For all the life-saving technology and drugs available to Americans, the U.S. health care system has serious problems. Many medications, especially prescription drugs, are prohibitively expensive. Quality of care varies widely from hospital to hospital and region to region. The cost of individual or family health insurance policies are on the rise (more than $4,000 per year for an individual and more than $12,000 for a family of four), and are usually not tax-deductible. Many working Americans are effectively locked into employer-provided health plans that provide little or no choice. Plans typically provide first-dollar coverage or affordable co-pays for routine medical examinations, but not the cost of prescription drugs or life-saving surgeries.
A common argument is that America needs a state-run health plan. Indeed, critics point to health care in other countries that appear to provide for citizens in ways that the U.S. system does not. These arguments do not stand the test of reason. Based on the track records of other countries with state-run health care, socializing medicine in the United States would likely be a tragic mistake.
Arguments for a ‘National Plan’
For the political left, along with some elements in the health care and business community, the solution is to create a government-run, single-payer system. Failing that, their aim is to solve our country’s health care woes through further increases in federal and state spending. This could include new mandates requiring businesses to provide a government-dictated minimum amount of care to their employees.
A number of nonprofits, including a group called Physicians for a National Health Program, lament that the United States is the “only industrialized country without national health care.” Controversial filmmaker Michael Moore’s movie “Sicko” points to problems with the American health care system and suggests it is inferior to those in Great Britain, France and Canada. New York Times columnist Paul Krugman prefers those three systems to the American one. Even some major U.S. corporations seek a national health care plan. Indeed, socialized medicine is their answer to soaring retiree health care burdens resulting from ill-considered union contracts.
In making the case that the American health care system is irredeemably flawed, advocates for a national plan sometimes play fast and loose with the facts. They overlook major difficulties in foreign systems while exaggerating the problems with our own.
In “Sicko,” Moore cites a study released in 2000 by the World Health Organization that ranks the U.S. health care system 37th in the world — behind countries like Saudi Arabia, Morocco and the United Arab Emirates and barely ahead of Slovenia. But the study has serious problems in evaluating the success of the American system. As Michael Tanner of the Cato Institute notes, the WHO report utilizes subjective criteria such as “fairness” which are not strictly related to a country’s health care system. For example, one of the criteria is “tobacco control.” Others include the lack of a sufficiently progressive tax system. Moreover, the WHO study penalizes the U.S. for adopting Health Savings Accounts and for the fact that patients pay out of pocket for health care. Other WHO criteria, such as life expectancy, are heavily distorted by factors such as violent crime, tobacco use, and obesity—factors resulting from behavior, individual choice, and other influences unrelated to the functioning of the health care system.
Advocates for a national plan also skew U.S. infant mortality data, which are often used in cross-country comparisons. For example, in the U.S., some high-risk pregnancies have a greater chance of being brought to term using the latest medical technologies. However, some of these infants die soon after birth, boosting the infant-mortality rate. But in European countries such as Austria, Germany, and Switzerland, fetuses must weigh at least one pound to count as a live birth; in Switzerland, the fetus must be at least a foot long to be counted.
In “Sicko,” Moore cites low infant mortality rates in Cuba, suggesting that the Communist nation is a model for the U.S. to adopt. But Tanner notes that Cuba has “one of the world’s highest abortion rates, meaning that many babies with health problems that could lead to early deaths are never brought to term.””
Better Care Abroad?
Moore, Krugman, and other advocates of more government control over the American health care system maintain that socialized medicine abroad results in higher quality health care and more access to new technologies. However, a large body of evidence calls these assertions into question.
In the 1970s, Great Britain invented the CT scanner, and for some period of time exported more than half the CT scanners used in the world. But today it has half the number of CT scanners per capita than we have in the United States. Canada faces similar problems with CT scanner shortages.
Canada and the UK suffer from other similar shortages compared to the U.S. “Among people with chronic renal failure, only half as many Canadians as Americans get dialysis, and only a third as many Britons on a per capita basis,” writes John Goodman of the National Center for Policy Analysis, who spent more than two decades analyzing the performance of world health care systems. “The American rate of coronary bypass surgeries is three or four times what it is in Canada, and five times what it is in Britain.”
