Wednesday, March 15, 2006


Health care is once again moving to the top of the national political agenda. The early evidence is that this debate will be dominated by misinformation and misconceptions. Advocates of a government-run, national health-care system will do everything they can to frighten Americans and discredit consumer-directed health care. But we would be advised to look at the facts and not the scare tactics.

The Claim: The U.S. spends too much on health care

The Facts: It is true that the United States spends more on health care than any other country. Why is that a bad thing? There is no "right" amount to spend on health care or anything else. The United States spends more on athletic shoes than any other country. No one speaks of the athletic shoe crisis. Economists consider health care a "normal good," meaning that spending rises or falls with income. As incomes rise, people demand more and better health care. America's wealth determines its spending on healthcare.

The real problem is the fact that the people spending the money are not the people paying the bills. Because those purchasing health care are able to pass the bill onto third parties, the usual market disciplines don't apply. True health-care reform would focus on giving consumers a greater stake in the decision-making process.

The Claim: Though we spend more, we get less

The Facts: America offers the highest quality health care in the world. Most of the world's top doctors, hospitals and research facilities are located in the United States. Eighteen of the last 25 winners of the Nobel Prize in Medicine either are U.S. citizens or work here. U.S. companies have developed half of all the major new medicines introduced worldwide over the past 20 years. And Americans played a key role in 80 percent of the most important medical advances of the past 30 years. If you are diagnosed with a serious illness, the United States is the place you want to be. Tens of thousands of patients from around the world come to this country every year for treatment.

Critics of American health care often point out that other countries have higher life expectancies or lower infant mortality rates, but those two indicators are bad ways to measure the quality of a nation's health-care system. In the United States, very low-birth-weight infants have a much greater chance of being brought to term with the latest medical technologies. Some of those low-birth-weight babies die soon after birth, which boosts our infant mortality rate, but in many other Western countries, those high-risk, low-birth-weight infants are not included when infant mortality is calculated.

Life expectancies are also affected by other factors like violent crime, poverty, obesity, tobacco, and drug use, and other issues unrelated to health care. When you compare the outcome for specific diseases like cancer or heart disease, the United States outperforms the rest of the world.

The Claim: A government-run health-care system would expand access to care

The Facts: The one common characteristic of all national health care systems is that they ration care. Sometimes they ration it by denying certain types of treatment altogether. More often, they ration indirectly, imposing cost constraints through budgets, waiting lines, or limited technology. One million Britons are waiting for admission to National Health Service hospitals at any given time, and shortages force the NHS to cancel as many as 100,000 operations each year. Roughly 90,000 New Zealanders are facing similar waits. In Sweden, the wait for heart surgery can be as long as 25 weeks. In Canada more than 800,000 patients are currently on waiting lists for medical procedures.

The Claim: Health care is too complex for average Americans to make decisions about price and quality.

The Facts: Health care is increasingly high-tech and complex, but so are many other products and services that Americans purchase everyday without specialized expertise. A consumer does not need to know how an internal combustion engine works in order to buy a reliable car, or how silicon chips are manufactured before he selects a computer. When consumers have good information about product prices, quality and safety, they naturally gravitate toward the goods and services that offer the highest value for the lowest price.

There are numerous studies that show health-care consumers make decisions about price and quality. The current problem with the healthcare sector is that there isn't enough good information available for consumers to make sound decisions about which healthcare provider or facilities offer the best value. But that's rapidly changing as providers respond to increased consumer empowerment. At the same time, patient advocacy companies are springing up to help health-care consumers make informed choices. When consumers, rather than insurers or employers, control the money, markets naturally respond.

The U.S. health-care system represents one-seventh of the American economy, and is literally a matter of life and death for millions of Americans. Here's hoping that they'll be able to sort the facts from the fallacies in the coming debate.



When all is said and done, the philosophy on which Canada's ailing medicare system is based is this. That Canadians are perfectly content to eat sawdust, as long as they can be assured that no one is ever going to be allowed to buy a steak. Sure, guys like Premier Dalton McGuinty, Ontario Health Minister George Smitherman and, sadly, even Prime Minister Stephen Harper, dress up this basic premise with a lot of fancy talk these days. But that's all it is. Talk. And talk is cheap. Unfortunately, Canadian medicare isn't. It's now one of the world's most expensive health care systems while its efficiency is generally middle-of-the-pack, internationally.

But that's what happens when you share a philosophy of centralized, state-controlled medicine with such enlightened outposts as Cuba and North Korea. It's laughable. Indeed, if you want to assess Ottawa's real "expertise" in health care, look at virtually any remote native reserve where the feds are actually in charge of it. And this is the government that presumes to lecture the provinces on how to deliver health care?

The provinces are just beginning to address the implications of the now-famous Supreme Court of Canada ruling that put them on notice that if they cannot deliver medically necessary services in a timely way, then they will have to stop preventing patients from seeking that care on their own. In recent weeks, Quebec, and Alberta have proposed some baby steps in that regard, so that patients can use their own money to pay for faster care in some limited circumstances. Alberta went a bit further than Quebec in its ideas, but that's all they are. They're just suggestions by Alberta Premier Ralph Klein, who is notorious for talking a tough game about reforming medicare and then running away at the first predictable, hysterical reaction, by Canada's powerful pro-medicare lobby.

Many in this crowd have been wrong about some of the most important health care policy decisions made in Canada over the past few decades. That would include the brilliant plan to control health care costs by reducing the number of doctors which ... surprise! ... helped lead us to today's doctor shortage. Many of these same folks used to feed us the line that there was really nothing wrong with medicare that a little "more" tax money couldn't fix - with the "more" never being defined.

Some even argued that if Canadians were wondering why grandma had to wait a lot longer than the family dog for an MRI, this was only because they had succumbed to neo-con propaganda. While that tactic pretty much died with the Supreme Court ruling, these folks haven't given up. Today, anytime anyone makes any suggestion to fix the status quo - no matter how small - the same old chorus sings the same old chant: That it will all lead to "two-tier, U.S.-style health care."

Yawn. We suggest the next time you hear this, ask those doing the singing three questions: (1) How much more of our tax money will it take to "fix" medicare? (2) How long will it take to fix? (3) What do you mean by "fix"? See if you can get any answers. And if you can, see if the answers don't scare you half to death. Which will, of course, put you on another waiting list.



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. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.


No comments: