Universal health care's dirty little secrets

What many politicians and many other Americans fail to understand is that there's a big difference between universal health care coverage and actual access to medical care. Simply saying that people have health insurance is meaningless, say Michael Tanner, director of health and welfare studies, and Michael Cannon, director of health-policy studies at the Cato Institute.

Many countries provide universal insurance but deny critical procedures to patients who need them:

* Britain's Department of Health reported in 2006 that at any given time, nearly 900,000 Britons are waiting for admission to National Health Service hospitals, and shortages force the cancellation of more than 50,000 operations each year.

* In Sweden, the wait for heart surgery can be as long as 25 weeks, and the average wait for hip replacement surgery is more than a year.

According to Cannon and Tanner, the uninsured in the United States don't receive substandard care:

* Helen Levy of the University of Michigan's Economic Research Initiative on the Uninsured, and David Meltzer of the University of Chicago, were unable to establish a "causal relationship" between health insurance and better health.

* Similarly, a study published in the New England Journal of Medicine found that, although far too many Americans were not receiving the appropriate standard of care, "health insurance status was largely unrelated to the quality of care."

Everyone agrees that far too many Americans lack health insurance. But covering the uninsured comes about as a byproduct of getting other things right, say Tanner and Cannon. The real danger is that our national obsession with universal coverage will lead us to neglect reforms -- such as enacting a standard health-insurance deduction, expanding health-savings accounts and deregulating insurance markets -- that could truly expand coverage, improve quality and make care more affordable.

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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. 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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