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Sat 28 Jul, 2007 04:45 pm
Government vs. private medicine
July 27, 2007
Walter E. Williams - Sometimes the advocates of socialized medicine claim that health care is too important to be left to the market. That's why some politicians are calling for us to adopt health-care systems such as those in Canada, the United Kingdom and other European nations. But the suggestion we would be better served with more government control doesn't even pass a simple smell test.
Do we want the government employees who run the troubled Walter Reed Army Medical Center to be in charge of our entire health-care system? Or, would you like the people who deliver our mail to also deliver health-care services? How would you like the people who run the motor vehicles department, the government education system, foreign intelligence and other government agencies to also run our health-care system? After all, they are not motivated by the quest for profits, and that might mean they're truly wonderful, selfless, caring people.
As for me, I would choose profit-driven people to provide my health-care services, people with motives like those who deliver goods to my supermarket, deliver my overnight mail, produce my computer and software programs, assemble my car and produce a host of other goods and services I use.
There's absolutely no mystery why our greatest complaints are in the arena of government-delivered services and the fewest in market-delivered services. In the market, there are the ruthless forces of profit, loss and bankruptcy that make producers accountable to us. In the arena of government-delivered services, there's no such accountability. For example, government schools can go for decades delivering low-quality services, and what's the result? The people who manage it earn higher pay. It's nearly impossible to fire the incompetents. And, taxpayers, who support the service, are given higher tax bills.
Our health-care system is hampered by government intervention, and the solution is not more government intervention but less. The tax treatment of health insurance, where premiums are deducted from employees' pretax income, explains why so many of us rely on our employers to select and pay for health insurance. Since there is a third-party payer, we have little incentive to shop around and wisely use health services.
There are "guaranteed issue" laws that require insurance companies to sell health insurance to any person seeking it. So why not wait until you're sick before purchasing insurance? Guaranteed issue laws make about as much sense as if you left your house uninsured until you had a fire and then purchased insurance to cover the damage.
Guaranteed issue laws raise insurance premiums for all. Then there are government price controls, such as the Medicaid reimbursement schemes. As a result, an increasing number of doctors are unwilling to treat Medicaid patients.
Before we buy into single-payer health care systems like Canada's and the United Kingdom's, we might want to do a bit of research. The Vancouver, British Columbia, Fraser Institute annually publishes "Waiting Your Turn." Its 2006 edition gives waiting times, by treatments, from a person's referral by a general practitioner to treatment by a specialist. The shortest waiting time was for oncology (4.9 weeks). The longest was for orthopedic surgery (40.3 weeks), followed by plastic surgery (35.4 weeks) and neurosurgery (31.7 weeks).
As reported in the June 28 National Center for Policy Analysis' "Daily Policy Digest," Britain's Department of Health recently acknowledged 1 in 8 patients waits more than a year for surgery. France's failed health-care system resulted in the deaths of 13,000 people, mostly of dehydration, during the heat spell of 2003. Hospitals stopped answering the phones, and ambulance attendants told people to fend for themselves.
I don't think most Americans would like more socialized medicine in our country. By the way, I have absolutely no problem with people wanting socialism. My problem is when they want to drag me into it.
Walter E. Williams is a nationally syndicated columnist and is an economics professor at George Mason University.
Washington Times
First a comment... you are writing far too many threads on exactly the same topic. Every one knows my pet political issue, yet you will see the restraint I show in starting new threads on this issue. Just a comment.
I will respond on this one because it has at a core a clear untruth-- that government run services are failures.
Our education system for all of its critics-- has led unquestionably to the strongest economy in the world. Public education has, since its inception, been incredibly effective at creating an American workforce with skills to be both productive as workers and innovative as leaders.
You can't argue with clear success.
Other successful government programs include medical research, a development program that led to the internet (including a great government funded browser that got the whole thing going), space exploration (including moon landing and Martian robots that still haven't quit) and a post office that delivers mail reliably and cheaply with no cost to taxpayers.