Statistics compiled by the Paris-based Organization for Cooperation and Development (OECD) in June 2007 show that the United States compares very well with 11 other industrialized countries in the numbers of MRI units and CT scanners per one million people: The United States, with 32 CT scanners and 26 MRI units, led virtually every other nation (with the exception of Japan) in almost every category.
An article published last year in the British medical journal The Lancet strongly suggests that the United States is also outperforming the world when it comes to surviving diseases such as AIDS, heart disease, cancer, and pneumonia. For example, approximately 63 percent of Americans diagnosed with cancer survive for at least five years. This tops the survival rates in countries with state-run national health care, including Italy, Spain and Great Britain.
It is often argued that countries with state-run health care outpace the U.S. when it comes to ensuring access to drugs. For example, Tanner points out that only 44 percent of Americans benefit from statins, drugs which reduce cholesterol and protects against heart disease. That’s bad news—until you compare it to Germany, where just 26 percent have access to statins; or Great Britain, where 23 percent get them, or Italy, where just 17 percent do.
North of the Border
Some Americans believe that government-run health care is right for the U.S., based upon their limited experience with the Canadian system. Indeed, if one travels north of the border, flu shots and prescription drugs are wonderfully inexpensive. But again, this a skewed picture.
What most Americans don’t know is that Canadian drug prices are kept artificially low through price controls. Moreover, the U.S. health care system is a safety net for many Canadians. Indeed, they flock south of the border to obtain care that their own system denies them. Thousands of anguished Canadians have had hellish experiences getting the proper care they desire in their country’s affordable health system.
Consider the example of Jane Pelton of Ottawa, whose teenage daughter Emily was told she had to wait up to three years for a government-paid operation to repair her torn knee ligament. Rather than leave Emily in pain, the family decided to pay $3,300 for arthroscopic surgery at a private clinic with no help from the government.
“It’s like somebody’s telling you that you can buy this car, and you’ve paid for the car, but you can’t have it right now,” said Pelton. “Every day we’re paying for health care, yet when we go to access it, it’s just not there.”
Shockingly, the average Canadian family pays nearly half of its income in taxes each year, much of it to the health system. In 2005, the Canadian Taxpayers Federation estimated that citizens in the Ontario province were spending about 40 percent of their tax dollars on health care. By 2035, that figure could reach 85 percent.
In Alberta, a nonprofit organization called Friends of Medicare (Canada’s health care system for the elderly has the same name as the American one) emphasizes problems with the U.S. health system and defends Canada’s as the “most moral and the most cost effective health care system in the world,” adding: “Is your sick grandkid more deserving of help than your neighbor’s grandchild?”
The answer to that question is “yes,” replies arthroscopic surgeon Brian Day, if the child needs urgent care and cannot get it at a government-funded hospital. Day told the Associated Press that he became so frustrated with the long delays in getting authorization to perform surgery at public hospitals in Vancouver, he built his own private clinic.
Several years ago, Day testified before Canada’s Supreme Court on the myriad failings of Canada’s health system. The case involved 73-year-old George Zeliotis, who suffered excruciating pain and became addicted to painkillers during a year-long wait for hip replacement surgery. His doctor, Jacques Chaouli, claimed Zeliotis’ constitutional rights were violated because Quebec failed to provide the care he desperately needed. On June 9, 2005, the court ruled 4-3 in favor of Zeliotis, noting that as a result of delays in obtaining tests and undergoing surgery, patients have suffered or even died. The case was one modest step for common sense. It underscored the reality that the Canadian system can place severe limits on access to care that most Americans wouldn’t tolerate.
To be sure, the U.S. health care system is far from perfect. But it provides the overwhelming majority of Americans access to the best care in the world. Moreover, many of the flaws in the U.S. system result not from a private marketplace, but from flawed tax and regulatory policies implemented by the federal and state governments.
It is telling that even as Moore and Krugman seek to push the United States in the direction of a government-run, single-payer model, European nations are trying to integrate market practices into their own health care systems. Indeed, they seek to emulate the American system. Adopting the Moore-Krugman approach would only guarantee massive tax increases, rationing, and even denial of care.