international comparisons make for good headlines and moving speeches -- Democrats, in particular, like to cite the WHO findings on the stump -- these studies are frequently quite limited and flawed. Most of the work is either highly ideological (Michael Moore's cannot withstand a basic fact-check) or confuses health with health care (the Commonwealth Fund study reflects the fact that Americans smoke more and exercise less than citizens in many other Western countries). The WHO study -- intolerant of any patient-borne expenses, heavily rewarding "equity," and focusing on smoking rates and other public health measures—suffers from both these problems of ideology and confusion. That is how it could reach the conclusion that America's health care lags behind Colombia's -- a conclusion no patient or doctor would second with his feet. (And indeed, even the WHO study had to concede that the American health care system was more responsive to citizens' expectations than any other nation's system.)
Gratzer correctly argues that one should analyze how well a country's health system does once people actually become ill, and he uses cancer diagnosis and treatment as one measure, because we have good comparative data on this set of diseases:
Of course, there is more to health care than a response to one disease -- yet, with the focus of so many governments on cancer care, with the common nature of this illness, and with the excellent statistics available, it's fair to use it as a proxy for health care performance. How does the United States fare? Excellently, two major studies suggest.
...Looking at specific cancers yields striking results: For men, the bladder cancer survival rate in the United States is 15 percent higher than the European average. With prostate cancer, the gap is even larger: 28 percent. For American women, the uterine cancer survival rate is 5 percent higher than the European average; for breast cancer, it is 14 percent higher. The United States has survival rates of 90 percent or higher for five cancers (skin melanoma, breast, prostate, thyroid, and testicular), but there is only one cancer for which the European survival rate reaches 90 percent (testicular). Lung cancer, once considered a death sentence, now has better survival rates over five years -- and Americans do better than Europeans, 16 percent versus 11 percent.
He also discusses some of the controversy over prostate cancer statistics.
He then discusses the reasons for these differences:
Why then is the United States better in overall survival? There are several contributing factors. Certainly the ability of cancer patients to get access to new medicines is helpful.
...And socialized health care systems don't just lag on cancer drugs -- new technologies, too, are less available. The problem is well illustrated by the story of Deb Maskens, a mother of two young children who suffers from kidney cancer...
Government-managed and -funded health care systems are not simply averse to new drugs and technologies. These systems are often plagued by rationing through waiting. People wait for diagnostic tests and specialist consults, delays that allow cancers to grow and spread. The diagnostic gap is well documented...
And he offers some concluding thoughts:
Government-run health care systems control costs by rationing care. In contrast, for all its flaws, the American health care system does not hesitate to spend, eager to embrace new technologies and treatments. And that’s why Americans do so much better.
...Cancer care in London or Paris may not seem relevant to Americans in Las Vegas or Providence. But in the coming years, Americans will need to think very hard about their health care system. With a Democratic-controlled Congress and White House, the forces are aligned for far greater government involvement. This does not bode well: value in health care -- as in the other five-sixths of the economy -- will come from competition and choice, not a government committee.
...That is why American health care reform demands an American-made solution, one that respects the power of markets and competition instead of putting trust in government bureaucrats.
Overall, he makes many arguments that politicians should heed.
• Instead of a new government plan to compete against private health insurers, President Obama needs to remove the barriers that the government currently maintains against individual choice.
• Even the most benign government enterprise, the U.S. Postal Service, cannot compete against private couriers without a monopoly on basic letter delivery.
• By proposing to eliminate Medicare Advantage, a program that allows private insurers to compete for Medicare dollars, President Obama demonstrates that he cannot tolerate private competition against a government program.
The full paper is available here. (Note: In a fully free market, there would be no need for Medicare Advantage, because Medicare would no longer exist.)
Apparently in Canada, some provincial governments are arguing that health care is not a right, in order to protect its control over state-run medicine and to put providers of private medicine out of business. Here are a few excerpts from their post:
The advocates of government-run medicine base their claims on the notion that health care is a "right." They thus attempt to occupy the moral high ground over those who advocate reforms based on the principle of individual choice.
...[I]n British Columbia, the monopolistic provincial health plan is suing Dr. Day for allegedly receiving direct payment from patients for performing surgeries in his clinic. What makes the case remarkable is that the provincial monopolists have launched their legal attack against Dr. Day based on their new-found conviction that Canadian citizens do not, in fact, have a right to health care.
...As this episode shows, once the state takes over, the citizen hasn't got a chance. Governments are not competent to provide health care as a "right," any more than they would be competent to provide shoes as a "right." Therefore people who define their right to health care differently will have to continue to fight the state to recognize it.
How should it then be defined? When I'm speaking publicly on health reform, people sometimes ask: "Do you think that health care is a human right?" My answer is: "Yes, I believe that you have a right to spend your own money on health care of your choice, free of government interference."
In my opinion, this latter point is one of the most important issues in the health care debate -- namely that rights are freedoms of action, rather than automatic entitlements to goods and services that must be produced by others.
Fortunately, Dr. Leonard Peikoff makes this case with great eloquence and clarity in his essay, "Health Care Is Not A Right".
The province of Quebec lacks a medical helicopter system, common in the United States and other parts of Canada, to airlift stricken patients to major trauma centers. Montreal's top head trauma doctor said Friday that may have played a role in Richardson's death.