The idea that profit driven companies will be compelled to put customers needs first is laughable. The profit model has brought us tobacco companies responsible for the deaths of their customers, McDonalds Big Macs selling obesity to kids and Ford Pintos blowing up for a clear profit.
There are two problems with greed based healthcare. First of all... it is a captive market since everyone needs healthcare. Companies interested in profits want to give as little care at the highest price.
Worse insurance companies have found out long ago that it is cheaper to pay marketers (to trick consumers into paying full price for less than full coverage) and lawyers (to protect their asses when consumers get upset about this) than to pay doctors.
Greed is a fine way to get companies to provide services we can do without.
Greedy insurance companies are very dangerous indeed since it is far too easy for them to trap the people who depend on them (especially when people have nowhere to go but greedy, unregulated insurance companies).
When it comes to something as important as healthcare... I would prefer the public mechanism that brought me the Internet and kept brave little rovers on Mars for over year to the private mechanisms that brought me the Ford Pinto.
I would also add (as has been pointed out many times) there are objective measures of the sucess of a health care system-- particularly infant mortality rates, life expectancies and disease outcomes.
It is easy to show that countries like Canada have very good results on objective measures at a much lower cost per person covered.
ebrown_p wrote:greed based healthcare
Hey! What a nice, descriptive term, ebrown! I like that.....
ebrown_p wrote:I would also add (as has been pointed out many times) there are objective measures of the sucess of a health care system-- particularly infant mortality rates, life expectancies and disease outcomes.
It is easy to show that countries like Canada have very good results on objective measures at a much lower cost per person covered.
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The shortest waiting time was for oncology (4.9 weeks). The longest was for orthopedic surgery (40.3 weeks), followed by plastic surgery (35.4 weeks) and neurosurgery (31.7 weeks).
And...some of the wait times in Canadian ERs are as long as 5 days. Pack a couple of bags of food before your next visit to an ER, should you live in Canada.
ebrown_p wrote:
It is easy to show that countries like Canada have very good results on objective measures at a much lower cost per person covered.
One often-heard argument, voiced by the New York Times' Paul Krugman and others, is that America lags behind other countries in crude health outcomes. But such outcomes reflect a mosaic of factors, such as diet, lifestyle, drug use and cultural values. It pains me as a doctor to say this, but health care is just one factor in health.
IBDeditorial.com
Nothing like a 5 day visit to a Canadian ER, now is there E-Brown?
old europe wrote:ebrown_p wrote:greed based healthcare
Hey! What a nice, descriptive term, ebrown! I like that.....
Where's the "greed"? :wink:
Where's that 5 days in the ER? I've never heard of such a thing happening
No kidding, me either!! I think we're being maligned, Montana! Bunch'a hosers!
What a surprise: a new thread with new unsourced rumours by Miller.
Walter Hinteler wrote:What a surprise: a new thread with new unsourced rumours by Miller.
Walter E. Williams is a nationally syndicated columnist and is an economics professor at George Mason University.
Washington Times
Quote:Its 2006 edition gives waiting times, by treatments, from a person's referral by a general practitioner to treatment by a specialist. The shortest waiting time was for oncology (4.9 weeks).
Really?
For my husband, it was 3 days from GP to urologist, and less than an hour from urologist to oncologist.
A Canadian Doctor Describes How Socialized Medicine Doesn't Work
By DAVID GRATZER | Posted Thursday, July 26, 2007 4:30 PM PT
I was once a believer in socialized medicine. As a Canadian, I had soaked up the belief that government-run health care was truly compassionate. What I knew about American health care was unappealing: high expenses and lots of uninsured people.
My health care prejudices crumbled on the way to a medical school class. On a subzero Winnipeg morning in 1997, I cut across the hospital emergency room to shave a few minutes off my frigid commute.
Swinging open the door, I stepped into a nightmare: the ER overflowed with elderly people on stretchers, waiting for admission. Some, it turned out, had waited five days. The air stank with sweat and urine. Right then, I began to reconsider everything that I thought I knew about Canadian health care.
