Health Care Apples And Oranges
Posted by
tgirsch
This morning, a friend of mine sent me this smoldering piece of crap from the Wall Street Journal, and I just couldn’t let it go without comment.
‘I haven’t seen ‘Sicko,’” says Avril Allen about the new Michael Moore documentary, which advocates socialized medicine for the United States. The film, which has been widely viewed on the Internet, and which will officially open in the U.S. and Canada on Friday, has been getting rave reviews. But Ms. Allen, a lawyer, has no plans to watch it. She’s just too busy preparing to file suit against Ontario’s provincial government about its health-care system next month.
Her client, Lindsay McCreith, would have had to wait for four months just to get an MRI, and then months more to see a neurologist for his malignant brain tumor. Instead, frustrated and ill, the retired auto-body shop owner traveled to Buffalo, N.Y., for a lifesaving surgery. Now he’s suing for the right to opt out of Canada’s government-run health care, which he considers dangerous.
So, to start, we’ve found someone who’s got a complaint — maybe legitimate, maybe not — against the Canadian health care system. We’ve already started off on a bad foot, by making two fatally-flawed assumptions. The first is that anyone is arguing that the Canadian health care system is perfect. To my knowledge, absolutely no one argues this. The second is that just because there are problems with another country’s system, this somehow implies that ours is necessarily better. It simply doesn’t follow.
(It’s also worth noting that McCreith’s privately-obtained care in the US cost a reported US$27,600. How many people, American or Canadian, could afford that kind of expense?)
But it gets worse:
In the U.S., 83 House Democrats voted for a bill in 1993 calling for single-payer health care. That idea collapsed with HillaryCare and since then has existed on the fringes of the debate — winning praise from academics and pressure groups, but remaining largely out of the political discussion. Mr. Moore’s documentary intends to change that, exposing millions to his argument that American health care is sick and socialized medicine is the cure.
It’s not simply that Mr. Moore is wrong. His grand tour of public health care systems misses the big story: While he prescribes socialism, market-oriented reforms are percolating in cities from Stockholm to Saskatoon.
What are these “market-oriented” reforms? We’re left to wonder, because they give very few specifics. Of course, market-oriented reforms don’t mean gutting universal health care, and I’d bet dollars to donuts that “cities from Stockholm to Saskatoon” are proposing no such thing. More on this later.
Mr. Moore goes to London, Ontario, where he notes that not a single patient has waited in the hospital emergency room more than 45 minutes. “It’s a fabulous system,” a woman explains. In Britain, he tours a hospital where patients marvel at their free care. A patient’s husband explains: “It’s not America.” Humorously, Mr. Moore finds a cashier dispensing money to patients (for transportation). In France, a doctor explains the success of the health-care system with the old Marxist axiom: “You pay according to your means, and you receive according to your needs.”
It’s compelling material — I know because, born and raised in Canada, I used to believe in government-run health care. Then I was mugged by reality.
Consider, for instance, Mr. Moore’s claim that ERs don’t overcrowd in Canada. A Canadian government study recently found that only about half of patients are treated in a timely manner, as defined by local medical and hospital associations. “The research merely confirms anecdotal reports of interminable waits,” reported a national newspaper. While people in rural areas seem to fare better, Toronto patients receive care in four hours on average; one in 10 patients waits more than a dozen hours.
[Bold mine]
Where to start? Apart from glossing over the obvious shortcomings in the American system (where insurance companies maximize profits by denying coverage, and where those without job-provided insurance often can’t even afford basic care), they claim that half of patients are treated in a timely manner as defined by Canadian standards. They don’t bother to mention how they would stack up against American standards. One wonders why not. If American ERs did better in this regard, I would expect that they would be shouting that statistic from the rooftops. That they aren’t doing so is quite telling.
They go on to mention the four hour average wait in Toronto. Sounds awful, doesn’t it? Except that in the US, the nationwide average (including “rural areas” that tend to “fare better” in Canada) three hours and 42 minutes and rising as of 2005. Whoops.