"It's impossible for me to comment specifically about her case, but what I could say is ... driving to Mont Tremblant from the city (Montreal) is a 2 1/2-hour trip, and the closest trauma center is in the city. Our system isn't set up for traumas and doesn't match what's available in other Canadian cities, let alone in the States," said Tarek Razek, director of trauma services for the McGill University Health Centre, which represents six of Montreal's hospitals.
...Just look at the failure of existing government health programs -- both here and abroad. Many Medicaid patients have a difficult time finding a doctor. According to a 2003 study by the Medicare Payment Advisory Commission, doctors are five times more likely to turn away Medicaid patients than those with private insurance.
The situation is even worse in countries like Canada and Great Britain -- whose government-run systems Obama's health braintrust has cited approvingly.
More than 725,000 Canadians languish on months-long waiting lists for surgery and other necessary treatments. Doctors are in short supply - thanks largely to the government takeover of the health sector. In the early 1970s, when Canada launched its "universal coverage" system, the country ranked second among 28 developed countries in doctors per thousand people. Today, it's 24th.
Further, Canadians often lack access to the advanced medical technology that Americans take for granted. Canada ranks 19th among 26 reporting OECD nations in access to CT scanners and 14th out of 25 reporting OECD countries in access to MRI machines.
In the UK, the government-run health system explicitly rations medical treatments through the publicly chartered National Institute for Health and Clinical Excellence. NICE evaluates data from clinical drug trials to decide if newer medical treatments are more effective than older, cheaper alternatives. It then makes recommendations to Britain's state-run National Health Service about which treatments are worth paying for.
Last summer, British patients with kidney cancer were denied access to four lifesaving drugs. NICE's clinical and public health director said of the drugs at the time, "Although these treatments are clinically effective, regrettably the cost to the NHS is such that they are not a cost-effective use of NHS resources."
In other words, the British government admitted that patients would likely die without these treatments -- but refused to pay for them anyway.
This could happen here. Obama's stimulus package includes $1.1 billion for NICE-style comparative-effectiveness studies.
As the costs for his health reforms mount, Obama will be forced to employ the same strategies that Canada and Britain have to cut spending. That means the rationing of care (and significantly higher taxes).
Atlas on American Medical Care By Paul Hsieh, MD @ 12:05 AM
The February 18, 2009 Washington Times published the following OpEd by Dr. Scott Atlas. Atlas does some much needed "mythbusting" of the alleged problems with American health care. Here are a few excerpts:
Pardon The Interruption...
As politicians, economists, popular media and an ever increasing list of others convincingly proclaim cures for the ills of American health care, we Americans are subjected to a stream of opinion deriding as utterly miserable our health-care system compared to the rest of the developed world.
...In this interlude between health czar nominees, and before we legislate government as the solution and final arbiter of medical care, it may be a good time to consider a few unheralded facts about America's health-care system.
Dr. Atlas then cites (with references) the following facts:
(1) Americans have better survival rates from both common and rare cancers than Europeans
(2) Americans have significantly better survival rates from cancer than Canadians
(3) Americans have better access to treatment for chronic diseases than Canadians
(4) Americans have better access to preventive screening for major cancers than Canadians
(5) A marker for inequality of access and quality of health systems, the "health-income gradient" (i.e., that higher incomes achieve better health and lower incomes mean worse health) for adults 16 to 64 years old reveals a more severe disparity in Canada than in the United States
(6) In the United Kingdom and Canada, patients wait far longer than Americans (about twice as long, sometimes even more than a year) to see a specialist, have elective surgery like hip replacements or cataracts, or get radiation treatment for cancer
(7) Sixty percent of Western Europeans say their health systems need "urgent" reform
(8) More than 70 percent of Germans, Canadians, Australians, New Zealanders and U.K. adults (all countries in the survey except the Netherlands, with "only" 58 percent) say their health systems needs either "fundamental change" or "complete rebuilding"
(9) Although much maligned by economists and targeted by policymakers, an overwhelming majority of America's leading physicians themselves recently listed the computerized tomography (CT) scan and magnetic resonance imaging (MRI) as the most important medical innovations in improving patient care in the previous decade
(10) By any measure, the vast majority of all the innovation in health care in the world comes out of the U.S. health-care system
Surveys have shown that most Americans are satisified with the quality of their own health care. But because of the constant media drumbeat about the health care "crisis", too many are led to believe that everyone else is having a hard time and thus we need massive "reform" in the form of government-run "universal" care.
Articles like Dr. Atlas' will go a long ways towards countering these errors.
Esmail: "'Too Old' for Hip Surgery" By Paul Hsieh, MD @ 12:05 AM
The February 9, 2009 Wall Street Journal has published an OpEd by Nadeem Esmail warning of the health care rationing we'll be facing if we continue on our current course towards nationalized health care. Here is an excerpt:
'Too Old' for Hip Surgery
President Obama and Congressional Democrats are inching the U.S. toward government-run health insurance. Last week's expansion of SCHIP -- the State Children's Health Insurance Program -- is a first step. Before proceeding further, here's a suggestion: Look at Canada's experience.
