Jeff Hoard wonders why Americans are suspicious of Socialized Medicine. This article for the Heritage Foundation by Kevin Fleming may help him understand. (The Executive Summary of Fleming's heavily footnoted piece is here). Based in part on an analysis of the British and Canadian experiences, Fleming describes the ten things one can expect from a single-payer health system.
The first is reduced quality of care. For example, only three of 29 countries studied by the OECD had fewer practicing physicians than Britain. And in a study of cancer survival rates in 17 countries, Britain ranked near the bottom in lung cancer, colon cancer, and breast cancer survival. Britain has fewer medical oncologists than any country in Western Europe.
The second is periodic funding crises. Providing "free" medical care increases demand for it. When the government responds by restricting spending, as it has in Britain, patient demand far outstrips health care supply. As Fleming shows, this has been the pattern under Britain's single-payer system. Indeed, Britain has underinvested in health care during the past 30 years compared to the European average.
The third is politically driven inequalities. As Fleming documents, Canada has a three-tiered system. The wealthy jump queues by going to private clinics or to the U.S. for rapid treatment. The second tier consists of the well-informed and the aggressive, who push their way to the front of the line. This leaves behind the elderly, the poor, and the disenfranchised. Similarly, a 2002 investigation showed that in Britain more than 10,000 private-pay patients were given preference over National Health Service patients in Britain's best hospitals.
The fourth is labor strikes. Strikes are common in state-operated enterprises. The health care industry has proven to be no exception. CBC News reports that Canadians have "come to expect [strikes] as part of the negotiating process between doctors and the government." In the past three years, Canada has experienced major health care related work stoppages in New Brunswick, British Columbia, and Ontario.
The fifth is personnel shortages. According to Fleming, Canada has a serious shortage of physicians such that 18 percent of Canadians have trouble finding a doctor. Canada has 2.1 physicians per 1,000 people, compared to an OECD average of 2.8.
The sixth is outdated facilities and medical equipment. In government-run industries, equipment purchasing and technology investments are driven by politics. Fleming shows the adverse consequences that have resulted from this reality in Britain and Canada. For example, according to the president of the Canadian Association of Radiologists, much of the country's diagnostic equipment "is so outdated it would not be used by radiologists in the U.S."
The seventh is waiting times. This is topic Michael Moore didn't want to discuss. Waiting times in Canada and Britain are notoriously long. In Canada, for example, the average wait time between general practitioner referral and specialty consultation is 17.7 weeks.
The eighth is signifcant variations in patient care based on region and economic status. This, of course, is a major problem with health care in the U.S. But Fleming shows that it exists to a substantial degree under single-payer systems, as well.
The ninth is financial waste. In 2001, Britian reportedly lost 20 percent of its total spending on its national health care system due to "waste, fraud, and inefficiency." Britain now has more administrators than consultants in the system.
The tenth is loss of personal liberty. Personal freedom in the health care context means that patients can choose their treatments and which doctors will provide them. Under Socialized Medicine, a government official makes these choices. Pressure also arises for government officials to impose behavioral decisions on individuals in order to keep health care costs down. Americans tend to be quite suspicious of giving the state this kind of power, particularly in the life and death context of health care.
In sum, as the U.S. grapples with the issue of health care reform, there are very good reasons to eschew Socialized Medicine.
Reader Comments ( Page 1 of 15)
1. And? How does that make it any worse than we have it now?
Webster Hubble Telescope at 1:38AM on Jun 24th 2007
2. "This article for the Heritage Foundation by Kevin Fleming"
You should bother with tripe from a Heritage Hack.
Steve J. at 3:47AM on Jun 24th 2007
3. HERE'S SOME REAL RESEARCH...
U.S. healthcare expensive, inefficient: report
Tue May 15, 2007 1:25AM EDT
By Maggie Fox, Health and Science Editor
WASHINGTON (Reuters) - Americans get the poorest health care and yet pay the most compared to five other rich countries, according to a report released on Tuesday.
Germany, Britain, Australia and Canada all provide better care for less money, the Commonwealth Fund report found.
