“Pragmatic” Health Care Reform?
posted by Michael D. Tanner on the CATO blog
The Washington Post has a story today gushing over how “pragmatic” and “moderate” Democratic presidential candidates are being in pursuit of universal health care. Moderate in comparison to Michael Moore maybe, but let’s look at what those candidates are actually proposing:
1) An individual mandate requiring every American to purchase a specific government-designed insurance plan or face financial penalties. (Edwards and Clinton). Such a mandate, however unenforceable in practice, is an unprecedented (except for Massachusetts) infringement on individual liberty and sets the stage for further regulation of the insurance industry.
2) A “play or pay” mandate on businesses, requiring them to provide employees with health insurance or pay additional taxes (Obama, Edwards, Clinton). Such a mandate would raise the cost of employment resulting in a loss of jobs and lower employee compensation.
3) A government-mandated minimum benefits package for insurance (Obama, Edwards, Clinton). Rather than true insurance—spreading catastrophic risk—the government would require a “Cadillac” policy, leading to a feeding frenzy for special interests representing providers and disease constituencies.
4) Community rating and guaranteed issue, raising the cost of insurance for young and healthy individuals. (Obama, Edwards, Clinton).
5) Price controls on insurance premiums (Obama) and prescription drugs under Medicare (Obama, Edwards, Clinton).
6) Huge tax increases, ranging from $65 billion per year (Obama) to more than $120 billion per year (Edwards).
7) Massive expansion of government health care programs like Medicaid (Obama, Edwards, Clinton). Edwards would also create a new government-run health care program like Medicare to compete with private insurance.
8) Managed-competition-style regional insurance pools or “connectors.” (Obama and Clinton).
The fact that Massachusetts governor Mitt Romney and the Heritage Foundation also support many of these proposals doesn’t make them any more moderate. These proposals would radically increase government control over one seventh of the US economy, would increase taxes, destroy jobs, and slow economic growth, and most importantly would lead to worse health care for millions of Americans.
posted by Michael D. Tanner on 07.10.07 @ 9:50 am
Monday, March 24, 2008
The Anti-Universal Coverage Club Manifesto
I found the following quote on the blog of Cato and I find it very interesting.
The Anti-Universal Coverage Club is a list of scholars and citizens who reject the idea that government should ensure that all individuals have health insurance. It exists to challenge the idea that “universal coverage” is the best way to protect and promote health.
The following principles explain the club’s opposition to “universal coverage”:
Health policy should focus on making health care of ever-increasing quality available to an ever-increasing number of people.
“Universal coverage” could be achieved only by forcing everyone to buy health insurance or by having government provide health insurance to all, neither of which is desirable.
In a free society, people should have the right to refuse health insurance.
If governments must subsidize those who cannot afford medical care, they should be free to experiment with different types of subsidies (cash, vouchers, insurance, public clinics & hospitals, uncompensated care payments, etc.) and tax exemptions, rather than be forced by a policy of “universal coverage” to subsidize people via “insurance.”
To join, post something to your blog or email me here. If you blog about the club, pro or con, please send the link to that address as well.
posted by Michael F. Cannon on 07.06.07 @ 4:33 pm
The Anti-Universal Coverage Club is a list of scholars and citizens who reject the idea that government should ensure that all individuals have health insurance. It exists to challenge the idea that “universal coverage” is the best way to protect and promote health.
The following principles explain the club’s opposition to “universal coverage”:
Health policy should focus on making health care of ever-increasing quality available to an ever-increasing number of people.
“Universal coverage” could be achieved only by forcing everyone to buy health insurance or by having government provide health insurance to all, neither of which is desirable.
In a free society, people should have the right to refuse health insurance.
If governments must subsidize those who cannot afford medical care, they should be free to experiment with different types of subsidies (cash, vouchers, insurance, public clinics & hospitals, uncompensated care payments, etc.) and tax exemptions, rather than be forced by a policy of “universal coverage” to subsidize people via “insurance.”
To join, post something to your blog or email me here. If you blog about the club, pro or con, please send the link to that address as well.
posted by Michael F. Cannon on 07.06.07 @ 4:33 pm
Wednesday, March 19, 2008
Canadians face long waits for many kinds of health care
This one is for all these dreamers who want to socialize a whole sector of the American economy:
JEFFREY NACHT, M.D.Published: December 9th, 2007 01:00 AM at http://www.thenewstribune.com/opinion/insight/story/224748.html
As a half-time practicing orthopedic surgeon in Tacoma and a half-time faculty member in the Department of Medicine at the University of British Columbia in Vancouver, I have come to appreciate the differences of these two health care systems, both of which are often touted as the very best.
