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The sixth is outdated facilities and medical equipment.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 3 of 15)
31. So, George, your personal interest in the game is irrelevant? Like, if you were a moneyed interest we should just take your statements as though they were like all others who have no personal gain from our inefficiencies?
Sorry. I add (or delete) weight when I know they come from an industry hack.
Jack Lohman at 4:45PM on Jun 24th 2007
32. Jack
Is your point that if I am an "industry hack" my argument is wrong, or of lesser weight because of any personal characteristics I may have. Please google "ad hominem" and find out about the logical fallicy you are presenting. Arguments are right or wrong, independant of the person expressing them. Please make your remarks relevant to the points I've made about health care not being a right by offering counter arguments or make the case that health care is a right or stop wasting our time.
George Lundstrom at 5:27PM on Jun 24th 2007
33. No Jack, Medicare has been growing at extraordinary rates. It had to be restrained and that is not simply a Republican problem. The same problem bedeviled the Clinton administration. To argue that the problem is the politicians is, well, silly. It is the fundamental structure of the program itself.
"From: http://www.ncpa.org/pub/ba/ba409/
In 1970, Medicare accounted for 11 percent of all health care expenditures in the United States; but by 2000, its share stood at 17 percent"
And from this one: http://www.urban.org/UploadedPDF/growth-in-medicare.pdf
We find that the the projected expenditures of Medicare will have increased from $239.5 billion to $599 billion (in constant 2000 dollars). At that point Medicare will cover about 20% of the population. Now, you want to increase it 5 fold?
From the Heritage study:http://www.heritage.org/Research/HealthCare/bg1740.cfm
"According to Medicare Trustee Thomas R. Saving, a professor of economics at Texas A&M University and senior fellow at the National Center for Policy Analysis, the Medicare program is now projected to consume:
* 24 percent of all federal income taxes by 2019 and
* 51 percent of all federal income taxes by 2042". And you still want to increase it 5 fold?
Look, the problem is that in your over eager advocacy you seem think all this will be essentially free. You have overstated the administrative costs of the insurance companies and understated the administrative costs of Medicare.
The only references you have given me is some guy named "Fighting Bob" (there is a source you can trust) and a jpeg of what looks like stock charts. But, the charts are unlabeled and have some handwritten names in them. One of them is Wellpoint which is expanding to new states. But somehow, you are equating growth and profitability with excess cost. For a guy who claims to have owned his own business, you don't seem to understand capitalism and the benefits of advertising and selling. If Unite Health's costs exceed the cost of Wellpoint, then Wellpoint will get the business. Your plan for Medicare will have no constraints except the politicians you are so quick to denigrate. UNH has been growing, but that has stopped for now and the stock is basically static or dropping. Your charts are out of date. Being on Medicare, you probably don't notice that doctors and hospitals are constantly accepting new insurances and dropping others. You also note with some kind of approval that Canadian doctors are moving to the states. Could that be because the fees they get in Canada are not worth the effort and the education?
One last question. How many major medical advances have come out of Canada, or England, or ..., of late Does your analysis account for any of that or do you think the drugs and procedures we have now are the best that could ever be and no enhancement is necesary?
Rick
Rick Caird at 6:43PM on Jun 24th 2007
34. George, if you are the Dr. George Lundstrom in Minnesota, then I would naturally get the impression that you were more interested in your livelihood than in our "free society," because every time I hear the free society bit it is from someone with financial rather than freedom motives. But I'll play along: if you really want a "free" society we should eliminate all laws and let corporations defraud anybody they wish. Let them at us!
But I'll chose to believe that is not your goal, and you are concerned with the government running your practice. That's a bit more honest. But even the Medicare-for-all system under consideration will expand the patient base for doctors and dentists, all at the same costs we are spending today. The insurance industry is draining 31% of costs that should instead be going to physicians and health care. That's not my choice.
Jack Lohman at 5:45PM on Jun 24th 2007
35. This sort of dishonest manure is exactly what you see all day every day on Powerline. Sad that AOL is letting them do it on their own turf.
Britain uses a system completely different from any other country. It is unique among the countries that offer free health care to their citizens. NHS runs everything. And it is run on the cheap. This is well-known. Its deficiencies are primarily funding-based (as Mirengoff himself points out). So, if Britain wanted to improve the NHS system, they could pump more money into it, and it wouldn't be nearly as expensive as the United States'.
And also, I notice he doesn't mention France. Or any of the other countries that have free health care. Gee, I wonder why not? Because the care is better in those countries than it is in Canada and Britain. There are less (or no) waiting times even compared to the USA (and anyone who has been in a ER in the US lately can tell you there *are* waiting times).
Why are people such as Mirengoff and the Heritage Foundation so shockingly dishonest that they must point to perhaps the two poorest examples of free health care to prove their point? If socialized medicine was so bad couldn't they point to the systems which are generally considered the best (such as France) and use that as proof of how awful it is? I wonder why they don't? The word France isn't even in that Heritage article. Nor is Switzerland. Nor is Japan.
It's like looking at the 2007 Kansas City Royals *exclusively* and using that to say the quality of MLB has dropped as of late. It's pure nonsense. Why not look at the systems that succeed and use those as a base to build our own successful system?
Joshua at 6:01PM on Jun 24th 2007
36. That may sound far fetched, but 75 years ago, the idea of mandatory helmets for motorcycles would have struck most Americans as far fetched.
