Hsieh Cited in Re:new Magazine By Paul Hsieh, MD @ 9:05 AM
The February 2010 issue of the British magazine Re:new has published a story on the American health care debate and how it relates to ongoing problems with the British National Health Service. They quoted me as a representative of the free-market side.
The story is entitled, "A Bitter Bill".
Although the article is generally supportive of the concept of "universal health care", the author quoted me fairly and she gave me and FIRM a lot of space on the first page. In contrast, the representative for the pro-"single payer" US group, Physicians for a National Health Program, was not named and received less column space.
The online version of the story is not available yet, but you can see the print version here:
Despite living in the only Western country without universal healthcare, millions of Americans are keen to keep things as they are. The current system may not be perfect, but the alternative, or so they believe, is unthinkable.
To them, the idea of paying for others is a socialist one, going against their definitions of rights and freedom. Collective responsibility is an alien concept that means spending your hard-earned money on someone else. To these Americans, Obama's "socialism" is only a short step away from communism, the great fear of the 1950s.
Lobbying groups, such as Freedom and Individual Rights in Medicine (FIRM), argue that universal health care infringes on individual rights. "There is no such thing as a right to healthcare any more than there is to a car or a house," argues FIRM's Dr. Paul Hirsch [sic]. "President Obama's health care plan -- or any other form of universal health care -- is wrong, because attempting to guarantee an alleged right to health care must necessarily violate the actual rights of those forced to provide such care and those forced to pay for it".
The British National Health Service has often been dragged into the American debate, and Dr. Hirsh believes that government provision of healthcare like that in Britain results in unnecessary bureaucracy. "Whenever the government attempts to guarantee health care, it must necessarily also control it," he says. "Hence crucial medical decisions are inevitably made by government bureaucrats, rather than physicians and patients. Healthcare becomes just another privilege to be dispensed at the discretion of bureaucrats."
(The author apologized for misspelling my name and she told me that it would be corrected on their website.)
Overall, I thought she represented my views fairly, and I'm honored to have FIRM's ideas circulated to readers in the UK!
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.'
Mchangama summarizes some of the legal theories used around the globe to allegedly justify the concept of a "right" to health and health care.
I was particular struck by his discussion of how this plays out in Brazil:
...Brazil's constitution explicitly recognises the right to health, but many patients who call upon the state to fulfill this obligation are frequently met with shortages and stockouts in state pharmacies.
Many of these patients have therefore -- quite reasonably -- responded by suing the government. The right to health has therefore led to an explosion of judicial challenges by patients against the government, with more than 1200 cases of judicial review sought in the Rio Grande do Sul region alone each month.
Such claims act as a major burden on the judicial system as well as a heavy fiscal burden on the government.
There are also severe ramifications for equity. Rather than making access to healthcare universal, in Brazil the enforceable right to health has had the perverse consequence of favouring the politically connected or those who can afford the high cost of judicial review.
Turning healthcare into an individual enforceable right creates all kinds of legal complexities, undermines the rule of law and stifles political pluralism. Neither is there any evidence that "the right to health" has actually improved healthcare anywhere in the world -- in some cases it has undermined it.
In reality, the rights which are really fundamental to improved healthcare are those which underpin prosperity and economic development -- such as the right to own and exchange property. Such rights are denied to millions, yet are vital for creating the prosperity needed to pay for good healthcare.
(Note: I don't know anything about the IPN other than what I've seen in this article. But I'm glad ideas like these are being discussed at the international level.)
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".
* 5:45 a.m.: 911 call. * 5:50 a.m.: EMTs arrive. * 6 a.m.: Arrive at emergency room. * 6:07 a.m.: Wife in emergency room bed. * 6:20 a.m.: Initial physician consultation. * 11 a.m.: CT scan. (One machine out of service, hence the long wait.) * 1 p.m.: Surgery prep. * 2 p.m.: Surgery. * 3:30 p.m.: Recovery room. * 5 p.m.: Admitted to empty room. * 9:30 a.m. (the following day): Released.
