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The sixth is outdated facilities and medical equipment.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 15 of 15)
211. I personaly haven't seen the movie but this is what I think about socialized medicine.
Well the problem with socialized medicine is the fact I my self don't trust politicians with their budgeting of the government. Its been known for politicians to underfund schools and police departments. It may be differnt in other states but the state I live in has the some of poorest ratings in the country for various things like road work and schools. I for one would hate the fact of a politicans controlling the funding of medicine in this country. Face it we get some wacky poltiicians in office time and time agian that make bad decisions. Social security is already going bad as it is as a social service. Capitalized medicine can be no better either with greedy companies making profits, nothing wrong with making a profit but when it comes to peoples lives and inflation of pricesI don't agree with that either. I think it should work more like this, the government should keep pressure on pharmicical companies to keep prices of insurance and medicine down so that its easier and affordable, sorry Doc I believen everyone should be paid a good salary but at the same time peoples lives shouldn't be ruined or lost because they can't afford to be healthy or treated.
seanpdizzle at 3:20AM on Jun 26th 2007
212. We can thank betty atwood for showing us the future of socialized health care--Public schools! Public schools are an institution that we watch become worse while expoloring new depths of mediocrity, all the while becoming more expensive. Thanks but no thanks.
George Lundstrom at 8:44AM on Jun 26th 2007
213. I notice that people keep talking about how patients "deserve" cheaper care, medicine, and so on as if the exercise of pure power will magically create that for them. Has anyone pondered how educated and intelligent people tend to react when someone tries to shove raw power in their face? The most skilled surgeon I know came to the US from Spain not because of profit or money, he can't get board certified in this country because he's a political criminal in Spain, but because he doesn't like having power shoved in face, by anybody.
The mistake is in thinking that money and profit are what motivates the best people. Money's nice, but it's not a substitute for real living.
Darkmanwp at 10:22AM on Jun 26th 2007
214. I've seen the movie. There's a reason Fox News calls it brilliant. http://www.foxnews.com/story/0,2933,273875,00.html
Before you make an ass out of yourself like The Blowhard Thompson, watch the film for yourself. Moore has tapped a vein in the nation's conscience.
cktail at 11:45PM on Jun 29th 2007
215. I've seen the movie. There's a reason Fox News calls it brilliant. http://www.foxnews.com/story/0,2933,273875,00.html
Before you make an ass out of yourself like The Blowhard Thompson, watch the film for yourself. Moore has tapped a vein in the nation's conscience.
cktail at 11:45PM on Jun 29th 2007
216. About 30 years ago I was in London when I suffered a miscarriage. I was sent to a public health hospital where after a short wait, I was given an ultrasound that confirmed I was losing the pregnancy. At that time, there was no ultrasound being used in the US. I was given the necessary treatment that same day with no problems. No one asked if I had insurance before giving me tretment. In March of1992, my husband became very ill with a massive infection while we were travelling in northern Italy, and was taken from our hotel room on a stretcher by paramedics to a local hospital. After he was stabilized, an ambulance took him 50 kilometers down the road to the main hospital where he spent a week in intensive care. When he was recovered enough to travel, we flew to London for several days and then home to Seattle. The hospital apologized for billing us $4000 which our US insurance did pay. This was far less than the same treatment would have cost in the US at the time. I would trust medical care in other countries anytime. In this country people die all to often because of denial of even simple procedures, or have their condition worsen when their insurance companies deny treatment. It is terrible when people have insurance and still can't get proper treatment. This has happened to both of my daughters. One is now facing major surgery and two months off of work because of damage to her hands and wrists from work related stress but which doctors and insurance companies have refused to properly treat until now when she has dying bone! Where is the sense in that. Early treatment would have taken care of the problem much more cheaply and without her having to miss so much work.
Susan Hilpert at 3:19PM on Jun 28th 2007
217. The only sicko I see here is nasty Michael Moore. I can't stand him and I will never watch anything he has to do with. This guy can take care himself by loosing weight and keeping his big mouth shut! He is plain nasty!
Diana at 1:05AM on Jun 28th 2007
218. To John Irby,
You shouldn't comment on things you know obviously little about. As a Canadian, I can tell you that most Canadians are quite satisfied with our health care system, although we all realize that it can be improved. To Canadians, the issue isn't "public vs. private" - it's making our public system better (although I will concede that there are a small number of Canadians who would like to see a private system).
The real complaints you hear in Canada are about wait times, and some of these complaints are completely warranted. But I've been treated for a number of things over the past 30 years, and I've never had to wait long. I can call my doctors office and get an appointment usually the next day. Specialists take longer, sometimes a few months, but if your problem isn't urgent, then it's not a big deal. We do need to work on speeding up the waiting times for surgeries and critical care issues.
But to say Canadians are not satisfied b/c our system is a public one is completely misleading and incorrect. You would be hard pressed to find many Canadians who would give up their health cards to join an HMO in the states.
Duke at 11:51AM on Jul 5th 2007
219. Germany: Universal Coverage, but NOT single payer!
I wish everyone would stop assuming that universal health care is equal to single payer health care. It is not!