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Seatbelts would also have seem far-fetched, so what is your point?
Steve J. at 6:14PM on Jun 24th 2007
37. Collectivizing things never leads to improved results. There's not one instance of it working that way.
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Germany has "collectived" health care, superior to ours at half the cost. Can't you read?
Steve J. at 6:17PM on Jun 24th 2007
38. Jack
There are many false assertions in your last post, but they are irrelevant and would get us off track. Unless your next post makes the claim that health care is a right, or you make a counter argument to my first comment, then I am not interested in going off on tangents and will offer no more comments on your irrelevancies.
George Lundstrom at 6:23PM on Jun 24th 2007
39. George, healthcare as a "right" is an absolutely stupid diversion, but I find those with weak arguments falling back to that argument all the time, when all else fails.
Medicare-for-all is the right thing to do; for my kids, your kids, and everybody else's kids. If you demand "rights," why do we demand that hospital ERs administer life-saving procedures when someone comes in withour insurance? Doesn't this violate the hospital's "rights?" Give me a break.
Jack Lohman at 6:33PM on Jun 24th 2007
40. George,
I made the claim that health care is a right based on the Universal Declaration of Human Rights, yet you seem to ignore my comment.
You say that your motive is to retain the US as a free society, but a free society has to be cared for. Freedom is to, as in my case, live through a serious illness without having it ruining my financial future. My freedom to chose exactly which doctor is going to treat me, or my freedom from having to pay a modest tax is irrelevant to that.
I also wish to point out another weakness in Flemmings arguing: He points to Britain as having bad health care by comparing them to other European countries. This only shows how Britain fares against other countries with socialized medicine, not how it fares against the US system.
I'm going to bed now, but I'm looking forward to see your answer tomorrow.
Håvar at 7:04PM on Jun 24th 2007
41. Jack Lohman writes: "Sorry. I add (or delete) weight when I know they come from an industry hack."
Jack as well you should. For example, Paul had a financial interest in writing the blog because his firm represents a horde of insurer and insurer groups. I guess the person you were referring to also profits. These people have had a stranglehold on American and doing whats right by giving everyone good health care - because while it will help 47 million people (and also free the insured to have more job mobility) - their wallets may get hit. I'll choose the 47 million suffering over a few parasites on our society. National healthcare now!!!
Phil at 7:01PM on Jun 24th 2007
42. Oh come on, Rick, increasing Medicare five-fold by folding in every US citizen is just another diversion. If that process gives us 100% coverage of first-class health care at the same 16% of GDP we are spending, then it's damn well better that the mish-mash we have today.
And who is NATIONAL CENTER FOR POLICY ANALYSIS? Another Heritage Institute, or Fraser Institute or Pacific Research Institute or Cato? All funded by the insurance industry.
And no, Rick, nothing is free. We all pay for it somehow and the direction it is going it is projected to be 20% of GDP in 10 years. How much more of family income do the health care CEOs and shareholders need?
Doctors first started moving from Canada to the states because they couldn't become millionaires in Canada where they have a $400 salary cap. I know physicians here who make $4 million, so I can understand the attraction. But the trend has reversed and more Canadian docs are now going home than coming south, citing the focus on profits as a very distasteful aspect of American medicine.
Wondering where the technology is developed is a waste of time because even medical device and pharmaceutical companies are now outsourcing offshore. Most of our drugs (80%) are me-too drugs, not new developments. And even those Americans attempt to buy from Canada.
And Rick, by your questions and answers you have given away your secret. What part of the industry are you from?
Jack Lohman at 7:16PM on Jun 24th 2007
43. Håvar
I have not forgotten about you. I have a life to lead and only wish to deal with one at a time. Jack apparently cannot make the case that health care is a right, so he makes the assertion that is a "an absolutely stupid diversion". In fact it is the core principle. If health care is a right, then government must provide everyone all the health care they need. If it is not, and government provision of it is morally wrong (as I previously made the case), then government must not do it.
I read the Universal Declaration of Human Rights, and it merely asserts that health care (along with a list of other goods and services that only exist because someone has expended their energy to bring them into existance) is a right. I challange you to make the case that health care is a right. If you merely assert that health care is a right and I merely assert that it is not, what then? Do we vote? Then rights are subject to vote. (Do you want your rights subject to a vote?) Do we "duke it out"? Then might makes right. Is that the kind of society in which you want to live?
George Lundstrom at 8:09PM on Jun 24th 2007
44. George, you win. There is no written document (to my knowledge) that says that health care is a God-given right. Providing 100% health care is the humane thing to do, if you happen to believe in being humane. If you aren't humane, then a Medicare-for-all system is an infringement on your "rights." Even if it saves one of your loved ones, you've been sh*t upon. Get over it. It is the best thing that could happen to this nation, except for the fat cat insurance CEOs and shareholders.
But it would be a boon to US businesses and make them more competitive with foreign companies that do not have to add health care to their product prices. And to US workers whose jobs are less likely to be offshored. Sorry, we are not talking what's in the best interest of the nation or public; we are talking about YOUR "rights." And if you are in the health care industry, which you refuse to discuss, your wallet.
Jack Lohman at 8:29PM on Jun 24th 2007
45. And PS, screw that guy that shows up in the ER without insurance. We don't want the hospital shareholder's rights violated as well. How dare the Feds require them to treat him!
Jack Lohman at 8:32PM on Jun 24th 2007