Saturday, January 27, 2007

Universal Health Care: A lesson from Japan

If we in California and the United States had wings and infinite funds, we could fly the best available health care to everyone here, there, and everywhere. The ideological concept of "universal care" looks right, sounds moral, and feels good. California's Gov. Arnold Schwarzenegger deserves some credit for trying something bold. The problem is that history shows these programs do not work.

They have failed in Canada, Great Britain, France, Germany, and Sweden. Coverage has become too costly in Massachusetts in less than a year.

The etiology of health-care fever is always insufficient funds. The governor's plan is estimated to cost 12 billion a year. But if you believe that number, we have a long wide concrete bridge over Newport Bay to sell you for 23 bucks.

When the level of money injected into the blood sinks too low, the medical outcomes are rationing and restraint, accompanied by chronically high moral dilemmas. Medical care will be rationed, one way or another, so long as the government has finite resources and so long as people keep confusing insurance with fee-for-service.

Now, according to a recent release by the American Association of Physicians and Surgeons, it is failing in Japan. If universal care were the genuine cure-all, the one country where it should work is Japan. They have a homogenous population, healthier lifestyle, eat more fish and soy, more vegetables and far less obesity than here. If universal care does not work there why should it work anywhere?

According to Japanese legislator Takashi Yamamoto, who was just diagnosed with cancer, "abandoned cancer refugees are roaming the Japanese archipelago." Patients are told they1ll never get better, even when treatments exist, and many are not even informed of their diagnoses. Cancer mortality rates in Japan have been steadily climbing and are now more than 250 per 100,000, while U.S. rates are now around 180 per 100,000. Japanese public television showed the stark contrast. In the U.S., multiple specialists meet to discuss a cancer patient1s care. In Japan, a single doctor usually makes the diagnosis and carries out treatment with minimal consultation

While Japanese patients want American-style treatment, their policy-makers are alarmed. With a huge national debt and corporations worried about higher taxes, they say Japan can't afford to pour money into treatments that can1t extend life span by very much. "America did too much of this and that1s why their medical costs have grown," said Masaharu Nakajima, a surgeon and former director of the Health Bureau at the Ministry of Health, Labor and Welfare.

Since Japan enacted universal health insurance in the early 1960s, the emphasis has been on a minimum standard of care for all. People must pay a monthly health-insurance fee, and large companies pay also. Coverage decisions, doctors' pay, and other rules are set by the central government. Japanese doctors complain that they have no time to spend with patients. The experience of seeing a doctor is summarized as "a three-hour wait for a three-minute visit."

"Our rights as individuals are not being recognized," stated lung cancer patient Hidesuke Hashimoto. Mr. Hashimoto, a former math teacher, undertook to study his options on his own, moving along to a different hospital when told there was nothing more that could be done, and sometimes paying out of pocket (Landers, Wall Street Journal 1/11/07).

Commenting on the WSJ article, Craig Cantoni, a columnist in Scottsdale, Ariz., writes: "Like nationalized health care in other countries, the Japanese system is based on the premise that the state owns your body." Therefore, "the state can dictate what medical care can be withheld from you, either by policy or by making you wait so long for care that you die in the mean time. Nor is [this] justified by the fact that Japan spends about half as much per capita on health care as the United States, or by the fact that the Japanese have a longer life expectancy."

If rights are seized for reasons of cost or efficiency, no right is safe from do-gooders and busybodies, from lawyers, politicians, and bureaucrats, and from the tyranny of the majority. If the universal health-care system is failing in Japan, it will fail in California, just as in Massachusetts or any other state that experiments with it.


NHS cash crisis could cost diabetic children limbs

Thousands of diabetic children could risk losing limbs because the NHS cash crisis is hitting services, said a report out on Wednesday. Four out of five diabetic children have poor glucose control, putting them at risk of developing complications, it said. In the UK, there are 20,000 children under the age of 15 with type 1 diabetes, which means sufferers are dependant on insulin. Another 1,000 children have type 2, which is associated with obesity, but many more youngsters are undiagnosed.

The report, from the charity Diabetes UK, said there were poor services despite Government targets to provide good paediatric care. Comparing NHS performance between 2005 and 2006, it said services for children with diabetes had got worse in 75% of the areas studied in England. The cash crisis means Paediatric Diabetes Specialist Nurses (PDSNs) are overstretched, it said. According to the Royal College of Nursing, there should be no more than 70 children to each nurse but some NHS trusts have caseloads of up to 300 children, meaning PDSNs take on more. Almost every region in England has seen an increase in the number of children each PDSN manages, the reports said. Over a third (40%) of trusts have no protocols for transferring children into adult diabetic care while nearly a third of youngsters who want psychological support do not receive it, it added.

Douglas Smallwood, chief executive of Diabetes UK, said: 'No wonder 80% of children have poor blood glucose control. 'Most are struggling to even see a specialist nurse, so any additional support is out of the question. 'With the inevitable explosion of children with type 2 diabetes, with no additional resources, nurses will be faced with ever increasing caseloads. 'We can't afford to wait until our children start to lose their sight or need kidney dialysis before we make sure services improve. 'It is time resources are provided to supply the best possible specialised care and support for children with diabetes.'

A 'Diabetes InfoBank' is also being launched today, which will show progress in meeting Government targets. People will be able to access information on diabetic care in their area by going to



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?

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