As I have spent more time in Canada, I have started to appreciate the way its system affects doctors and their patients. The revelations have been nothing short of astonishing.
We hear a great deal about how much less Canadians spend on health care and what a wonderful system they have where everyone has access to “universal health care.” But how they accomplish this is not exactly as advertised.
According to no less a source than the World Health Organization, Canadians, for the price they pay, now have the worst health care system in the world. WHO ranks Canada’s health system as the third-most expensive system in the world, and rates it 30th in efficiency and 18th in access to care.
How does this affect its physician work force? The answers might shock you.
Surgeons are “controlled” by limiting access to operating rooms. In British Columbia, all elective operating rooms shut down at 3 p.m., except at Vancouver Hospital (the tertiary care center for all of the province), which shuts down at 5 p.m. except for emergencies.
Surgeons are given a very limited number of surgical “block times” in which to do their work. Younger surgeons get less time, and senior surgeons get the prime slots, just as in Britain. Each surgeon has a waiting list or “queue.” When a surgeon does an emergency case, the patients on his waiting list are pushed back by one slot for each emergency he does. That way the hospital’s budget for the number of surgeries it must pay for is not impacted by unexpected additions to the schedule.
Patients often try to call in favors or use their influence with their surgeon to find ways to “jump the queue” or move up in the list. Waiting times can be shocking.
In most major metropolitan areas, a patient will usually wait for nine to 12 months for a smaller procedure such as carpal tunnel surgery or a hernia repair, and 14 to 18 months for a major procedure such as a total joint replacement or cardiac valve replacement.
Somewhat more urgent cases do not fare much better. My wife’s aunt developed symptomatic coronary artery disease a few years ago. She was referred to a cardiac surgeon at Vancouver Hospital, who recommended that she have a two-vessel bypass. He put her on the “wait list” and estimated that she would have her surgery in eight months.
Because of emergencies that kept adding delays to his “elective” schedule, the aunt finally had her surgery 18 months later. By that time, she was virtually a cardiac cripple and required a four-vessel bypass. Due to her severely deteriorated condition by the time she got to surgery, she did not survive.
My Canadian father developed a large abdominal aortic aneurysm when he was about 70. He was referred to a vascular surgeon, who scheduled him for repair of the aneurysm nine months later. He finally had his surgery 13 months after the decision for surgery was made. Three times he was admitted to the hospital for the surgery and sent home when an emergency bumped him off the schedule.
Imagine how that would work here in our community.
To make matters even more difficult, the provincial government started additional budget-cutting measures a few years ago, dictating that half of the elective operating rooms in the entire province close for eight weeks each year to save money. Each hospital was allowed to choose which eight weeks it would close.
Economic decisions like these are based on the fact that for hospitals, patient care is a liability that must be limited whenever possible to remain within their budget, not a source of revenue as it is here in the U.S. This turns the equation of health care economics upside down and leads to the worst kind of rationing.
Internists and primary care physicians have another set of issues. The government limits how many patients each doctor can see and bill for each day. If you exceed the government’s quota, you simply won’t get paid for the additional work.
However, there is a work-around. Many physicians do their office practice and quit when they see their “limit.” They then travel to another community and work in an urgent care or after-hours clinic. As long as it is in another municipality (an outlying community with a health care need) they can bill additionally and get paid. This often means traveling 50 miles or more to work in a clinic distant enough to circumvent the quota rules.
Similarly, services are often limited by available resources. There are only a few MRI machines in the whole province, so the waiting list for these studies can be six to 12 months. CAT scanners and ultrasound units are more readily available and might only take a few weeks to schedule.
In the Foot and Ankle Reconstruction Centre in Vancouver, I work alongside three full-time orthopedic specialists who do most of the complex surgery of this type for all of southwestern British Columbia, which has a population base of about 2 million people. These poor guys have a waiting list of over 5,000 patients who need surgery. Their waiting list for elective cases exceeds three years.
