HEALTH CARE DEBATE LIVES ON DREAMS

Our national flirtation with the illusory benefits of "free" national health insurance corrodes our debate about improving the quality of health care in the United States. Partly because of the allure of this delusion of free or single-payer national health insurance, we are slowly ceding our medical service system to government mismanagement at patient and taxpayer expense.

The reasoning behind these delusions is explained and exposed in detail in a new book, "Lives at Risk: Single-Payer National Health Insurance Around the World," by John C. Goodman, Gerald L. Musgrave and Devon M. Herrick. The book discusses 20 myths that underlie the push for single-payer national health insurance. The first three form the movement's philosophical base.

The first myth is well-expressed in this quote from the U.S. Physicians' Working Group for Single- Payer National Health Insurance: "Access to comprehensive health care is a human right. It is the responsibility of society, through its government, to ensure this right." The authors point out that the so-called basic human right to health care in countries with national health insurance is "nothing more than the opportunity to get services for free (or at very little cost) as the government decides to make those services available. But government is under no obligation to provide any particular service."

Government controls costs by imposing global budgets on hospitals and health authorities and limiting supply. As a result, demand exceeds supply for virtually every service, and patients are forced to wait months and even years for treatment. An electrocardiogram appointment letter from the Moncton Hospital to a New Brunswick, Canada, heart patient said the examination would be in three months. It added: "If the person named on this computer-generated letter is deceased, please accept our sincere apologies."

Rationing of health care occurs in the U.S. too, especially in public hospitals that provide care for the uninsured, and for those on Medicare and Medicaid. In spite of this, average wait times in the U.S. are far shorter than in countries with national health care systems. For example, 27 percent of Canadian patients and 36 percent of British patients must wait more than four months for elective, non-emergency surgery. By contrast, only about 5 percent of American patients wait that long.

The second myth was articulated by Aneurin Bevan, father of the National Health Service established in Britain in 1948: There must be equal access to health care for all people. He declared "the essence of a satisfactory health service is that rich and poor are treated alike, that poverty is not a disability and wealth is not advantaged." While this goal may be high- minded, studies in both Britain and Canada indicate their socialized systems are far from achieving it. In an article on the problems of unequal access in Britain, Patrick Butler observed: "Generally speaking, the poorer you are and the more socially deprived your area, the worse your care and access is likely to be."

Disparities by region and wealth also exist in the United States. But because emergency rooms cannot turn away any patient and the private medical sector is relatively robust, people in the United States have more actual access to health care services than is available in nationalized systems. We don't want to lose this access.

The third myth is related to the first two: that care should be based on medical need rather than ability to pay. But people in countries with a socialized system are increasingly willing to pay outside the system for better and faster treatment. "Free" surgery isn't worth much if you have to wait until you're near death to receive it. Rationing, inefficiencies and lack of quality are the real fruits of this socialist experiment. And we need less, not more of it. When patients decide with their own resources, including private insurance and savings, hospitals and physicians pay attention - and meet their needs.

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FDA and bureaucratic logic: "The Food and Drug Administration just yanked or restricted all but two of the nation's top painkilling drugs, throwing patients requiring regular anesthesia into what Dr. Joshua Prager, head of the University of California-Los Angeles Pain Center, called 'great confusion, not only among patients, but for physicians' about how to treat severe and chronic pain. The only painkillers the FDA will recommend as working without long-term high-risk are aspirin and [Tylenol]. Ibuprofen and naproxen will now require warnings against using more than two weeks. Bextra will be taken off the market, and Celebrex and Vioxx ... will require the maximum warning that its use could cause heart attacks and strokes. ... Rule No. 1 for bureaucratic regulators: What you do can get you in trouble ...what you deny no one can see. The ideal would be approving NO drugs so no one could get hurt using them."

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation.

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