Health-care resources are not unlimited in any country, even rich ones like Canada and the U.S., and must be rationed either by price or time. When individuals bear no direct responsibility for paying for their care, as in Canada, that care is rationed by waiting.
Canadians often wait months or even years for necessary care. For some, the status quo has become so dire that they have turned to the courts for recourse. Several cases currently before provincial courts provide studies in what Americans could expect from government-run health insurance...
For more discussion of problems with Canadian health care, click here.
Rhoads: What Administrative Savings? By Paul Hsieh, MD @ 12:05 AM
Jared Rhoads of the Lucidicus Project has written another OpEd, which I am reposting here with his permission. His topic is the myth of administrative savings under government-run "single payer" systems:
Many people seeking national healthcare reform -- particularly those on the political left -- believe that the United States should adopt a single-payer insurance system, similar to that of Canada's. Proponents say that single-payer systems achieve lower per capita healthcare expenditures because they eliminate "wasteful and unnecessary" business practices such as advertising and screening of new applicants, and that this lowers administrative costs. By empowering the government to pay all health insurance claims, they say, we could simplify paperwork, standardize billing procedures, and consolidate many other activities entailed in processing claims. In other words, if we would just leave the business of health insurance to the government, we could get the same great care we have always had, except at a much lower cost.
But do single-payer systems really achieve lower expenditures through operational efficiency, or is something else going on in this picture?
At first glance, the argument regarding administrative costs may seem plausible. After all, businesses are always trying to reduce costs by building economies of scale, so what could be more economical than having one payer for the entire nation? And statistics do show that per capital spending on healthcare is lower in many countries with single-payer systems. For example, in 2005, Americans on average spent $6,401 on healthcare, versus $3,326 for Canadians -- a difference of over three thousand dollars per person per year.
What pundits and politicians fail to disclose, however, is that the reduction in administrative costs by and large does not account for this difference. In fact, it doesn't even account for most of the difference. According to an article in the New England Journal of Medicine, administrative costs totaled an estimated $1,059 per person annually in the United States versus just $307 per person in Canada.[1] That's a difference of just $752, or about 23 percent of the difference. So where does the rest of the alleged savings come from?
In effect, Canada's relatively low per capita rate of expenditure comes not from reducing paperwork, but from using the financial grip of the government to withhold care.
Consider how the Canadian system works. Canada uses a global budget system in which government officials dictate to hospitals how much they will be allowed to spend in a given year. Looking at variables such as patient volume, supply costs, and inflation, they come up with a projection -- i.e. a wild guess -- for how much it will cost to treat all of the patients who come for care. Each hospital receives a lump-sum payment (or is put on a schedule of recurring payments), an amount of money that must last until the next round of guessing and granting.
When the money runs out, as it predictably does each time, care slows to a crawl. In order to defer or reduced costs, hospitals put patients on long waiting lists or substitute lower quality services (e.g. giving x-rays or ultrasounds in lieu of higher-resolution but more expensive MRI scans). In short, if you are a patient in Canada and need an expensive procedure, you had better hope that the facility is either early in its budget cycle and therefore still awash in money, or that it has deprived enough other patients the services that they need so there is still a ration left for you.
One of the most the perverse things about any socialized system of healthcare, including Canada's, is that the less the system does for its patients, the better its financial performance looks on paper. For instance, if a hospital withholds care from a patient long enough, the patient may give up and travel over the border to get their diagnostic test, surgery, or other procedure done elsewhere. In terms of the hospital's pocketbook (and therefore also the nation's pocketbook), this scenario goes down as an unseen and unaccounted-for personal expense, not an expenditure. Or, perhaps the patient on a six-month waiting list for hip surgery simply dies while waiting. In that scenario, there is no cost to the system at all.
Whatever the case, national expenditure figures of single-payer systems can be set as low as government officials desire, because what ultimately determines how much care patients receive is what the government is willing to fund -- not how much patients want to spend or how much their physicians recommend they spend. (And even if patients wanted to pay out of their pocket for faster or better care by their own doctor, in many cases it is illegal to do so.) Quality and access to care can always be sacrificed to create the illusion of a government-run system that is low-cost and efficient because they are much more difficult to measure and compare.
The notion of administrative efficiency as the primary source of savings is nothing but a shabby cover story to hide the rationing inherent in a single-payer system. Most people wouldn't trust (or allow) a government official to set a budget for what they spend on dry cleaning in a year, yet with a little rhetoric and some confusing statistics, they are willing to hand over control of their own healthcare. Rather than emulating our neighbors to the north and instituting a top-down, centralized system in which the government makes decisions about how much care each person should get, Americans ought to demand the freedom to pay for as many or as few services as they desire, and to keep for themselves whatever they do not spend.
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1 Woolhandler, Campbell, and Himmelstein. "Costs of Health Care Administration in the United States and Canada" N Engl J Med 2003;349(25):2461.
(1) Her waiting time for the initial appointment to see the orthopedic surgeon was 10 months. Then her waiting time for the surgery itself would have been another 18 months had she not taken matters into her own hands.
(2) She had no qualms about doing what she needed to do to "jump the queue". At some implicit level, most people realize that it's right to seek to improve one's health and life -- i.e., that pursuing one's self-interest is good.