So how do Canadians like their health care system? Surprisingly, most think it’s great, at least until they need access to care. There is a pervasive socialist mentality that most Canadians subscribe to. Even though there are long waits and limited available high-tech services, at least everyone waits the same amount of time.
There is no deductible or co-pay, so when patients do need care, it’s essentially free. Canadians do pay for health insurance, but the premiums are graduated, based on income, and even the highest premiums are only a fraction of what Americans pay for private insurance. If you make less that modest income, your premiums are waived altogether.
However, you can’t access care outside of the system. Tiny pockets of “private health care” have emerged here and there. However, these centers take no government payments; it’s cash only. They treat primarily workers’ compensation and “third party injury” cases, as well as patients from outside the province.
So do Americans really want this type of system? More pertinently, do American doctors want to work in this environment?
The answer, once you’ve looked at the dirt swept under this rug, is likely to be absolutely not.
JEFFREY NACHT, M.D.Published: December 9th, 2007 01:00 AM at http://www.thenewstribune.com/opinion/insight/story/224748.html
As a half-time practicing orthopedic surgeon in Tacoma and a half-time faculty member in the Department of Medicine at the University of British Columbia in Vancouver, I have come to appreciate the differences of these two health care systems, both of which are often touted as the very best.
As I have spent more time in Canada, I have started to appreciate the way its system affects doctors and their patients. The revelations have been nothing short of astonishing.
We hear a great deal about how much less Canadians spend on health care and what a wonderful system they have where everyone has access to “universal health care.” But how they accomplish this is not exactly as advertised.
According to no less a source than the World Health Organization, Canadians, for the price they pay, now have the worst health care system in the world. WHO ranks Canada’s health system as the third-most expensive system in the world, and rates it 30th in efficiency and 18th in access to care.
How does this affect its physician work force? The answers might shock you.
Surgeons are “controlled” by limiting access to operating rooms. In British Columbia, all elective operating rooms shut down at 3 p.m., except at Vancouver Hospital (the tertiary care center for all of the province), which shuts down at 5 p.m. except for emergencies.
Surgeons are given a very limited number of surgical “block times” in which to do their work. Younger surgeons get less time, and senior surgeons get the prime slots, just as in Britain. Each surgeon has a waiting list or “queue.” When a surgeon does an emergency case, the patients on his waiting list are pushed back by one slot for each emergency he does. That way the hospital’s budget for the number of surgeries it must pay for is not impacted by unexpected additions to the schedule.
Patients often try to call in favors or use their influence with their surgeon to find ways to “jump the queue” or move up in the list. Waiting times can be shocking.
In most major metropolitan areas, a patient will usually wait for nine to 12 months for a smaller procedure such as carpal tunnel surgery or a hernia repair, and 14 to 18 months for a major procedure such as a total joint replacement or cardiac valve replacement.
Somewhat more urgent cases do not fare much better. My wife’s aunt developed symptomatic coronary artery disease a few years ago. She was referred to a cardiac surgeon at Vancouver Hospital, who recommended that she have a two-vessel bypass. He put her on the “wait list” and estimated that she would have her surgery in eight months.
Because of emergencies that kept adding delays to his “elective” schedule, the aunt finally had her surgery 18 months later. By that time, she was virtually a cardiac cripple and required a four-vessel bypass. Due to her severely deteriorated condition by the time she got to surgery, she did not survive.
My Canadian father developed a large abdominal aortic aneurysm when he was about 70. He was referred to a vascular surgeon, who scheduled him for repair of the aneurysm nine months later. He finally had his surgery 13 months after the decision for surgery was made. Three times he was admitted to the hospital for the surgery and sent home when an emergency bumped him off the schedule.
Imagine how that would work here in our community.
To make matters even more difficult, the provincial government started additional budget-cutting measures a few years ago, dictating that half of the elective operating rooms in the entire province close for eight weeks each year to save money. Each hospital was allowed to choose which eight weeks it would close.
Economic decisions like these are based on the fact that for hospitals, patient care is a liability that must be limited whenever possible to remain within their budget, not a source of revenue as it is here in the U.S. This turns the equation of health care economics upside down and leads to the worst kind of rationing.
Internists and primary care physicians have another set of issues. The government limits how many patients each doctor can see and bill for each day. If you exceed the government’s quota, you simply won’t get paid for the additional work.