In Germany, there is a two-and-a-half tier system of health care delivery. There is first the distinction between private health insurance and non-private health insurance. Private health insurance is basically the same as here in the U.S. The insurer is free to charge what he wishes and the purchaser can choose his coverage as he likes. The caveat is that in order to purchase private health insurance, you must have a certain minimum yearly income, the level of which is set by the government. When I was there a few years ago, the minimum was approximately €80,000 per year. If you earn more than that - you may purchase private insurance, if you earn less than that, you may not. Private health insurance in Germany is better than non-private in almost every way: front-of-the-line treatment by doctors, private hospital rooms, better coverage, etc. The downside is once you move into private insurance, you have to stick with it forever - even if your health deteriorates or you get old - either of which will send your premiums skyrocketing of course. As a privately insured individual, you may return to the non-private insurance system only if you are broke.
Most Germans don't earn enough to purchase private insurance, so they are in what I call the "non-private" system. I don't call it public insurance, because it isn't. Non-private insurers in Germany operate like credit unions in the U.S. They are medical co-operatives that pool health-related risk. There are many hundreds of these organizations. Any given individual will qualify for several of these medical co-operatives based on their profession, home address, religious affilation, etc., in much the same way that people qualify to join various credit unions here. You pick an insurance provider from among the co-operatives for which you qualify. You can choose based on coverage, rates (which may vary within certain boundaries), perceived "goodness" (usually related to how much they pay doctors - and therefore how much doctors like people covered by that co-operative), etc. Premiums in these medical co-operatives are based on a percentage of your salary, and deducted like payroll taxes - but they are not taxes: the money goes to your provider, not to the government. The higher your salary, the higher percentage you pay as your insurance premium - up until the above mentioned private health insurance minimum. When you earn more than that, the percentage of salary charged as a premium stays constant. This is to encourage people to stay in the non-private system even though they could afford private insurance.
With non-private insurance your medical experience will not be as nice as with private insurance - all the basics are covered well, but you will share a hospital room, and you will not be bumped to the front of the line, or have access to special appointment times. I was in this system and I found it entirely satisfactory. It didn't bother me that someone with private insurance could come to the doctor's office at 8 when appointments for the rest of us began at 9. But then again, I'm not a bitter jealous person.
Medical services for non-privately insured people are basically "free" at the point of service, but there is a co-pay of €10 to discourage frivolous doctor visits encouraged by completely "free" health care.
German health care provides universal coverage by making membership in the local government's medical co-operative available to people who don't have jobs, income, etc. Their premiums are paid by the government as a social welfare benefit.
Oh, and paying cash for medical services is entirely legal. I did it myself before I entered the German health insurance system.
By introducing a measure of market economics to their health care system, Germany provides universal care without the typical waiting lists and rationing that are a common feature of all socialist economic systems. In fact, German newspapers often run articles on the horrors of medical care in the British NHS - the awful stories that Michael Moore doesn't want to talk about, but that are all too common in Britain, but almost completely unknown in Germany.
In short, Universal Coverage: YES! Single Payer: NO!
Will S at 4:55PM on Jun 29th 2007
220. You know, It's sad. I really wish all Americans could take two month long trip over here to Europe. The healthcare systems here are better. Productivity of the workers is higher. Living standards are higher. five weeks paid holiday. I just thank my stars I left the US and moved to Sweden. Honestly, If you have never experienced both socialized medicine and the HMO shit in the US than you have no room to talk. I had cancer when I was 18 in the US, luckly mommy and daddy had money and I had insurance. Best cancer specialist in the So. Cal area. what happened late when I was an average joe trying to find a proper job after college? I was employed by sears, payed for the best medical program I could through the company. I went to the doctor that was one of my approved providers for the plan. Well I guess I should have asked the doctor which lab she sent my tests to. I got a bill for $600.00 saying that the lab wasn't covered! The health care plans in the US are great if you have cash but if you are not middle or upper middle class you are screwed. I may have to wait a few weeks to see the doctor if I have a general question or something that does not need immediate care here in Sweden but if I have a problem it gets fixed.
Save up some cash take a trip here to europe and see how much your being screwed by your politicians. A properly functioning government should be afraid of it's citizens, not the other way around.
Nathan at 10:34AM on Jul 3rd 2007
221. I have read this article and all of these comments and it never stops to amaze me what people have to say. I am a professional I have worked very hard over the years during my career I have had very good medical coverage paid by my Employer, but why should I be dependent on my Employer to pay my medical coverage? Specially when the medical cost continue to rise above everything else my wages are not increasing at these rates and I am sure your wages are not either? If the medical Industry is not willing to control these costs (Physician, Insurance CO, Pharmaceuticals, etc.) then I am ready to have the Goverment implement regulations that allows controls. Good healthcare at a reasonable cost should be a right for every American Citizen and if that means Socialized Medicine so be it. I think it is very sad to live in one of the richest Countries in the World and people have to go Bankrupt because of an illness or worse even though you have health insurance you avoid going to the Doctor because of the extreme expense. I can only hope to understand what the poor of the low middle class is going through. If you want to get rich go invest in the Oil Industry stop using others peoples misery to get rich.
Manny at 11:23PM on Jul 7th 2007