I soon discovered that the problems went well beyond overcrowded ERs. Patients had to wait for practically any diagnostic test or procedure, such as the man with persistent pain from a hernia operation whom we referred to a pain clinic ?- with a three-year wait list; or the woman with breast cancer who needed to wait four months for radiation therapy, when the standard of care was four weeks.
Government researchers now note that more than 1.5 million Ontarians (or 12% of that province's population) can't find family physicians. Health officials in one Nova Scotia community actually resorted to a lottery to determine who'd get a doctor's appointment.
These problems are not unique to Canada ?- they characterize all government-run health care systems.
Consider the recent British controversy over a cancer patient who tried to get an appointment with a specialist, only to have it canceled ?- 48 times. More than 1 million Britons must wait for some type of care, with 200,000 in line for longer than six months. In France, the supply of doctors is so limited that during an August 2003 heat wave ?- when many doctors were on vacation and hospitals were stretched beyond capacity ?- 15,000 elderly citizens died. Across Europe, state-of-the-art drugs aren't available. And so on.
Single-payer systems ?- confronting dirty hospitals, long waiting lists and substandard treatment ?- are starting to crack, however. Canadian newspapers are filled with stories of people frustrated by long delays for care. Many Canadians, determined to get the care they need, have begun looking not to lotteries ?- but to markets.
Dr. Jacques Chaoulli is at the center of this changing health care scene. In the 1990s, he organized a private Quebec practice ?- patients called him, he made house calls and then he directly billed his patients. The local health board cried foul and began fining him. The legal status of private practice in Canada remained murky, but billing patients, rather than the government, was certainly illegal, and so was private insurance.
Eventually, Chaoulli took on the government in a case that went all the way to the Supreme Court. Representing an elderly Montrealer who had waited almost a year for a hip replacement, Chaoulli maintained that the patient should have the right to pay for private health insurance and get treatment sooner. A majority of the court agreed that Quebec's charter did implicitly recognize such a right.
The monumental ruling, which shocked the government, opened the way to more private medicine in Quebec. Though the prohibition against private insurance holds in the rest of Canada for now, at least two people outside Quebec, armed with Chaoulli's case as precedent, are taking their demand for private insurance to court.
Consider, too, Rick Baker. He isn't a neurosurgeon or even a doctor. He's a medical broker ?- one member of a private sector that is rushing in to address the inadequacies of Canada's government care. Canadians pay him to set up surgical procedures, diagnostic tests and specialist consultations, privately and quickly.
Baker describes a man who had a seizure and received a diagnosis of epilepsy. Dissatisfied with the opinion ?- he had no family history of epilepsy, but he did have constant headaches and nausea, which aren't usually seen in the disorder ?- he requested an MRI.
The government told him that the wait would be 4 1/2 months. So he went to Baker, who arranged to have the MRI done within 24 hours ?- and who, after the test revealed a brain tumor, arranged surgery within a few weeks. Some services that Baker brokers almost certainly contravene Canadian law, but governments are loath to stop him.
Other private-sector health options are blossoming across Canada, and the government is increasingly turning a blind eye to them, too, despite their often uncertain legal status. Private clinics are opening at a rate of about one a week.
Canadian doctors, long silent on the health care system's problems, are starting to speak up. Last August, they voted Brian Day president of their national association. Day has become perhaps the most vocal critic of Canadian public health care, having opened his own private surgery center and challenging the government to shut him down.
And now even Canadian governments are looking to the private sector to shrink the waiting lists. In British Columbia, private clinics perform roughly 80% of government-funded diagnostic testing.
This privatizing trend is reaching Europe, too. Britain's Labour Party ?- which originally created the National Health Service ?- now openly favors privatization. Sweden's government, after the completion of the latest round of privatizations, will be contracting out some 80% of Stockholm's primary care and 40% of its total health services.