In my experience as a practicing physician, that's pretty typical for American health care.
Pitts then noted:
I used Facebook to let my friends and family know about my wife's condition.
The Americans were all appropriately sympathetic.
The Europeans -- who suffer under socialized medicine -- were mostly amazed.
Amazed that we didn't wait hours for an emergency-room bed.
Amazed that we saw a doctor in less than five or eight hours.
Amazed that we weren't told to go home and come back at a later date -- because her white-blood-cell count was only slightly elevated and the appendix wasn't in danger of bursting.
And not amazed but astounded that the surgery was done immediately. That there was actually a room available and that it was vacant -- at a large urban hospital -- they couldn't even fathom.
Here is one verbatim comment from a continental comrade:
"I waited three days in London to see a GP and 20 hours at ER for an 'exploratory op.' It burst and I nearly died (to say nothing of the two life-threatening incidents whilst I was being 'cared' for). But hey! The public option is better... right?"
NHS Maternity Meltdown By Paul Hsieh, MD @ 12:05 AM
British midwife Verena Burns recently described the horrors she experienced working within the UK's government National Health Service (NHS).
...In the 13 years since I joined the NHS, conditions have deteriorated. Starting from the moment they arrive through the hospital doors, birth plans tucked neatly in their overnight bags, women are being betrayed.
There is reams of evidence to prove that a woman's labour is likely to be shorter and she runs less chance of needing medical intervention if she feels calm and relaxed in the early stages. It's not rocket science.
Yet because midwives don't have time to sit with women in early labour for more than a few minutes at most, we are encouraged to do the next best thing.
We offer them strong painkilling drugs such as pethidine or diamorphine -- which is a form of heroin.
Drugs keep the mother nice and quiet which, of course, suits staff.
But they also likely to make her and her unborn baby terribly sleepy.
Although these drugs can sometimes increase contractions, they all too often slow them down.
The end result at the woman will need more drugs, not fewer, and labour will take longer.
But, of course, we don't explain of that as we dole out our pain killers. Besides, on a busy ward, what's the alternative?
Once a woman is in full labour, you'd thought we'd put her needs first. But I'm embarrassed to admit that, all too often, we were not allowed to.
Most hospitals rigidly enforce the rule that, once in labour, a woman's canal must dilate at the rate of 1cm an hour.
If that isn't happening, midwives are encouraged to tell the her that her baby may be getting in distress -- even if that isn't the case.
Terrified and exhausted by a haze of drugs, the woman agrees to anything which is offered.
In practice, this means we give her extra drugs to intensify the contractions and so speed the arrival of the child.
Her pain levels increase and she'll need an epidural injection in her spine to numb the pain around her groin.
It's a vicious circle. I felt terribly mean persuading women to go along with it. I knew I wasn't always acting in their best interests. But what could I do?
Basically, the NHS system created incentives in which providers were encouraged to act against their patients' interests.
Whenever the government attempts to provide a service such as "universal" health care, it must also control it. This means controlling the doctors, nurses, midwives, and others who will provide that service. As Ms. Brown's story illustrates, the government's priority will inevitably be cost control, even if it means compromised patient care.
Do Americans really want a system where doctors are constantly forced to choose between the priorities of their paymasters and their patients?
National health care works great... so long as you're rich enough to afford the premium level of government insurance and to buy multiple additional private policies; so long as you have influential relatives; and so long as you're willing and able to brazenly bribe the doctors and bureaucrats who run the system.
...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?
..."Up to 10,000 people," the British Guardian reported Sunday, are dying needlessly of cancer each year "because their condition is diagnosed too late, according to research by the government's director of cancer services."
...Researchers at Durham University have identified four other types of delays patients encounter in receiving cancer care: doctor delay, delay in primary care, system delay and delay in secondary care. All are part of a state-operated system that has a poor record of keeping its trapped patients alive and healthy.