However, there is a work-around. Many physicians do their office practice and quit when they see their “limit.” They then travel to another community and work in an urgent care or after-hours clinic. As long as it is in another municipality (an outlying community with a health care need) they can bill additionally and get paid. This often means traveling 50 miles or more to work in a clinic distant enough to circumvent the quota rules.
Similarly, services are often limited by available resources. There are only a few MRI machines in the whole province, so the waiting list for these studies can be six to 12 months. CAT scanners and ultrasound units are more readily available and might only take a few weeks to schedule.
In the Foot and Ankle Reconstruction Centre in Vancouver, I work alongside three full-time orthopedic specialists who do most of the complex surgery of this type for all of southwestern British Columbia, which has a population base of about 2 million people. These poor guys have a waiting list of over 5,000 patients who need surgery. Their waiting list for elective cases exceeds three years.
So how do Canadians like their health care system? Surprisingly, most think it’s great, at least until they need access to care. There is a pervasive socialist mentality that most Canadians subscribe to. Even though there are long waits and limited available high-tech services, at least everyone waits the same amount of time.
There is no deductible or co-pay, so when patients do need care, it’s essentially free. Canadians do pay for health insurance, but the premiums are graduated, based on income, and even the highest premiums are only a fraction of what Americans pay for private insurance. If you make less that modest income, your premiums are waived altogether.
However, you can’t access care outside of the system. Tiny pockets of “private health care” have emerged here and there. However, these centers take no government payments; it’s cash only. They treat primarily workers’ compensation and “third party injury” cases, as well as patients from outside the province.
So do Americans really want this type of system? More pertinently, do American doctors want to work in this environment?
The answer, once you’ve looked at the dirt swept under this rug, is likely to be absolutely not.
Monday, March 17, 2008
The Myths of Single-Payer Health Care
I found this on the net. It is so good that I am posting it here as a full, complete copy. I agree 100%. This is something everybody needs to know!
Itw as written and published by
By David Hogberg (about)
Begin quote:
A single-payer health care system is one in which a single-entity -- the government -- collects almost all of the revenue for and pays almost all of the bills for the health care system. In most single-payer systems only a small percentage of health care expenses are paid for with private funds. Countries that have a single-payer system include Australia, Canada, Sweden and the United Kingdom.
Single-payer is popular among the political left in the United States. Leftists have emitted tons of propaganda in favor of a single-payer system, much of which has fossilized into myth.
Here are some of the more prominent single-payer myths:
· Myth No. 1: Everyone has access to health care a single-payer system.
· Myth No. 2: Claims of rationing are exaggerated.
· Myth No. 3: A single-payer system would save money on administrative costs.
· Myth No. 4: Single-payer will provide fair and quality care for everyone.
· Myth No. 5: Single-payer leaves medical decisions to patients & doctors.
· Myth No. 6: Single-payer systems achieve better health outcomes.
· Myth No. 7: The U.S. systems also engages in rationing.
· Myth No. 8: A single-payer system will not hamper medical research.
· Myth No. 9: Single-payer will save money as patients seek care earlier.
· Myth No. 10: The free market in health care has failed in the U.S.
Myth No. 1: Everyone has access to health care a single-payer system.
Everyone in a single-payer system has health insurance, not necessarily health care.
While the government in a single-payer system will pay for everyone's health care, it limits the access to health care. In a single-payer system, citizens often believe that "the government" is paying for their health care. When people perceive that someone else is paying for something, they tend to over-use it. In a single-payer health care system, people over-use health care. This puts strain on government health care budgets, and to contain costs governments must ration care.
Governments in a single-payer system ration care using waiting lists for surgery and diagnostic procedures and by canceling surgeries. As the Canadian Supreme Court said upon ruling unconstitutional a Quebec law that banned private health care, "access to a waiting list is not access to health care." [Back to Top]
Myth No. 2: Claims of rationing are exaggerated.
Jonathan Cohn, author of Sick, wrote that the "stories about [rationing in] Canada are wildly exaggerated." Yet advocates of single-payer never say what they mean by "exaggerated."
The fact is that people often suffering great pain and anxiety while they spend months on a waiting list for surgery. Others spend months waiting for a surgery, only to have it cancelled, after which they will spend even more time waiting for another surgery. Sometimes people even die while on the waiting list.