(3) She also explicitly recognized that what she was doing was "cheating the system". However, she doesn't ever quite come out and say that the system was morally wrong. Instead, her final remarks sound like a form of moral rationalization for her actions. It's therefore unclear to me whether she personally thinks her actions were right and the system was wrong, or the other way around. This highlights the importance of explicit discussion of the morality (or lack thereof) of government-run health care.
(4) This sort of "queue jumping" happens all the time in Canada. Lee Kurisko, a physician who has practiced in both Canada and the US calls this the "deep dark secret" of Canadian medicine.
Most Americans want freedom to make health care decisions
As a new Congress begins to look at health-care insurance options, some of the members are discussing proposals for a single-payer, universal health-care plan.
That's not the best solution. Senators and representatives would be much better off focusing on health-care solutions that effectively bring down health-care costs, expand access to quality care, and reward patients for shopping around.
Advocates of single-payer health plans want the U.S. government to be the only entity that pays for health care: With Uncle Sam picking up the tab, proponents predict health-care spending would be reduced, administrative burdens would be eliminated, and doctors would be free to practice as they wish.
Do they really believe that adding another major program to the federal government would actually eliminate administrative headaches and make it easier for doctors? We need only to look to our neighbors to the north, in Canada, for a clear view of what we could expect under a single-payer system.
The biggest problem is the wait -- for office visits, diagnostic tests, lab work, even surgeries.
There are only so many doctors and so much medical equipment in Canada. That means that most patients can't get the help they need when they need it. At any given time, nearly 750,000 Canadians are waiting for a medical procedure. According to a report by the Commonwealth Fund, 42 percent of Canadians with chronic illnesses said they had to wait more than two months to see a specialist.
Another major problem faced by those in a single-payer system is the health risk that is faced by participants.
A recent study by the Fraser Institute indicates that much of the health technology in Canada is aging and outdated. Such equipment has a higher risk of failing, may be less accurate, and may not provide the most up-to-date medical readings.
As consumers, we want is health care that is reasonably priced, of high quality and that is convenient -- without having to wait months on end for needed surgery.
Many of us have had experiences with limited access to health care — through HMOs. Such plans tried to control health costs by controlling which doctors patients could see, limiting the specialists that one can visit, and reducing the options that were available.
It didn't catch on because few Americans like limited health-care options. We want to make our own choices, based on what's best for our health and our wallet.
Instead of wasting time on a system that limits our choices, creates long waiting times and has the potential to jeopardize our health, the United States should opt for a system of innovation and choice.
The best reform would liberate doctors to meet patient needs in innovative ways, free patients to become smart shoppers, and allow a competitive medical marketplace to allocate resources, while raising quality and lowering cost in the process. Mandates should be avoided in favor of making more options available through consumer-driven health plans. Most such plans include the expansion of health savings accounts to encourage greater participation. Patients with health savings accounts are significantly more likely to talk to their doctor about treatment costs and options, track their health-care payouts and estimate future expenses.
So, would you rather make your own choices on medical care and cost options or delegate the quality, cost and timing of your care to the federal government?
Now is not the time to move ahead with proposals for single-payer, universal health care. Nor is next year or the year after that. Instead, Congress should act now to let American consumers, not federal bureaucrats, make their health-care decisions.
When we force medical providers to compete on price, we're all much better off.
Herrick is a senior fellow specializing in health-care economics at the free-market oriented National Center for Policy Analysis (www.ncpa.org).
Herrick's economic analysis is spot-on, and I wish more elected officials would listen to him. The serious economic problems associated with single-payer care are the predictable consequence of the fact that it violates individual rights, such as the rights of patients, providers, and insurers to contract freely in the marketplace for their mutual benefit.
The UK may start allowing patients to use their own money to purchase small amounts of extra private medical care, without automatically forfeiting their government NHS medical care. (Via RS.)
Canadian patients are facing waits of up to 5 years for government-run sleep apnea testing. Canadian medical guidelines call for a maximum of two to six months for this disorder. (Via DS.)
Physician Disempowerment in Canada By Paul Hsieh, MD @ 12:05 AM
Brian Lee Crowley, a senior fellow at the Galen Institute, gave the following speech about physician disempowerment in Canada at the recent Center for Medicine in the Public Interest conference on October 14, 2008.
1) Potential physicians are severely restricted in their ability to choose their profession 2) Physicians are increasingly restricted in whom they can see 3) Physicians are increasingly restricted in what they can prescribe 4) Physicians are increasingly restricted in getting their patients access to the latest technology 5) Physicians have totally lost the power to determine what they will charge 6) Physicians are gaining some slight ability to practice in both the public and the private sectors after having lost that right for years. 7) Physicians have great difficulty getting their patients treated in a timely manner
Point 6 is the one slender silver lining in the otherwise bad news.
The others are the inevitable consequences of any system of "universal health care".
When the government attempts to guarantee a good or service such as health care as a universal "right", it must necessarily control the creation and distribution of that service. This removes the control from the physicians who create the service and the patients who purchase it. Instead, the government determine who gets what care and when. In the end, rather than being a "right", health care becomes a de facto privilege dispensed at the discretion of bureaucrats.
Socialized medicine great, but don't get sick Tish Jeffers, Centennial
I had the opportunity to live in Canada for almost 20 years, so I think I have a fair background in how socialized, government-orchestrated medicine works.