"The U.S. health care system ranks last compared with five other nations on measures of quality, access, efficiency, equity, and outcomes," the non-profit group which studies health care issues said in a statement.
Canada rates second worst out of the five overall. Germany scored highest, followed by Britain, Australia and New Zealand.
Per capita health spending in the United States in 2004 was $6,102, twice that of Germany, which spent $3,005. Canada spent $3,165, New Zealand $2,083 and Australia $2,876, while Britain spent $2,546 per person.
According to the report, 61 percent of U.S. patients said it was somewhat or very difficult to get care on nights or weekends, compared with 25 percent to 59 percent in other countries.
Steve J. at 3:49AM on Jun 24th 2007
4. I dont support Moore but I would like to comment that America should have a particular simple health care insurance for every single individual.
Why would you compare America with other countries as there laws and politics system is totally different. America is still the most powerful country in the world and it can do the very best for its citizens when we are ready to do it. You can compare the american politicians and corruption together with third world countries politicians. Politicans are taking America towards down side and if we still not rise and awake it will be too late as Democrats cannot do anything to stop the war against Bush's VETO. America is United but what about the Americans? ARE THEY?????
Daniel at 5:58AM on Jun 24th 2007
5. First, the Heritage Foundation receives major funding from the insurance and pharmaceutical industries, so I would expect this kind of garbage from them. But I wouldn't have from Paul Mirengoff, and suggest he do his own homework in the future.
Secondly, so do our politicians take hoards of cash from these industries. Eliminate the campaign contributions and you'll see our health care system fixed overnight. And it'll be fixed not with socialized medicine but with a Medicare-for-all system. Medicare is the ONLY part of health care that works efficiently today, and 64% of doctors and 60% of business leaders prefer it. The doctors and hospitals remain private, they just get paid by Medicare's state contractors, and they are private too.
The Medicare-for-all system would eliminate the 31% of waste caused by the insurance bureaucracy, which includes the doubled billing clerks in the hospitals and clinics, and provide first-class health care to 100% of the population for the same 16% of GDP we are expending today.
For more benefits see Business Leaders for Single-Payer Healthcare at http://www.businesscoalition.net
Jack Lohman at 8:13AM on Jun 24th 2007
6. Daniel's comment reminds me of a general kind of comment I've heard from many people over the years: If America is rich and powerful enough to put people on the moon, we're rich enough to find a cure for cancer. The thing is, rich and powerful has nothing to do with it. Neither does having the will via politicians. Collectivizing things never leads to improved results. There's not one instance of it working that way. It's true that we already have third party payments pretty well established, but moving to only ONE third party would be disastrous. You could look it up.
betsybounds at 8:01AM on Jun 24th 2007
7. From a Canadian perspective those are all true and valid points Paul makes. The Canadian healthcare system is riddled with the same problems and inefficiencies that plague every government-ran program. If you look at Dental care, Eye care and Prescription Drugs (which are not covered under Canada's Medicare Program) you find there is no shortage of dentists, optometrists or pharmacists. Waiting times for treatment are next to nil, they never go on strike and there are plenty options for rich and poor patients. I don't know what kind of medical system would suit Americans but stay away from the Canadian model.
John Tilley at 10:48AM on Jun 25th 2007
8. As a primary care physician with 25 years experience I never cease to be amazed at patients who say to me: "I stopped taking my prescription because I didn't have health insurance." Yes, many prescription drugs are costly, and the out of pocket cost of a visit to me for a six month review of a condition like hypertension or diabetes would be around $100. But do people cease going to the barber because they don't have haircut insurance? If you are working and your employer pays your health care premiums, do you think that cost does not come out of your pocket? If so, I have a bridge in Brooklyn I would like to sell you. The fundamental mistake in the US that has led to the high percentage of people without health care coverage was the decision post WWII to encourage employer funded health care coverage and give the attendant tax breaks to corporations and not individuals. This has fostered the illusion that financial coverage for health care expenses is a "right" like the bill of rights in the Constitution. I'm not sure it will ever be possible to undo the harm that has caused in terms of persuading people that someone else will pick up the tab for medical costs. We physicians, or at least our medical associations, share some of the blame for insisting as part of the Medicare Act in 1965 that we be allowed to set our own fees. What a recipe for inflation. For years the government accepted what was termed "usual and customary fees" without blinking an eye. I once saw a graph depicting medical costs over time. It had a very shallow slope until 1965, at which point the line took a sharp increase, which continues at the present time. The recipients of medical services--I like to still use the antiquated term "patients"--are completely insulated from the cost of the services by third party payers, who in the past 25 years have used all manner of techniques to cut down on increases. If auto insurance provided for the purchase of a new car every five years, how many consumers would elect to buy a Prius, especially if part of the insurance paid for fuel costs? Well, that is exactly what our "health insurance" does. No wonder it seems that everyone wants to own a Lexus, but pay Kia rates!