If you’re sensing a pattern here, you’re not alone. The author has a clear agenda, and it’s to poke holes in the Canadian system to make it seem as bad as possible, all the while meticulously avoiding any discussion of the US system, and how it compares. The reason for this should be obvious by now. This type of thing goes on:
This problem hit close to home last year: A relative, living in Winnipeg, nearly died of a strangulated bowel while lying on a stretcher for five hours, writhing in pain. To get the needed ultrasound, he was sent by ambulance to another hospital.
In Britain, the Department of Health recently acknowledged that one in eight patients wait more than a year for surgery. Around the time Mr. Moore was putting the finishing touches on his documentary, a hospital in Sutton Coldfield announced its new money-saving linen policy: Housekeeping will no longer change the bed sheets between patients, just turn them over. France’s system failed so spectacularly in the summer heat of 2003 that 13,000 people died, largely of dehydration. Hospitals stopped answering the phones and ambulance attendants told people to fend for themselves.
Cherry-picking, anyone? These examples are presented as if they’re typical, but are they really? And how hard would one have to look to find similar examples in the US?
Market reforms are catching on in Britain, too. For six decades, its socialist Labour Party scoffed at the very idea of private medicine, dismissing it as “Americanization.” Today Labour favors privatization, promising to triple the number of private-sector surgical procedures provided within two years. The Labour government aspires to give patients a choice of four providers for surgeries, at least one of them private, and recently considered the contracting out of some primary-care services — perhaps even to American companies.
Other European countries follow this same path. In Sweden, after the latest privatizations, the government will contract out some 80% of Stockholm’s primary care and 40% of total health services, including Stockholm’s largest hospital. Beginning before the election of the new conservative chancellor, Germany enhanced insurance competition and turned state enterprises over to the private sector (including the majority of public hospitals). Even in Slovakia, a former Marxist country, privatizations are actively debated.
Here we at least get a general idea of what sort of “market-oriented reforms” are under consideration. UK’s Labour party is considering “privatization,” which might lead one to believe they favo[u]r doing away with the country’s universal health care system, NHS. Except that according to their web site, this simply isn’t the case. They’ve more than doubled spending on NHS since 1997, and where they do favor privatization, it’s privatization of services provided, not privatization of coverage and payment. Private interests may indeed become part of the system, but that doesn’t mean British citizens will have to start paying out of pocket for services received.
The same holds true for Germany, the author’s other proffered example. Over 90% of the German public qualifies for coverage under the federal system. The privatization that’s being implemented is to introduce competition and (theoretically, anyway) drive down costs for the government, which will continue to pay the bills. (Germany’s system is funded by payroll taxes split between employers and employees, similar to how we fund Medicare and Social Security in the US.) Also not mentioned is that while Germany has the third-most-expensive health care system in the world, it’s still less expensive than ours.
Finally:
Under the weight of demographic shifts and strained by the limits of command-and-control economics, government-run health systems have turned out to be less than utopian. The stories are the same: dirty hospitals, poor standards and difficulty accessing modern drugs and tests.
Again, he mentions those stories as if they’re unique to government-run health systems and virtually unheard of in the US. Except that this is patently false on its face.
The final elephant in the room, which the author conveniently avoids discussing, is public opinion in those countries that have universal (or near-universal) health care. While I’m sure many of them have plenty of complaints and can imagine ways in which the systems could be improved, if you were to ask them if they would prefer a US-style, totally private system, the answer would be an overwhelming “no.”
The bottom line is that just because there are problems with other systems doesn’t mean ours is better. In most measurable ways, it’s not. Especially if you’re at or below the median income in this country, in which case there’s a good chance you’re screwed.
The WSJ can throw all the stones it wants at Canada and England and Germany, but it defies reason to ignore our own glass house.