Keep in mind, there are approximately 32 million people in Canada and approximately 302 million people in the United States.
My assessment then, as it is now when I talk to my aging Canadian friends: Socialized medicine is great... as long as you never get really sick!
What I find interesting is that if socialized medicine ever comes into play here in the United States, Americans will never stand for the waiting, the lines, the paperwork and the bureaucracy the Canadians put up with when they go to the doctor. We won't have the option, like our Canadian friends do, to load up on buses and come over to the United States to get the instant care most of us take for granted!
It isn't medicine that needs reform, it's the insurance companies that need reform. The government has screwed up so many things, like our current issue with our finances! Do we want them messing around with our medicine, too?
Jeffers is quite right -- the Canadian system controls costs through rationing and waiting lists.
However, the problems in the US should not be blamed solely on insurance companies. Much of their behaviour is driven by onerous government regulations that prevent them from offering cost-effective services in a free market to willing customers. For more, please see our article on "universal health care".
The study shows that health care in Canada appears to cost less because relative to the United States, Canadian public health insurance does not cover many advanced medical treatments and technologies, common medical resources are in short supply, and access to health care is often severely delayed.
"On average, Americans spend more of their incomes on health care but they get better access to superior medical resources," [co-author Brett] Skinner said.
"If Canadians had access to the same quality and quantity of health-care resources that American patients enjoy, the Canadian health-insurance monopoly would cost a lot more than it currently does."
According to the most recent data, the United States outscores Canada on many key indicators of available health care resources, including:
* Number of MRI units per million population in 2006: US: 26.5; Canada: 6.2 * Number of MRI exams per million population in 2004/05: US: 83,200; Canada: 25,500 * Number of CT Scanners per million population in 2006: US: 33.9; Canada 12 * Number of CT exams per million population in 2004/05: US: 172,500; Canada 87,300 * Number of inpatient surgical procedures per million population in 2004: US: 89,900; Canada: 44,700.
...Even on health insurance coverage, the Canadian system does not perform much better than the U.S. when it comes to actually delivering insured access.
"Access to a wait list is not the same thing as access to health care," Skinner said.
The study cites government data showing an estimated 1.7 million Canadians (aged 12 and older) were unable to access a regular family physician in 2007. And it points to other research showing that the actual number of "effectively" uninsured Americans is less than half of the figure usually reported and that being uninsured is usually only a temporary condition.
Based on these figures, the study estimates that the percentage of the population that was "effectively" uninsured for non-emergency, necessary medical services at any given time during 2007 was not significantly different between the two countries: 7.9 percent in the U.S. compared to six percent in Canada.
"When Canadians can't get access to health care because they can't find a physician or wait so long that they are effectively uninsured, they are no better off than uninsured Americans," Skinner said.
(For the record, I do disagree with the authors' support of an individual insurance mandate for reasons covered here.)
PAUL KRUGMAN: Actually, can I just — I wanted to ask a question. And—
JOHN DONVAN: Please—please do—
PAUL KRUGMAN: —and I wanted to ask, actually two questions, to the audience. First, how many Canadians, would Canadians in the room please raise your hands. [ONE PERSON APPLAUDS, LAUGHTER]
JOHN DONVAN: We have about seven hands going up—
PAUL KRUGMAN: Okay, not as many as I thought. Okay, of those of you who are not on the panel who are Canadians, how many of you think you have a terrible health care system. [PAUSE] One, two—
JOHN DONVAN: We see—almost all of the same hands going up. [LAUGHTER]
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.
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?
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?
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:
I won't presume to speak for Dr. Fisch, but I will offer an answer of my own:
Americans are far more used to having personal control over many of their health care decisions, as opposed to the government having this degree of say. So if an average middle-class American were told by the government, "Sorry, you can't have an MRI this week for your knee injury -- the waiting time is 6 months" (as may be the case for an average Canadian), he would be far more likely to be outraged, rather than accepting that as the price to pay for "free" health care. According to the New York Times, a government system of health care "has long been considered politically sacrosanct in Canada, and even central to the national identity". This is clearly not the case in the US -- instead, the issue is one of contentious debate, and far from politically sacrosanct.
Similarly, the government system in the UK regards it as more important that citizens have equal access to health care (even if that care is bad) than that people be able to freely seek what's in their best interest although it might lead to inequalities. This is typically expressed by UK politicians as a rejection of any "two-tier" system.
Americans don't have the same degree of visceral dislike of a two-tier (or multi-tier) system as Canadians and Western Europeans. Nor should they. One marvelous advantage of the free market is that it respects and facilitates the right of an individual to purchase better goods and services from willing sellers according to his judgment and priorities. Those who want to pay extra for gold-plated health care can do so, whereas those who want to go with a minimal degree of coverage (and spend the money on other priorities) can do so as well. Or they can pick anything in between. No one is forced into a "one size fits all" system.
In summary, Dr. Fisch is right: American values such as "liberty and free thought with regard to one's health and health care are paramount". As they should be. As a result, government-run medical systems that necessarily infringe upon those liberties would stick in the craw of most Americans.