Media in foreign nations are full of stories about people suffer while on a waiting list. In Canada, Diane Gorsuch twice had heart surgery cancelled; she suffered a fatal heart attack before her third surgery. In Great Britain, Mavis Skeet had her cancer surgery cancelled four times before her cancer was determined to have become inoperable. In Australia, eight-year-old Kyle Inglis has lost 50 percent of his hearing while waiting nearly 11 months for an operation to remove a tumor in his ear. Kyle is one of over 1,000 children waiting over 600 days for ear, nose and throat surgery in Warnbro, a suburb in Western Australia.
These are not mere anecdotes. Much academic literature has examined the impact of waiting lists on health. A study in the Canadian Medical Association Journal found that 50 people died while on a wait list for cardiac catheterization in Ontario. A study of Swedish patients on a wait list for heart surgery found that the "risk of death increases significantly with waiting time." In a 2000 article in the journal Clinical Oncology, British researchers studying 29 lung cancer patients waiting for treatment further found that about 20 percent "of potentially curable patients became incurable on the waiting list." [Back to Top]
Myth No. 3: A single-payer system would save money on administrative costs.
Single-payer advocates often claim that the U.S. private sector health care system is wasteful, spending far more on administrative costs than do government-run single-payer systems. According to single-payer advocates David Himmelstein and Steffie Woolhandler, "Streamlining administrative overhead to Canadian levels would save approximately $286.0 billion in 2003, $6,940 for each of the 41.2 million Americans who were uninsured as of 2001."
Yet comparisons of private sector administrative costs with those of government are misleading. Many government administrative expenses are excluded in such comparisons, such as what it costs employers and government to collect the taxes needed to fund the single-payer system, and the salaries of politicians and their staff members who set government health-care policy (the salary costs of executives and boards of directors who set company policy are included in private sector administrative costs).
But even if the U.S. would save money on administrative costs by switching to a single-payer system, the savings would prove temporary. The main cause of rising health care costs is not administrative costs, but over-use of health care. A single-payer system would not solve that problem. Indeed, it would make it worse. [Back to Top]
Myth No. 4: Single-payer will provide fair and quality care for everyone.
Leftist Dave Zweifel claims that the U.S. "could make the system so much more fair by enacting a national single-payer health plan." Jonathan Cohn, when asked why he had faith that the government could run the health care system for all when it didn't do it very well for the poor, responded, "My answer is that they do it, and do it well, abroad."
Well, no they don't. According to Canada's Fraser Institute:
... a profusion of research reveals that cardiovascular surgery queues are routinely jumped by the famous and politically-connected, that suburban and rural residents confront barriers to access not encountered by their urban counterparts, and that low-income Canadians have less access to specialists, particularly cardiovascular ones, are less likely to utilize diagnostic imaging, and have lower cardiovascular and cancer survival rates than their higher-income neighbours.
It isn't much better in Great Britain. Take a look at the Saga 'Good Hospital Guide' for British hospitals. Compare the ones in Inner London, which tend to be in wealthier areas, to the ones in Outer London, which tend to be in poorer areas. You'll notice that in general, the ones in Inner London have more doctors and nurses per bed, shorter wait times for MRIs and hip replacements, and lower mortality ratios. [Back to Top]
Myth No. 5: A single-payer system will leave medical decisions to a patients and his or her doctor.
According to Physicians for a National Health Program (PNHP), a group pushing for a single-payer system in the U.S.:
There is a myth that, with national health insurance, the government will be making the medical decisions. But in a publicly-financed, universal health care system medical decisions are left to the patient and doctor, as they should be. This is true even in the countries like the UK and Spain that have socialized medicine.
Yet PNHP seems to be talking out of both sides of its mouth. Here is how PNHP addresses the question of how to keep doctors from doing too many procedures in a single-payer system:
[Doing too many procedures] is a problem in systems that reimburse physicians on a fee-for-service basis. In today's health system, another problem is physicians doing too little for patients. So the real question is, "how do we discourage both overcare and undercare"? One approach is to compare physicians' use of tests and procedures to their peers with similar patients. A physician who is "off the curve" will stand out. Another way is to set spending targets for each specialty. This encourages doctors to be prudent stewards and to make sure their colleagues are as well, because any doctor doing unnecessary procedures will be taking money away from other physicians in the same specialty.