An American Physician Reports From New Zealand By Paul Hsieh, MD @ 11:10 AM
Dr. Ross Stevens is an American radiologist currently working temporarily in New Zealand. He recently composed this detailed analysis of the NZ state-run medical system, which I received as an e-mail forward from a colleague.
Dr. Stevens has graciously given me permission to post the full text of his e-mail here. Any American who wants to know what his or her health care future will look like under "universal health care" should read this eye-opening piece:
I am currently on a sort of sabbatical and am working in New Zealand for a public government hospital. New Zealand has a purely socialist medical system although there is also private insurance that can be obtained as well. This is a single payer system from a government ministry that controls all care through District Health boards. Each District Health Board gets a lump sum of money each year to provide for their population.
Primary care physicians (general practitioners) are private contractors and are paid fee for service from the government plus a copay from the patient. Specialists (including radiologists as well as surgeons, pediatricians, internists, cardiology, gastroenterology, urology, etc) are paid a salary which is based only upon the number of years since board certification plus bonus for after hours call coverage.
All specialists are paid the same. The top salary band (15 years + after certification) is about NZ $200.000 which is about $150,000 US. Call coverage can add another 15-25% depending on how busy and how frequent. All New Zealand citizens and permanent residents are covered by the National Health Service.
General practitioners see one patient every 7 minutes and, I am told, can make up to NZ$600K - $800K with their fee for service.
Patients must go first to their GP for all initial care--adult and pediatric. Pediatricians are specialists and only see patients after referral from GPs. All routine obstetrics is handled by midwives who receive 2 years training post high school. To go to the ER you must have a referral from your GP unless it is emergent (trauma, etc).
How does this work? Well, my hospital is over budget for the year, so they are closing the hospital (the only one within a 3-4 hour driving radius) to all but emergent patients for 6 weeks in December and January!! No elective surgery or non emergent patients. I could give many stories about delays in diagnosis that would be unheard of in the US.
That said, patients are generally happy with their healthcare and are glad that it is "free". The mentality of patients here is different from the US. Patients are not as demanding. No one gives a second thought to waiting 4-6 weeks for a staging CT for their newly discovered lung cancer prior to treatment -- many don't accept treatment anyway. If they are told they have a cancer, they just go home to die. They are generally happy for what they have and don't worry (or know) what they don't.
For radiology, I am working in a small rural district, so our waiting times are good, but in many of the urban districts, the waiting times for a routine CT scan are up to 9 months. GP's cannot order CT or MRI -- only specialists. The radiology department runs 8:30 am - 5:00 pm and I read about half of what I would read in the US. If it is not done by 5:00, it doesn't get done until tomorrow. In some cases, it might be weeks until a routine film is read. Call back after hours are pretty much only for trauma or surgical emergencies. Everything else can wait until the next morning, or Monday.
Our department is over budget, because they forgot to include the $35,000 equipment maintenance contract in this years budget. They installed a PACS system but didn't buy the Physicians Hanging Protocol software or the RIS [Radiology Information System] -- they are using a 20 year old system that is no longer supported.
Physicians who live here are generally satisfied due to the light workload and the lifestyle. However, there is a huge brain drain from the country. Many New Zealand doctors emigrate to Australia, Canada, or the US where the pay is better.
The country is critically short of physicians, especially specialists such as radiologists. In my hospital, about 2/3 of the medical staff in not native New Zealander -- most from South Africa or Europe) and about 1/4 of the staff is made up of locum tenens like me -- people from outside of New Zealand who come here for 6-12 months for the experience.
It is an interesting system and I have had an interesting time here. They spend about 1/4 per capita compared to what we spend in the US for health care. The care is good but not great here. They have a hard time recruiting and keeping physicians and are critically in short supply. I do not think that the American public would accept the level of care that is provided here. We will see what our future brings!
Ross Stevens, MD
Dr. Stevens is absolutely correct. Americans would not accept the levels of restrictions on access and quality of care caused by New Zealand's government policies.