* * *
As a side point, the Colorado Health Insurance Insider blog also repeats the commonly cited figure, "47 million of our people to be without health care - without access to any sort of quality health care". There are two serious problems with that citation:
First, the "47 million" figure exaggerates the problem by a huge amount, as discussed in this short video, "Uninsured in America" as well as in numerous articles such as "The '47 Million' Uninsured Myth" in the August 29, 2007 issue of Investors Business Daily.
Second, it assumes the common error of equating health insurance with health care. The nature and significance of this error is covered in much more depth in the article co-author by Lin Zinser and myself, "Moral Health Care vs. 'Universal Health Care'".
When I was a radiology resident at the University of Toronto, Toronto General Hospital ran short of funds. In order to ration funds the radiology department closed the MR scanner at 5 pm even for emergencies. One evening however I was paged interpret an emergent MRI. A member of parliament had developed acute back pain and we fired up the MRI scanner and performed the study. He happened to be the head of the NDP (New Democratic Party). The NDP is the socialist party and evolved from the CCF party. The CCF party was founded by Tommy Douglas, the original creator of Medicare!
Socialist leaders usually are the best fed and get the best medical care. It is easy to support socialist ideals when you are so rich that taxes and budgets are irrelevant.
Thank you for sharing this.
This sort of abuse by celebrities and those with political connections is so rampant in Canada that ordinary Canadians have a word for those who jump to the head of the government waiting lists for medical care -- "queue jumping":
Dr. Day's [president of the Canadian Medical Association] experience is one example of what he calls the "parallel public system," a system of social connections that make it easier for people in a certain class of society to get quick access to medical treatment.
He admits he himself used the system when he needed knee surgery, jumping a long queue to get the procedure done within a week by a surgeon who was also his friend.
It's not realistic, Dr. Day believes, to expect people not to use their connections to jump the queue when their own or their family's health is at stake.
More generally, it's not realistic to set up a government system that pits patients rational self-interest in getting good health care against following the rules. This is why a free market which allows patients, providers, and insurers to voluntarily contract for services according to their own best judgment to their mutual benefit is the right system -- because it aligns one's rational self interest with the rules.
The notion that "universal health care" will deliver medical treatment to all on the basis of need without any political considerations is a fantasy, and is one of the 20 myths debunked in the following article from the National Center for Policy Analysis, "20 Myths About Single-Payer Health Insurance". Similar information can be found here at, "The Myths of Single-Payer Health Care" by David Hogberg.
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 problem has peaked, with British Columbia and Ontario each sending a record number of women to U.S. neonatal intensive care units (NICUs).
..."Neonatologists are very stretched right now," Dr. Lalonde [Andre Lalonde, executive vice-president of the Society of Obstetricians and Gynaecologists of Canada] said in a telephone interview from Ottawa. "We're so stretched, it's kind of dangerous."
..."We're transferring babies across the province, in all directions, to try to find an extra bed for the next potential birth or for any baby already born," Dr. Chessex [Philippe Chessex, division head of neonatology for B.C. Women's Hospital & Health Centre] said in a telephone interview from Vancouver. "We now have babies who have been transferred up to six times after leaving here before reaching home."
This story resonated with me because, as it happens, my eldest daughter was a premie. She was a "thirty-week baby," fifteen inches long and weighing in at a little less than three pounds.
And how did she fare in the evil "profit-driven" U.S. system? Well, there was a bed for her ...about 100 yards away. And a neonatologist was on hand to manage her care from the moment she took her first breath.
What kind of moron would want to exchange a system like that for a pig's breakfast like the Canadian system?
What good is having medical insurance if you cannot get medical care? Peddlers of "universal health care" - from Hillary, Obama, to 2nd Congressional Democratic candidate Jared Polis - don't get this.
"Universal health care" is false advertising for politically controlled medicine, with government as the "single payer" monopolistic insurer. But having coverage does not guarantee getting medical care.
Since patients prepay through taxes, medical care appears "free." Hence, they have strong incentive to over-consume and providers need not compete on price.
To contain costs, governments restrict your access to life-saving treatment. In countries with such "universal coverage," patients die waiting for treatment.
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."
"Physicians across Canada are in an advanced stage of burnout due to work conditions" which "causes them to retire early . . . or simply leave," a former Canadian Medical Association president told the New York Times. He "attributed much of the problem to technological shortages and the powerlessness doctors feel when patients complain about long waits for treatment."
"Access to a waiting list is not access to health care," wrote Canadian Chief Justice McLachlin when striking down legislation banning private insurance in 2005. Last year, a New York Times headline read: "As Canada's Slow-Motion Public Health System Falters, Private Medical Care Is Surging."
And England? The BBC reports that "up to 500 heart patients die each year while they wait for potentially life-saving surgery." The Times claims that a British woman "will be denied free National Health Service treatment for breast cancer if she seeks to improve her chances by paying privately for an additional drug."
A Daily Telegraph headline reads: "Sufferers pull out teeth due to lack of dentists." Another article says that "doctors are calling for NHS treatment to be withheld from patients who are too old or who lead unhealthy lives."
Consider politically controlled health care in America: Medicaid and Medicare.
Doctors are five times more likely to refuse seeing new Medicaid patients than privately insured patients. Increasing reimbursement rates won’t help much; more than two-thirds of doctors reported being overwhelmed by Medicaid's billing requirements, paperwork, and delays in payment.