In practice what this will mean is medical decisions will be left up to you and your doctor as long as your doctor isn't doing too many (or too few) procedures and is within a spending target.
The truth is that single-payer systems often interfere with treatment decisions. For example, most single-payer systems have bureaucracies that delay the approval of new drugs, preventing patients from using them. Alice Mahon, a former member of the British parliament, needed the drug Lucentis to slow her macular degeneration. Because of delays due to the National Health Service not yet having approved Lucentis at the time of her diagnosis, Mahon lost much of the sight in her left eye.
In 1999, Canadian patient Daniel Smith, a cystic fibrosis sufferer, and his doctors agreed that he needed a lung transplant. But his surgery was cancelled by administrators because an open hospital bed could not be found.
So much for medical decisions being left to patients and their doctors. [Back to Top]
Myth No. 6: Single-payer systems achieve better health outcomes.
Most single-payer advocates point to life expectancy and infant mortality as evidence that single-payer systems produce better health outcomes than the U.S. And, indeed, the U.S. has lower life expectancy and higher infant mortality than many nations with a single-payer system.
The problem is that life expectancy and infant mortality tell us very little about the quality of a health care system. Life expectancy is determined by a host of factors over which a health care system has little control, such as genetics, crime rate, gross domestic product per capita, diet, sanitation, and literacy rate.
The primary reason is that the U.S. has lower life expectancy is that we are ethnically a far more diverse nation than most other industrialized nations. Factors associated with different ethnic backgrounds -- culture, diet, etc. -- can have a substantial impact on life expectancy.
A good deal of the lower life expectancy rate in the U.S. is accounted for by the difference in life expectancy of African-Americans versus other populations in the United States. Life expectancy for African-Americans is about 72.3 years, while for whites it is about 77.7 years. What accounts for the difference? Numerous scholars have investigated this question. The most prevalent explanations are differences in income and personal risk factors. For example, one study found that about one-third of the difference between white and African-American life expectancies in the United States was accounted for by income; another third was accounted for by personal risk factors such as obesity, blood pressure, alcohol intake, diabetes, cholesterol concentration, and smoking and the final third was due to unexplained factors.
Infant mortality is also impacted by many of the same factors that affect life expectancy -- genetics, GDP per capita, diet, etc. -- all of which are factors beyond the control of a health care system. Another factor that makes U.S. infant mortality rates higher than other nations is that we have far more pregnant women living alone; in other nations pregnant women are more likely to be either be married or living with a partner. Pregnant women in such households are more likely to receive prenatal care than pregnant women living on their own.
Perhaps the biggest drawback of infant mortality is that it is measured too inconsistently across nations to be a useful measure. Under United Nations' guidelines, countries are supposed to count any infant showing any sign of life as a "live birth." While the United States follows that guideline, many other nations do not. For example, Switzerland does not count any infant born measuring less than 12 inches, while France and Belgium do not count any infant born prior to 26 weeks. In short, many other nations exclude many high-risk infants from their infant mortality statistics, making their infant mortality numbers look better than they really are.
In areas where a health care system does have an impact, such as treating disease, the U.S. outperforms single-payer systems. For example, the U.S. has a higher five-year survival rate for victims of heart attacks than Canada, due to the fact that we do more bypass surgeries and angioplasties in the U.S. Hospitals in the U.S. also commit fewer errors than hospitals in countries with single-payer systems like Australia, Canada, New Zealand, and the United Kingdom. [Back to Top]
Myth No. 7: The U.S. systems also engages in rationing - 18,000 people die each year due to lack of insurance.
According to PNHP, "Rationing in U.S. health care is based on income: if you can afford care you get it, if you can't, you don't. A recent study by the prestigious Institute of Medicine found that 18,000 Americans die every year because they don't have health insurance."
The Institute of Medicine study purporting to show that 18,000 people die each year due to a lack of health insurance is actually a "meta-analysis," a study that summarizes the results of other studies. Yet many of the studies the Institute relied on have some rather odd results. One study in the New England Journal of Medicine found that women with private insurance were more likely to survive breast cancer than those uninsured. However, data in the study also showed that those who were uninsured had a higher survival rate than women covered by Medicaid. This suggests that factors other than health insurance, like education and income, were at play in determining breast cancer survival.