Long waits, outdated technology cost overruns, patients going home to die -- this is not change I can believe in.
Let's hope the US health system never gets to this point!
The Deceptive WHO Rankings By Paul Hsieh, MD @ 12:05 AM
This October 21, 2009 Wall Street Journal article explains why we should take the WHO (World Health Organization) study that ranks the US as 37th in the world in health care with a grain of salt.
The WHO ranking was ambitious in its scope, grading each nation's health care on five factors. Two of these were relatively uncontroversial: health level, which is roughly the average healthy lifespan of a nation's residents; and responsiveness, which is a sort of customer-service rating encompassing factors such as the system's speed, choice and quality of amenities. The other three measure inequality in health-care outcomes; responsiveness; and individual spending.
These last three measures struck some analysts as problematic, because a country with unhealthy people could rank above a healthier one where there was a bigger gap between healthy and unhealthy people. It is certainly possible that spreading health care as evenly as possible makes a society healthier, but the rankings struck some health-care researchers as assuming that, rather than demonstrating it.
An even bigger problem was shared by all five of these factors: The underlying data about each nation generally weren't available. So WHO researchers calculated the relationship between those factors and other, available numbers, such as literacy rates and income inequality. Such measures, they argued, were linked closely to health in those countries where fuller health data were available. Even though there was no way to be sure that link held in other countries, they used these literacy and income data to estimate health performance.
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?
...Under Japan's health care coverage, companies administer check-ups to employees once a year. Those who fail to meet the waistline requirement must undergo counseling. If companies do not reduce the number of overweight employees by 10 percent by 2012 and 25 percent by 2015, they could be required to pay more money into a health care program for the elderly. An estimated 56 million Japanese will have their waists measured this year.
...Health care costs here are projected to double by 2020 and represent 11.5 percent of gross domestic product. That’s why some health experts support the metabo law.
Such nanny-state regulations are already present to a lesser degree in the United States. If we adopt some form of "universal health care", we can expect to see them explode in scope and number.
...Government attempts to regulate individual lifestyles are based on the claim that they must limit medical costs that would otherwise be a burden on "society." But this issue can arise only in "universal healthcare" systems where taxpayers must pay for everyone's medical expenses.
[Specific US nanny-state health regulation examples omitted...]
Just as universal healthcare will further fuel the nanny state, the nanny state mind-set helps fuel the drive toward universal healthcare. Individuals aren't regarded as competent to decide how to manage their lives and their health. So the government provides "cradle to grave" coverage of their healthcare.
Nanny state regulations and universal healthcare thus feed a vicious cycle of increasing government control over individuals. Both undermine individual responsibility and habituate citizens to ever-worsening erosions of their individual rights. Both promote dependence on government. Both undermine the virtues of independence and rationality. Both jeopardize the very foundations of a free society.
The US will soon have to decide whether we will base our health care policy on the principle of individual rights or a collectivist model, as in Japan.
For our sakes, I hope we won't be "turning Japanese".
One point I'd like to make is that the good aspect (i.e., the fact that health insurance is "individually owned, personal, and portable" would naturally happen in a free market, and would not require an individual mandate. As Goodman points out in the sections on the bad and the ugly, new regulations are driving insurance costs and and reducing patients' ability to retain a desirable plan.
In other words, the good elements of the Swiss system are present despite the mandates and regulations, not because of it.
The Stressed German Model By Paul Hsieh, MD @ 12:15 AM
The October 10, 2009 Wall Street Journal points out that Germany's system of universal care is on the verge of collapsing.
Germany's health-care system was brought to life in 1883 by Otto von Bismarck and became the model for virtually every such state-directed national insurance plan since. Alas, the German system is starting to come apart at the financial seams. Germany's system relies on a handful of state-supported health insurers. This week they informed the government that the system was on the brink of a financial shortfall equal to nearly $11 billion.