Dan Smith at 8:40AM on Jun 24th 2007
9. As the spouse of a physician, and a small business owner for over 30 years, I heartily endorse Dan Smith's comments. I will emphasize the fact that medical costs began escalating in 1965 - just as the government started infusing money into the system. I want to also mention that the assuming of health insurance costs by employers did not start "post WWII", but was a direct consequence of wage controls imposed during WWII. Since employers could not compete for scarce labor by offering higher wages, they began offering increased "fringe benefits". Another example of the unintended (bad) consequences of government interference in the free market. Keep government out of health care!
Tom Roshetar at 9:17AM on Jun 24th 2007
10. I would like to add to the last point that Paul made, ie the loss of our liberties. Those advocating universal healthcare like to make the assertion that health care is a right.
Rights are not created or granted by governments. They are as much a part of you as your mind or your hand. Governments either recognize and protect them or penalize you for exercising them.
Rights apply to all people at all times. In other words, crossing a border does not change your rights. When someone crosses the border from Mexico to the United States, they do not gain rights. They just pass from a jurisdiction that penalizes one for exercising rights to one that recognizes and protects rights.
Health care is not a right or a privilege (a false dichotomy often presented by those trying to impose socialized medicine), but it is a service. This service exists only because some individual has supplied his or her mental, physical, spiritual, and emotional energy. If you have a right to health care, than you have a right to the mental, physical, spiritual, and emotional energy of another person. That relegates that other person to the status of a slave and is therefore morally wrong!
Not only is socialized health care a violation of individual rights, the adoption of state run health care will result in the loss of other rights also. We can see how this is being played out now wherever government is paying for someone’s healthcare. Whenever someone else is paying for your healthcare, they acquire an interest in the choices you make that impact your health and the money that is spent fixing it.
All you need to do is look at areas where busybody liberals are trying to restrict your freedom and using government spending on your health care as a rational for doing so. One of the main rationales for motorcycle helmet laws, is that if you are in an accident and suffer a serious brain injury, the taxpayer is going to end up paying for years of your intensive care.
We know from past experience that the cost of the program will far exceed what the proponents of government health care say it will when they try to sell it to us. Then studies will be done to determine why the costs are so much higher than what was predicted. A recent Purdue University study showed that 74 percent of all healthcare spending is a result of personal health habits. Most of you will be found guilty of life style choices that are driving up healthcare costs. At first they try to convince us to change our ways through large advertising campaigns. When that fails to work, you will lose more of your freedom and liberty as they will mandate the changes, using precedents like mandatory motorcycle helmet laws. Each successive infringement on our liberties will be used as a precedent for further infringements on our liberties.
Diet, exercise, and recreational choices are all on the table when government starts paying for your health car.
If they can tell us what we cannot do, how big of a step is it for them to tell us what we must do. After all, we all know that people that exercise regularly are healthier. Will we have government drill instructors getting us up at five in the morning doing calisthenics and jogging around the block? That may sound far fetched, but 75 years ago, the idea of mandatory helmets for motorcycles would have struck most Americans as far fetched. As far as I am concerned, these moral arguments "close the case" and the other nine arguments that Paul makes, as true as they may be, are superfluous.
