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Universal health care is the wrong prescription

By BRIAN SCHWARTZ
INDEPENDENCE INSTITUTE

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.

Labels: Canada, CO, Insurance, MA, Medicaid, Medicare, OpEd, UK

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Repeal laws raising cost of health insurance

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.

Brian T. Schwartz, Boulder

Labels: Canada, CO, Countries, Insurance, LTE, MA, States, UK

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"Universal" Health Care Kills

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.

Labels: Canada, CO, Countries, MA, OpEd, States, UK

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Scandal of patients left for hours outside A&E
The Observer, Sunday February 17 2008

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.

Labels: Countries, UK

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Paying Patients Test British Health Care System

...One such case was Debbie Hirst's. Her breast cancer had metastasized, and the health service would not provide her with Avastin, a drug that is widely used in the United States and Europe to keep such cancers at bay. So, with her oncologist's support, she decided last year to try to pay the $120,000 cost herself, while continuing with the rest of her publicly financed treatment.

By December, she had raised $20,000 and was preparing to sell her house to raise more. But then the government, which had tacitly allowed such arrangements before, put its foot down. Mrs. Hirst heard the news from her doctor.

"He looked at me and said: 'I'm so sorry, Debbie. I've had my wrists slapped from the people upstairs, and I can no longer offer you that service,' " Mrs. Hirst said in an interview.

"I said, 'Where does that leave me?' He said, 'If you pay for Avastin, you'll have to pay for everything'" -- in other words, for all her cancer treatment, far more than she could afford.

Officials said that allowing Mrs. Hirst and others like her to pay for extra drugs to supplement government care would violate the philosophy of the health service by giving richer patients an unfair advantage over poorer ones.

...But in a final irony, Mrs. Hirst was told early this month that her cancer had spread and that her condition had deteriorated so much that she could have the Avastin after all -- paid for by the health service. In other words, a system that forbade her to buy the medicine earlier was now saying that she was so sick she could have it at public expense.

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NHS threat to halt care for cancer patient

A 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.

Colette Mills, a former nurse, has been told that if she attempts to top up her treatment privately, she will have to foot the entire £10,000 bill for her drugs and care. The bizarre threat stems from the refusal by the government to let patients pay for additional drugs that are not prescribed on the NHS.

Ministers say it is unfair on patients who cannot afford such top-up drugs and that it will create a two-tier NHS. It is thought thousands of patients suffer as a result of the policy.

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Be Healthy or Else!

By Yaron Brook and Don Watkins

As part of his universal healthcare proposal, John Edwards would make doctor visits and other forms of preventive care mandatory. In a similar proposal in England, a Tory panel suggested that Britons should be forced to adopt a government-prescribed "healthy lifestyle." Britons who "cooperate" by quitting smoking or losing weight would receive Health Miles that could be used to purchase vegetables or gym memberships; those who don't would be denied certain medical treatments.

These paternalistic proposals are offered as solutions to the spiraling costs that plague our respective healthcare systems. It is unrealistic, states the Tory report, for British citizens "to expect that the state will underwrite the health implications of any lifestyle decision they choose to make."

But any proposal that expands the government's power to control our lives--to dictate to us when to go to the doctor or how many helpings of veggies we must eat--cannot be a solution to anything. Instead of debating what coercive measures we should be taking to lower "social costs," we should be questioning the healthcare systems that make our lifestyles other people's business in the first place.

Both the American and British systems, despite their differences, are fundamentally collectivist: they exist on the premise that the individual's health is not his own responsibility, but "society's." Both Britain's outright socialized medicine and America's semi-socialized blend of Medicare, Medicaid, and government-controlled, employer-sponsored health plans aim to relieve the individual of the burden of paying for his own healthcare by coercively imposing those costs on his neighbors.

When the government introduces force into the healthcare system to relieve the individual of responsibility for his own health, it is inevitably led to progressively expand its control over that system and every citizen's life.

For example, in a system in which medical care is "free" or artificially inexpensive, with someone else paying for one's healthcare, medical costs spiral out of control because individuals are encouraged to demand medical services without having to consider their real costs. When "society" foots the bill for one's health, it also encourages the unhealthy lifestyles of the short-range mentalities who don't care to think beyond the next plate of French fries. The astronomical tab that results from all of this causes collectivist politicians to condemn various easy targets (e.g., doctors, insurance companies, smokers, the obese) for taking too much of the "people's money," and then to enact a host of coercive measures to control expenses: price controls on medical services, cuts to medical benefits--or, as with the current proposals, attempts to reduce demand for medical services by forcing a "healthy lifestyle" on individuals.

Properly, your healthcare decisions and expenditures are not anyone's business but your own--any more than how much you spend on food, cars, or movies is. But under collectivized healthcare, every Twinkie you eat, doctor's visit you cancel, or lab test you wish to have run, becomes other people's right to question, regulate, and prohibit--because they are paying for it. When "society" collectively bears the costs of healthcare, the government will inevitably seek to dictate every detail of medical care and, ultimately, every detail of how you live your life.

To protect our health and our freedom, we must reject collectivized healthcare, and put an end to a system that forces us to pay for other people's medical care. We must remove government from the system and demand a free market in medicine--one in which the government's only role is to protect the individual rights of doctors, patients, hospitals, and insurance companies to deal with one another voluntarily, and where each person is responsible for his own healthcare.

Let's not allow the land of the free and the home of the brave to become a nation of dependents looking to the nanny-state to take care of us and following passively its dictates as to how we should live our lives.


Yaron Brook is the president of the Ayn Rand Institute (ARI) in Irvine, CA. Don Watkins is a writer and research coordinator at ARI. The Institute promotes Objectivism, the philosophy of Ayn Rand--author of "Atlas Shrugged" and "The Fountainhead."

Copyright © 2007 Ayn Rand® Institute. All rights reserved.

Labels: Analysis, Countries, OpEd, UK

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Falling numbers of state dentists in England has led to some people taking extreme measures, including extracting their own teeth, according to a new study released Monday.

Others have used superglue to stick crowns back on, rather than stumping up for private treatment, said the study. One person spoke of carrying out 14 separate extractions on himself with pliers.

...Overall, six percent of patients had resorted to self-treatment, according to the survey of 5,000 patients in England, which found that one in five had decided against dental work because of the cost.

...Almost half of all dentists -- 45 percent -- said they no longer take NHS patients, while 41 percent said they had an "excessive" workload. Twenty-nine percent said their clinic had problems recruiting or retaining dentists.

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...Mr Howard, 76, has been told by health chiefs not to expect a penny of NHS treatment until he goes blind in one eye and starts losing sight in the other.

Retired midwife Doreen Kenworthy was last week given the devastating diagnosis that she was suffering from the eye condition age-related macular degeneration.

But her shock was compounded when doctors told her the NHS would not pay for treatment until she lost the sight in her affected eye and began to lose it in the other -- although further loss of sight could be prevented if she paid out thousands of pounds for private care.

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"Doctors admit: NHS treatments must be rationed"

British doctors will take the historic step of admitting for the first time that many health treatments will be rationed in the future because the NHS cannot cope with spiralling demand from patients.

...James Johnson, the BMA [British Medical Association] chairman, will warn that patients face a bleak future because they will increasingly be denied treatments. He will urge the NHS to be much more explicit about what it can realistically afford to do and ask political leaders to engage in an open, honest debate about rationing.

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...[T]wo out of three doctors and nurses said they often did not get results when needed, and a half said the delays affected patient decisions daily.

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