There's no reason to think that state-controlled health insurance will work any better in the United States.
...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?
Swiss Hit -- Or Miss? By Paul Hsieh, MD @ 12:05 AM
As more American realize that they don't want to duplicate either the Canadian or British health care systems, proponents of "universal health care" have been casting about for other less well-known countries to propose as models.
The latest model being pitched as a "hit" is Switzerland. For example, the September 30, 2009 New York Times featured a piece by Nelson Schwartz entitled "Swiss Health Care Thrives Without Public Option".
In particular Schwartz claims:
The Swiss government does not "ration care" -- that populist bogeyman in the American debate -- but it does keep down overall spending by regulating drug prices and fees for lab tests and medical devices. It also requires patients to share some costs -- at a higher level than in the United States -- so they have an incentive to avoid unnecessary treatments. And some doctors grumble that cost controls are making it harder these days for a physician to make a franc.
...[W]hen the Swiss replaced mixed government and private financing of health care with mandatory health insurance in 1994, the resultant cost cutting efforts both damaged quality and introduced a lot of waste into the Swiss system.
In 2002, the government banned all new medical practices to control costs. The ban runs until 2010. Until then, a new physician cannot open a practice unless an old physician retires or dies. Efforts to save money by merging hospitals have created irrational allocations of specialty units. Alphonse Crespo, a Swiss orthopedic surgeon, reports that resources are now so poorly distributed that "because of the mergers, the distances between specialty units in some cantons are large." Patients needing a urologist may have to go to another hospital. Patients have actually been put in helicopters just for a consultation. Researchers at the University of Lausanne report difficulties in accessing psychiatric care, rehabilitation care, long-term care, and orthopedic care. Rationing is more likely to be imposed on the elderly and those with "a poor level of social integration."
...Between 1971 and 2005, the average inflation-adjusted general practitioner salary in Switzerland fell by 37 percent before taxes. More young doctors are choosing to become specialists because the pay is better and the work is more interesting. There is a developing shortage of primary care. In March, swissinfo.ch reported that general practitioners held the first doctors' strike "in living memory." The government had decided to further ration practitioner access to laboratory tests.
With mandatory health insurance premiums set to rise 15 percent this year, the Swiss government is proposing more cuts. The cuts include restrictions on the type of health insurance that can be offered, restrictions on outpatient services, and a "patient tax" that would require people to pay for their first six visits to a doctor’s office.
...Even with the cuts, in some cantons, the mandatory premium increase may be as much as 20 percent.
Life expectancy and infant mortality statistics are notoriously poor measures of the quality of a nation's health care system. For instance, more Americans are killed in car accidents and homicide than in Canada and Europe. According to ABC News, if one adjusts for these fatal injuries, then U.S. life expectancy is actually higher than in nearly every other industrialized nation.
International comparisons of infant mortality rates are similarly suspect. The U.S. counts any premature infant born with a heartbeat as a live birth even if it survives only a few hours. Many European countries count such children as "stillborn" if they weigh less than 1 pound even if they show a heartbeat. Japan doesn’t count such infants as "live births" unless they survive for more than 24 hours.
Flawed statistics make a poor basis for public policy.
Paul Hsieh, M.D., Sedalia The writer is co-founder of Freedom and Individual Rights in Medicine.
For more information on infant mortality statistics, see this column by former NIH director and former Red Cross president Dr. Bernadine Healy, "Behind the Baby Count".
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.
...There are countless reports, articles, essays and books that will give you all the statistics, anecdotes and arguments you could possibly want (please see the links at the end of this article). I don’t want to debate figures here; plenty of misinformation is swirling around on both sides of the political divide and I see no value wading in to fight over the shifting minutiae. I’m interested in exploring the underpinning ideas.
...The primary reason, however, that the NHS has a death-grip on the psyche of our nation is tied to its founding beliefs. It is no coincidence that the NHS was sold to the British public during wartime. In a country conditioned by emergency measures, nationalised industries and rationing the idea of an egalitarian "free" health service, based on need not ability to pay, struck a powerful chord. No-one would be left behind; everyone would be treated the same; we were all in it together.