ABC News says that "Medicare rules bar cancer drugs for patients," including the privately insured.
"Single payer" advocates cite international comparisons of life expectancy to support their cause. But life expectancy depends on factors unrelated to health care, such as unintentional injury and homicide. Health economist Robert Ohsfeldt found that when accounting for these two factors, life expectancy in America is comparable to that of Canada and England.
What really matters is your chance of surviving a serious illness. The American Cancer Society claims that "U.S. patients have better survival rates than European patients for most types of cancer."
So if politically controlled medicine isn’t the solution, what is? Not a Massachusetts-style "individual mandate," which forces everyone to buy insurance. This is essentially single-payer in disguise. Insurance regulations severely limit competition, so insurance companies are effectively government contractors for politically defined insurance.
The Boston Globe reports that to contain costs, Massachusetts authorities will "probably cut payments to doctors and hospitals" and "reduce choices for patients." Sound familiar?
Instead, we must recognize how government policies have crippled free markets.
Because the tax code deeply discounts employer-provided insurance, you're essentially stuck with your employer's non-portable plans. Hence, insurance companies can afford to be stingy and deny you care; they know that losing you as a customer requires that you change jobs. With government as "single payer" it's even worse: To change insurance providers you must move to a different state or country.
Our current system also encourages thoughtless over-consumption and skyrocketing costs.
The tax code punishes paying for medical care out-of-pocket and rewards buying insurance. So "insurance" has become prepaid medicine, and patients over-consume like business travelers dining on their company's expense account.
Further, legislation mandating minimum benefits makes insurance unaffordable for many. Consider: Colorado law compels widowed wives to pay higher premiums for prostate screening, maternity, and marital therapy.
Some Colorado legislators recognize this injustice. Just as businesses incorporated in other states can operate in Colorado, Coloradans should be able to buy affordable policies from insurance companies that meet less damaging regulations of another state.
While "universal health care" may provide health insurance, it doesn't guarantee health care. The uninsured are not the problem, but the symptom of the real problem - government meddling in personal choices of how we care for ourselves and our families.
Brian Schwartz, an optical engineer in Boulder, is a guest author for the Independence Institute. His free-market proposal to the Blue Ribbon Commission is at WhoOwns You.org.
Re: "Health coverage gets new push," March 28 news story.
Democrats like state Sen. Bob Hagedorn, and state Rep. Anne McGihon want to force us all to buy medical insurance - as they define it. But government-mandated insurance does not guarantee actual care. Consider Canada, England and Massachusetts.
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 BBC reports that "up to 500 heart patients die each year while they wait for potentially life-saving surgery." The Boston Globe reports that in response to soaring costs, Massachusetts "policymakers could face difficult choices: spend more state money or cut back the two programs by reducing enrollment, cutting subsidies, or eliminating benefits."
Sen. Hagedorn says it's "immoral for us to sit on our hands and do nothing." Hence, instead of passing more laws that kill, politicians should do something that is moral and actually works: repeal laws that make insurance prohibitively expensive.
For example, Colorado House Bill 1327 would allow us to buy insurance plans that meet less damaging regulations of other states. This would make quality, affordable insurance available to thousands of Coloradans.
The Best Part of Living in Canada? Being Close to the U.S. The safety valve for long waits for medical treatment
It's been said that Canada's single-payer systems "works" to the extent that it does because the U.S. serves as a safety valve. Since most of the population lives within a short drive, it can, if need be, get around rationing queues by crossing the border.
This morning I came across an anecdote in that same vein. It's from a sports-related blog, maintained by two guys in Toronto who love to cycle and go snowboarding.
Adam, the snowboarder, suffered a knee injury while playing basketball. On March 25, 2006, he wrote about his first trip to a medical facility. The people there were friendly and knowledgeable, but further treatment would expose him to the long queues of Canadian health care. "It’s really, really tempting," he said, "to go to Buffalo, Montreal or somewhere else to get an MRI sooner, so I can get on the road to recovery sooner. Is recouping my summer worth shelling out $500 to $1000?"
Rather than wait 55 days—the projected queue in Ontario—he must have come up with the money, since on April 22—28 days later—he had an MRI done in Buffalo, New York.
Would the doctor in Canada object on the grounds that Adam was subverting socialized medicine, that quality that (aside from "not being the United States") seems to define the country? Nope. "The [Canadian] company rep I spoke to said they had very few issues with doctors protesting, because the end result was that you were making the waiting list in Ontario shorter."
Once Adam placed the call to the U.S., he could have gotten his appointment with the New York clinic in a New York minute—they offered a screening that evening.
"To say I was impressed was an understatement," he wrote. "My overall impression: so worth the money. I'm now four months ahead of where I would be using the Ontario system."
But it took him over a month for an appointment in Canada to review the results. They weren't good: a scope on his knee, and possibly more, was called for. And "this being Ontario and all, when will I get the surgery? Six to eight months from now." [Emphasis in the original.]
The schedule must have loosened up a bit. (Maybe more Canadians decided to have their surgery in the U.S., too.) Adam decided to delay on scheduling his operation, so as to make better use of the winter. When he called in November 2006 for a date, he was told he would have a ...five month wait, which was in fact the truth.