George Lundstrom at 10:47AM on Jun 24th 2007
11. For anyone in the US, especially from the Heritage Foundation, to be criticizing any other country with a national system is like Paris Hilton criticizing Stephen Hawkings over his interpretation of black hole theory.
Alec Pruchnicki at 6:39PM on Jun 25th 2007
12. I'm glad someone addressed the 'right' angle. No one has the right to something that depends on the talent, education or hard work of someone else. Therefore, healthcare is not a right. Housing is not a right. You do, however, have the right to provide for yourself and your family the best healthcare and housing you can afford, wherever you choose to live.
Nationalized healthcare will actually take away that right, as well as the autonomy of every individual who works in the health care system.
I don't know where "webster hubble telescope" lives, but I've never had to wait 17.7 weeks for a consultation on anything!
MLP at 11:11AM on Jun 24th 2007
13.
George, you should understand the Medicare-for-all proposal before shooting it down. It is not socialized medicine, it is a single-payer system using private contractors (hospitals and physicians). You do not lose your rights, OPT OUT if you don't like it! But don't force others to opt out with you. THAT is removing their "rights" to opt in.
And if you think Medicare-for-all is going to remove your "health care" rights, just wait until the privatized system morphs into a managed-care-for-all system that is run by CEOs and shareholders denying care so they can increase profits. You haven't seen anything yet, and that is going to be your only choice in five years unless you are self-employed. Follow the dominoes!
There are some things best done by the government, and acting as a payment system for private health care is just one of them. Can you imagine how it would be for your state patrol were private and reimbursed on the basis of how many tickets they wrote? Or your fire department on the number of fires there were. Or 100% of the roads were private toll roads?
And MLP, health care costs are already passed to 100% of consumers regardless, and they will continue being paid by consumers no matter what we do. What the reformers are trying to do is eliminate the rip-offs and provide for 100% care so the 18,000 Americans who die prematurely every year because they do not have health care can perhaps live a bit longer.
I realize that is not an issue the insurance companies care about, but many others do. You can learn more at Business Leaders for Single-Payer Healthcare at http://www.businesscoalition.net
Jack Lohman at 12:12PM on Jun 24th 2007
14. One factor all of you leave out of the equation, is this:
Healthy persons generate more money than sick persons.
That's why allmost all of the western countries have chosen socialized medicine. Many the people in the US who can't afford proper care end up beeing unemployed, thus not generating values by working. They rather cost money because they take advantage of the social security they're granted from the state.
I feel exeptionaly lucky living in Norway, as I was diagnosed with testicular cancer one year ago. Norway has a very good socialized medicine system, and I benefited from that. I was operated the day after I got my diagnosis and got exellent treatment at my local municipal hospital. From there I was transfered to the national cancer hospital, which is top notch and has an exellent research division; they have made many breakthroughs in for example breast cancer.
I decided to study in another town in the automn, and there was no problem in getting my chemo treatement there while following my studies, even getting a hightened scholarship because of my illness.
I am now cancer free and kicking after a swift and effective treatment from a socialized medicine healthcare, and all it cost me was ca. $200.
Instead of geting limited care from a lacking health insurance, I'm perfectly healthy and can generate values and pay taxes to help others who fall ill.
Håvar at 1:19PM on Jun 24th 2007
15. Jack,
You should understand Medicare before you advocate it for all. Medicare does not pass the cost to consumers it passes to taxpayors. Most senior citizens pay little to no tax now and didn't contribute near what they consume when they did work. Medicare receipiants have no motivation to prudently use resources as it is free to them. That is why Medicare is so inefficient. Many seniors use doctor visits as social outings, it's something to do to get out of the house doctors are more then happy to oblige them.
Medicare is the most restricitve form of managed care in existance. What is covered, what docotr you see, how much the doctor gets paid, how the doctor does their job, everything is 100% controlled by politicians.
What do you mean in 5 years private healthcare will morph into managed care? Wake up it morphed 15 years ago when Federal Government mandated employers offered HMOs if they wanted to or not. You can't purchase a non managed care plan today. Where are you getting your stale outdated information from?
Nate Ogden at 12:49PM on Jun 24th 2007