The wartime spirit is palpable in NHS hospitals even today. Nowhere else in 21st Century British life do you feel this atmosphere. The staff seem to be constantly fighting a losing battle. As a patient you're a supplicant, not a customer, pathetically grateful for what you receive. You’re just one of the many faceless victims waiting to be treated. Waiting, for everything, is a matter of course. Queueing, filling in forms, being moved by harassed looking nurses, more waiting. But you mustn’t grumble; stiff upper-lip and all that.
The consequence of this is clear:
...People often assume that removing financial incentives encourages virtue and will somehow simplify the decision making process, but resources are limited and the need for medical care is infinite. If money is taken out of the equation other, less direct, constraints become necessary and the remaining incentives are twisted. Long waiting times, mushrooming administrative bureaucracy, rationing of care and lack of transparency are not simply a matter of insufficient funding; they’re inescapable components of this type of system.
Here’s an example. You come in for a check-up and your doctor notices a minor discrepancy. It's probably nothing but to eliminate all doubt she needs to order an expensive test. If you were paying for your healthcare, or had control over your insurance, she could explain the situation candidly and leave the decision up to you. You would need to balance the small risk against the expense, or -- depending on the nature of the potential problem -- a change in your lifestyle. You might even shop around for a cheaper kind of test; it's your money after all. But if your doctor is required to give you free treatment the situation changes drastically. She must now consider the fact that if she tells you the whole truth you will naturally demand the test. It doesn't matter to you how much it costs or how tiny the risk; you’re not paying for it. Your doctor, however, has to think about the hospital targets, the other patients waiting for tests and, if you're elderly, the effectiveness of continuing treatment considering your age.
As far as I can tell, most doctors maintain their integrity. They're honest with their patients and zealously fight their corner against the hospital managers. But what kind of system sets up a clash between the interests of the patient and the doctor? What kind of system punishes virtue?
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.
France Fights Universal Care's High Cost By Paul Hsieh, MD @ 12:05 AM
France is often touted as a shining example of how governments can provide universal health care in a cost-effective manner. Hence, as the flaws in Canada and England become more apparent to Americans, many on the political left are pointing to France as the model to emulate.
...France claims it long ago achieved much of what today's U.S. health-care overhaul is seeking: It covers everyone, and provides what supporters say is high-quality care. But soaring costs are pushing the system into crisis. The result: As Congress fights over whether America should be more like France, the French government is trying to borrow U.S. tactics.
One key problem is that the system is founded on socialist premises:
...French taxpayers fund a state health insurer, Assurance Maladie, proportionally to their income, and patients get treatment even if they can't pay for it.
In other words, following the Marxist principle of, "From each according to his ability, to each according to his need".
The inevitable result:
...[S]ervice cuts -- such as the closure of a maternity ward near Ms. Cuccarolo's home -- are prompting complaints from patients, doctors and nurses that care is being rationed. That concern echos worries among some Americans that the U.S. changes could lead to rationing.
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).
My wife Diana brought this comment to my attention:
Funny. In Sweden, right now, the government has all the hospitals agree to this "guarantee of service" which means when you seek non-emergency care, you must be guaranteed to see a doctor within 7 days. And if the doctor sees it is needed, he will refer you to a specialist, and you must be seen within 90 days. Then if treatment is needed, you must be treated within 90 days.
Nice, but, the hospitals can't meet that arrangement, so hospitals are quietly asking their doctors not to issue referrals -- that way they get out of the 7-90-90 agreement, and the heavy fines imposed on the hospitals if they do not fill them.
This sort of "doctoring" of the numbers is not limited to Sweden.
Last year, a controversy erupted in the UK when it turned out that ambulance drivers were told to keep critically ill patients within the ambulance, even after the vehicle had pulled up to the hospital property just outside of the doors of the emergency rooms (called "A&E" for "Accident & Emergency" in Great Britain).