At least three lessons come from this story: Time and money are interchangeable. A "right" to health care is a right to a queue. And if you need to see a doctor in a government-financed system, take a number.
What good is having medical insurance if you cannot get medical care? Peddlers of "universal health care" — from Hillary, Obama, to Colorado congressional candidate Jared Polis — don't get this.
"Universal health care" is false advertising for politically-controlled medicine, with government as the "single-payer" monopolistic insurer. But having coverage does not guarantee getting medical care.
Since patients prepay through taxes, medical care appears "free." Hence, they have strong incentive to over-consume and providers need not compete on price. To contain costs, governments restrict your access to life-saving treatment. In countries with such "universal coverage," patients die waiting for treatment.
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."
This week the Globe and Mail reported that:
Inside Sylvia de Vries lurked an enormous tumour and fluid totalling 18 kilograms. But not even that massive weight gain and a diagnosis of ovarian cancer could assure her timely treatment in Canada.
She sought treatment in the United States, as do Canadians in need of intensive care and emergency cardiac care.
"Physicians across Canada are in an advanced stage of burnout due to work conditions" which "causes them to retire early... or simply leave," a former Canadian Medical Association president told the New York Times. He "attributed much of the problem to technological shortages and the powerlessness doctors feel when patients complain about long waits for treatment."
"Access to a waiting list is not access to healthcare," wrote Canadian Chief Justice McLachlin when striking down legislation banning private insurance in 2005. Last year a New York Times headline read: "As Canada's Slow-Motion Public Health System Falters, Private Medical Care Is Surging."
And England? The BBC reports that "up to 500 heart patients die each year while they wait for potentially life-saving surgery." The Times reports that a British woman "will be denied free National Health Service treatment for breast cancer if she seeks to improve her chances by paying privately for an additional drug." A Daily Telegraph headline 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.
Consider politically-controlled health care in America: Medicaid and Medicare. Doctors are five times more likely to refuse seeing new Medicaid patients than privately-insured patients. Increasing reimbursement rates won't help much; more than two-thirds of doctors reported being overwhelmed by Medicaid’s billing requirements, paperwork, and delays in payment.
ABC News reports that "Medicare rules bar cancer drugs for patients," including the privately-insured. As the population ages and Medicare costs continue to increase, Medicare may further restrict patients and doctors.
"Single payer" advocates cite international comparisons of life expectancy to support their cause. But life expectancy depends on factors unrelated to healthcare, such as unintentional injury and homicide. Health economist Robert Ohsfeldt found that when accounting for these two factors, life expectancy in America is comparable to that of Canada and England.
What really matters is your chance of surviving a serious illness. The American Cancer Society reported that "U.S. patients have better survival rates than European patients for most types of cancer."
So if politically-controlled medicine isn't the solution, what is?
Not a Massachusetts-style "individual mandate," which forces everyone to buy insurance. This is essentially single-payer in disguise. Insurance regulations severely limit competition, so insurance companies are effectively government contractors for politically-defined insurance.
The Boston Globe reports that to contain costs, Massachusetts authorities will "probably cut payments to doctors and hospitals" and "reduce choices for patients." Sound familiar?
Instead, we must recognize how government policies have crippled free markets.
Because the tax code deeply discounts employer-provided insurance, you're essentially stuck with your employer's non-portable plans. Hence, insurance companies can afford to be stingy and deny you care; they know that losing you as a customer requires that you change jobs. With government as "single-payer" it's even worse: to change insurance providers you must move to a different state or country.
Our current system also encourages thoughtless over-consumption and skyrocketing costs. The tax code punishes paying for medical care out-of-pocket and rewards buying insurance. So "insurance" has become prepaid medicine, and patients over-consume like business travelers dining on their company's expense account.
Further, legislation mandating minimum benefits makes insurance unaffordable for many. Consider: Colorado law compels widowed wives to pay higher premiums for prostate screening, maternity, and marital therapy. Sponsors of Colorado House Bill 08-1327 recognize this injustice. Just as businesses incorporated in other states can operate in Colorado, Coloradans should be able to buy affordable policies from insurance companies that meet less damaging regulations of another state.
So remember, the uninsured aren't the problem, but a symptom of political meddling in our most important personal choices.
Thank you, Brian!
For more on HB 08-1327 see this post by Lin Zinser.
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.
Most of the heart patients who have been sent south since 2003 typically show up in Ontario hospitals, where they are given clot-busting drugs. If those drugs fail to open their clogged arteries, the scramble to locate angioplasty in the United States begins.
"They rushed me over to Detroit, did the whole closing of the tunnel," said Eric Bialkowski, 47, of the heart attack he had on March 14, 2007, in Windsor, Ont. "It was like Disneyworld customer service."
..."We keep coming back to the same root cause," Dr. Day [Canadian Medical Association president Brian Day] said in a telephone interview from Ottawa. "The health system is not consumer-focused."
Patients first learn of the problem when they are critically ill.
So much for the myth of, "Sure, there may be some waiting for elective care in Canada, but if you have a true life-and-death emergency, then the Canadian system will be there for you..."
If America adopts such a system, where will we send our critically sick patients after we destroy the last semi-free medical system in the world?