[For the record, I don’t support adopting a strictly Canadian-style health care system. Instead, we should survey the top health care systems in the world and selectively pick the best aspects of them to build a world-class health care system for everyone, not just the well-to-do. Unless, of course, you think that health care ought to be a luxury of wealth, in which case you’re bound to disagree. Unlike Canada, I’d also allow private practitioners to provide pay-out-of-pocket care to those who are willing and able to do so, noting that doing so does not exempt you from paying your share toward the larger system. Think of this like education, where putting your kids in private school, home schooling them, or simply not having any kids are all perfectly legal options, but they do not exempt you from chipping in to pay for the school system.]
UPDATE: KTK adds something big that I missed:
The most telling point is that every single example cited, and virtually all of the issues commonly raised as objections to single-payer plans, is caused by one simple thing: lack of funds.
The most telling point is that every single example cited, and virtually all of the issues commonly raised as objections to single-payer plans, is caused by one simple thing: lack of funds. The systems are doing the best they can with the budgets they’re given, and they make ends meet the only reasonable way possible: by prioritizing the most necessary services and providing others on an as-available basis. But every single country with government-funded (whether or not socialized) healthcare spends a much lower percentage of its GDP on that care than does the US, while covering their entire populations (in comparison to the US’s patchwork system covering about 60%).
In other words, they get the level of care they’re willing to pay for. They could have easier access and shorter waiting times if they were willing to pay for them. If the US adopted a similar system, we could cover our entire population at far greater levels of access and immediacy than many other countries, for the same amount of money we’re paying now.
Two things are impossible, however: To provide the entire population of another country with the level of technology and ease of access of the most-privileged US citizens at the budget levels they currently have, and to cover the entire US population with the level of technology and ease of access the most-privileged citizens now have while spending the same amount in total as we now are.
Every country has to make a decision how much it’s willing to spend on healthcare. Virtually every country but the US has made that decision by insisting, first, on a guarantee that every citizen must be covered to an equal minimal level of quality, and then crafting some combination of public and private care to increase the overall quality of available care as high as they choose to do so. The US - or, the corporate interests who control policy - has made the decision, first, on a guarantee that healthcare corporate interests will be as free as possible to extract maximal profit from people’s health needs, then that specific, carefully-selected sub-sections of the population will have grudging access to minimal care, and then that everybody else can go screw. The result is that the US system provides the highest possible care to a fraction of the market, while running up enormous costs, and substandard or no care to another significant fraction, while every other industrialized country provides a higher median level of care at lower cost by simply not squandering all its resources on a small number of super-privileged citizens. If the US were to do the same, at its current levels of expenditure, we would have universal coverage with the world’s highest median level of care. We could raise that median level even higher if we chose (as those other countries could do if they chose) by paying more for it. But doing so would mean ending the days of “the sky’s the limit” care for the most powerful and privileged.
That’s what the single-payer debate is really about. It’s not about quality of care or waiting times: every country with a single-payer plan can have the level of care they want simply by budgeting for it; accusing another country of having too-long waiting times is simply accusing them of budgeting too little for their single-payer plan, which seems kind of pointless (it’s their budget, after all). It’s about the fundamental decision whether those who have everything should be a part of - and accept the limitations of - a system that instead tries to guarantee that everyone has something. Opponents of single-payer are simply saying they want 15% of Americans to have no healthcare at all, and another 25% to have dangerously limited care, so that they can still have immediate access to everything that’s medically possible no matter what, without paying any more than they do now - as opposed to having highest-in-the-world-but-not-unlimited care for everyone at the same price, or even-higher-than-that-but-not-unlimited care at a higher price.
Which is to say they’re selfish assholes who are willing to see other people die so they don’t have to wait for elective surgeries.
Comment 6/29/2007
“Which is to say they’re selfish assholes who are willing to see other people die so they don’t have to wait for elective surgeries.”
Not to mention that elective surgery fields are siphoning off more and more of our most talented medical students.
Why have to worry about chasing down payments from begrudging insurance companies and bureaucracies when you can make what is basically straight cash to, as Kanye West would say, “throw some D’s on that bitch.”