Hospitals were last night accused of keeping thousands of seriously ill patients in ambulance 'holding patterns' outside accident and emergency units to meet a government pledge that all patients are treated within four hours of admission.
Those affected by 'patient stacking' include people with broken limbs or those suffering fits or breathing problems. An Observer investigation has also found that some wait for up to five hours in ambulances because A&E units have refused to admit them until they can guarantee to treat them within the time limit. Apart from the danger posed to patients, the detaining of ambulances means vehicles and trained crew are not available to answer new 999 calls because they are being kept on hospital sites.
If the US adopts government-run "universal health care", we will see American hospitals acting similarly and placing a higher priority on "doctoring their numbers" rather than their patients.
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.
In this Bloomberg News piece, Betsy McCaughey points out how the current stimulus bill calls for a "Federal Coordinating Council for Comparative Effectiveness Research" to essentially dictate how doctors should practice medicine. The government will decide what treatments are "most effective" and should therefore be paid for. If your doctor thinks a different treatment may be more appropriate for you, then he risks losing money and/or running afoul of the authorities.
Advocates of "universal health care" like to say that it would create a "compassionate" system in which money would no longer pose a corrupting influence on medical practice. Instead, doctors would be able to practice in their patients' interests free from economic concerns.
Of course, this is not possible. Any system of "universal health care" merely shifts the economic decision-making from the affected parties (doctors and patients) to government bureaucrats who will not necessarily have the patients' best interests in mind.
Free market health care is reviled by the leftists because it supposedly "puts a price on life". But as Betsy McCaughey points out, it is the government-run systems that actually do put a price on life and will explictly deny care to patients if it costs too much.
After getting struck by a motorcycle, an elderly Japanese man with head injuries waited in an ambulance as paramedics phoned 14 hospitals, each refusing to treat him.
He died 90 minutes later at the facility that finally relented -- one of thousands of victims repeatedly turned away in recent years by understaffed and overcrowded hospitals in Japan.
Paramedics reached the accident scene within minutes after the man on a bicycle collided with a motorcycle in the western city of Itami. But 14 hospitals refused to admit the 69-year-old citing a lack of specialists, equipment and staff, according to Mitsuhisa Ikemoto, a fire department official.
The Jan. 20 incident was the latest in a string of recent cases in Japan in which patients were denied treatment, underscoring health care woes in a rapidly aging society that faces an acute shortage of doctors and a growing number of elderly patients.
Nor is the problem one that would be solved by imposing a law like the US EMTALA statutes which force hospitals to accept and stabilize emergency patients. In the US, this has creating yet more overcrowding of emergency room. EMTALA has also driven away physicians from working at these hospitals. What cardiologist or neurosurgeon wants to take ER call if he isn't compensated for any care he delivers, but can still be sued for any alleged malpractice?
Instead, Japan's problems are more systemic and "is nearing collapse". When people are told they have a "right" to care without limit, costs will also rise without limit. Soon, the only alternative will be rationing, as is already commonplace in other countries like Canada and the UK.
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.
It includes some useful economic data as well as some pretty damning criticisms of the Massachusetts mandatory insurance plan.
The CAHI is a little more sympathetic to the Swiss system of mandatory insurance that I would be. The Swiss system still violates individuals' right to contract, although the subsequent bad economic effects have not (yet) hit Switzerland as hard as Massachusetts.
But overall, the CAHI piece is informative and well worth reading!
Our new single payer video "Truth or Consequences—the Beth Ashmore Chronicle" demonstrates through the personal experiences of Beth Ashmore and her mother why the purported advantages of a single-payer health care system are really myths. The Beth Ashmore Chronicle offers real world evidence of the inadequacies of the single payer concept versus the quality and expediency of our current private market health care system.
Just one additional comment in response to a line in the video: There is a solution to the current health care problems in the US -- the free market.
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.)