Since the fall of communism, Slovakia has looked to liberalize its state-run system, introducing co-payments and privatizations. And modest market reforms have begun in Germany.
Yet even as Stockholm and Saskatoon are percolating with the ideas of Adam Smith, a growing number of prominent Americans are arguing that socialized health care still provides better results for less money.
Politicians like Hillary Clinton are on board; Michael Moore's new documentary, "Sicko," celebrates the virtues of Canada's socialized health care; the National Coalition on Health Care, which includes big businesses like AT&T, recently endorsed a scheme to centralize major health decisions to a government committee; and big unions are questioning the tenets of employer-sponsored health insurance.
One often-heard argument, voiced by the New York Times' Paul Krugman and others, is that America lags behind other countries in crude health outcomes. But such outcomes reflect a mosaic of factors, such as diet, lifestyle, drug use and cultural values. It pains me as a doctor to say this, but health care is just one factor in health.
Americans live 75.3 years on average, fewer than Canadians (77.3) or the French (76.6) or the citizens of any Western European nation save Portugal. Health care influences life expectancy, of course. But a life can end because of a murder, a fall or a car accident. Such factors aren't academic ?- homicide rates in the U.S. are much higher than in other countries.
In The Business of Health, Robert Ohsfeldt and John Schneider factor out intentional and unintentional injuries from life-expectancy statistics and find that Americans who don't die in car crashes or homicides outlive people in any other Western country.
And if we measure a health care system by how well it serves its sick citizens, American medicine excels. Five-year cancer survival rates bear this out. For leukemia, the American survival rate is almost 50%; the European rate is just 35%. Esophageal carcinoma: 12% in the U.S., 6% in Europe. The survival rate for prostate cancer is 81.2% here, yet 61.7% in France and down to 44.3% in England ?- a striking variation.
Like many critics of American health care, though, Krugman argues that the costs are just too high: health care spending in Canada and Britain, he notes, is a small fraction of what Americans pay. Again, the picture isn't quite as clear as he suggests. Because the U.S. is so much wealthier than other countries, it isn't unreasonable for it to spend more on health care. Take America's high spending on research and development. M.D. Anderson in Texas, a prominent cancer center, spends more on research than Canada does.
That said, American health care is expensive. And Americans aren't always getting a good deal. In the coming years, with health expenses spiraling up, it will be easy for some to give in to the temptation of socialized medicine. In Washington, there are plenty of old pieces of legislation that like-minded politicians could take off the shelf, dust off and promote: expanding Medicare to Americans 55 and older, say, or covering all children in Medicaid.
But such initiatives would push the U.S. further down the path to a government-run system and make things much, much worse. True, government bureaucrats would be able to cut costs ?- but only by shrinking access to health care, as in Canada, and engendering a Canadian-style nightmare of overflowing emergency rooms and yearlong waits for treatment.
America is right to seek a model for delivering good health care at good prices, but we should be looking not to Canada, but close to home ?- in the other four-fifths or so of our economy. From telecommunications to retail, deregulation and market competition have driven prices down and quality and productivity up. Health care is long overdue for the same prescription.
Gratzer, a physician, is a senior fellow at the Manhattan Institute. This article is adapted from the forthcoming issue of City Journal
IBDeditorial.com
Your link above worked (for me at least), Miller.
So these personal remarks by that person are disqualifying the study, you mean?
So, my real life experiences don't count?
I don't have a lot of ER experience -- been in one maybe 4 times. The first time was supporting a co-worker who thought he was having a heart attack. I told the triage nurse "heart" and they had him in treatment before I started the admitting paperwork. The next 3 times were for my husband -- one horrible time of 10 hours (the day after Christmas, and a flu epidemic, ER was swamped), the next time was maybe one hour of wait time, and the final time was no wait time at all (arrival by ambulance).
I'm not saying that there isn't problems, but these reports that are posted here show a completely different picture than my own experiences, or those of other Canadians that I've talked to.
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