The (un)ethical spillover from the American medical model infects, and promotes the infection of other spheres of our culture. How can we expect our citizenry to have a healthy view of health in general when our mechanisms to ensure it are in such disrepair, and ill-conceived at root?
Comment 6/29/2007
The central contradictions of government provided health care are obvious to anyone with a basic understanding of economics. Which of course why the idea enjoys something like a 70% support rate among the US public.
While I’m convinced it’s a bad idea, it seems to be an inevitable bad idea. The current death of a thousand cuts method of gradually socializing the system is merely delaying the inevitable.
In addition, since each new government intrusion into health care is ienvitably trumpeted as ‘market oriented reform’ we’re ruining any future chance of fixing things by making people think the quasi-socialist mess we’ve created is actually capitalism.
The small minority of people who still support actual free markets would be better off just letting the public have what it wants (and get what it deserves).
Comment 6/29/2007
Stormy:
Except that there has never in modern history been an example of a free-market health care system that actually works. If you know of one that provides adequate care to anything on the order of 90% of the citizenry, I sure would love to see it.
And for what it’s worth, what makes our government’s forays into health care so bloated and expensive isn’t that it’s “quasi-socialist”; it’s that it’s heavily protectionist. Protecting the profit margins of health care providers is by law a higher priority than accessibility or cost control, in many (probably most) cases.
(By the way, the only contradiction I’m aware of is if you want government-provided for profit health care.)
Comment 6/29/2007
>Except that there has never in modern history
>been an example of a free-market health care
>system that actually works.
Only because there has never in modern history been an example of a free market health care system PERIOD.
Comment 6/29/2007
Then I’ll broaden the question. In modern history, has there ever been an example of anything that’s inherently expensive but nearly-universally needed, where the free market alone has done a good job of providing it equitably and nearly universally?
Comment 6/29/2007
Things that are inherently expensive aren’t universally needed and vice versa. If the were, mankind would have gone extinct long ago.
Comment 6/29/2007
Ah yes, higher education and health past one’s child-bearing years aren’t needed; we lasted millenia without them. Let’s go back to sitting in huts asking the sky beings to not let Dad and Grandma suffer too long before they finally croak.
Comment 6/29/2007
Yeah, Stormy, I’m with Dan M on this one. When you define “needs” like you just did, you’ve created a pretty bleak outlook for life. I’m not sure why you’re eager to live in a world like that.
Comment 6/30/2007
Oh I assure you, I’m not eager to live in Dan’s world of false dilemmas.
Pointing out that medical care that is both inherently expensive and necessary only represents a small portion of healthcare spending doesn’t mean I think all of the potentially cheap and/or elective care ought to be eliminated.
Comment 6/30/2007
“Protecting the profit margins of health care providers is by law a higher priority than accessibility or cost control, in many (probably most) cases.”
Let’s take the profits out of health care and see what kind of health care we all get.
Comment 7/1/2007
“Dan M. Says:
June 29th, 2007
Ah yes, higher education and health past one’s child-bearing years aren’t needed; we lasted millenia without them. Let’s go back to sitting in huts asking the sky beings to not let Dad and Grandma suffer too long before they finally croak. ”
The subject of this blog is religion?
Comment 7/2/2007
Okay, Fred, usually you’re inane and wrong-headed, but usually one can tell at least what the hell you’re going on about. What did that last comment even mean? Perhaps you’ve confused me with Dan G.?
Comment 7/4/2007
“Perhaps you’ve confused me with Dan G.?”
Yes, I did. My apologies to Dan G.
Comment 7/9/2007
[…] …Unlike Canada, I’d also allow private practitioners to provide pay-out-of-pocket care to those who are willing and able to do so, noting that doing so does not exempt you from paying your share toward the larger system. Think of this like education, where putting your kids in private school, home schooling them, or simply not having any kids are all perfectly legal options, but they do not exempt you from chipping in to pay for the school system.] […]
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