Furthermore, everyone in the U.S. can get care regardless of income. In 1986 the U.S. Congress passed the Emergency Medical Treatment and Active Labor Act. This requires emergency rooms to treat any person who shows up seeking medical treatment, regardless of their ability to pay. [Back to Top]
Myth No. 8: A single-payer system will not hamper medical research.
The PNHP claims:
Medical research does not disappear under universal health care system. Many famous discoveries have been made in countries that have national health care systems. Laparoscopic gallbladder removal was pioneered in Canada. The CT scan was invented in England. The new treatment to cure juvenile diabetics by transplanting pancreatic cells was developed in Canada.
While it is true that medical research will not "disappear," it will surely decline. Consider what has happened to pharmaceutical research in single-payer systems, where the government imposes price controls on prescription drugs. A study (PDF) conducted by U.S. Commerce Department found that drug price controls in other nations reduced annual investment in pharmaceuticals by $5-8 billion, resulting in 3 to 4 fewer drugs being launched each year. The Boston Consulting Group found (PDF) an even bigger effect of price controls, showing a loss of $17-22 billion annually in pharmaceutical research resulting in the loss of 10 to 13 new drug launches.
In a free market, producers make a profit by providing services that consumers find useful. Profits also act as a signal to research - research dollars go toward services that make more profit. This is desirable because services that make more profit are the ones that consumers find most useful. Medical services that make profit -- i.e., the ones that patients find most useful -- will attract more research dollars.
In a single-payer system, government sets the prices for medical services. Since government is not good at setting prices, it inevitably over-pays for some services. Research dollars will go not necessarily toward the services that patients find most useful but toward the services that government over-pays since those will be the ones that will be most profitable. [Back to Top]
Myth No. 9: Single-payer will save money because patients will seek care earlier (since they will no longer face financial barriers to health care) when it is easier and more affordable to treat diseases.
This assumes that patients will be able to get access to health care easily in a single-payer system. But as nations with single-payer have shown, even the most basic health care, like routine doctors visits, are rationed. According to a report by Statistics Canada:
· Despite the fact that most individuals had a regular family doctor, almost one in five individuals of those who required routine care experienced difficulties accessing care. The rates were significantly lower in Saskatchewan (12%), Alberta (13%) and British Columbia (12%), and significantly higher in Newfoundland and Labrador (20%) and Quebec (19%).
· The top two barriers to receiving routine or on-going care were difficulties getting an appointment, and long waits for an appointment.
· Overall, 16% of Canadians who had required health information or advice indicated that they had experienced difficulties accessing care. The rates were significantly lower in Saskatchewan (13%) and Alberta (13%), and significantly higher in Ontario (18%).
Seeking care earlier will make little difference if patients have trouble getting a routine appointment with a doctor. [Back to Top]
Myth No. 10: The free market in health care has failed in the U.S.
What has failed in the U.S. is government micromanagement of the health care system. Over the past 40 years government's role in the health care system has continually expanded, from programs like Medicare, Medicaid and SCHIP, to regulations like HIPPA and COBRA. Like most government interventions, it has only made the problem worse.
The fact is we do not have a free market in health care in the U.S. Ask yourself: How many markets in the U.S. do you get a tax break for buying a product, but only if you buy it through your employer, as we do with health insurance? In how many markets are you prohibited from purchasing a product out of state, as we are with health insurance? In how many markets are employers prohibited from providing bonuses to employees for improving quality and productivity, as hospitals are prevented from doing with doctors? If government policy inhibited other markets that way, those markets would be dysfunctional too.
The solution to our health care problems is to reduce the role of government, not increase it by switching to a single-payer system. [Back to Top]
End quote
My only comment is that "myth" is a very polite and nice and friendly way of wording it. I would use other words
Itw as written and published by
By David Hogberg (about)
Begin quote:
A single-payer health care system is one in which a single-entity -- the government -- collects almost all of the revenue for and pays almost all of the bills for the health care system. In most single-payer systems only a small percentage of health care expenses are paid for with private funds. Countries that have a single-payer system include Australia, Canada, Sweden and the United Kingdom.
Single-payer is popular among the political left in the United States. Leftists have emitted tons of propaganda in favor of a single-payer system, much of which has fossilized into myth.
Here are some of the more prominent single-payer myths:
· Myth No. 1: Everyone has access to health care a single-payer system.
· Myth No. 2: Claims of rationing are exaggerated.
· Myth No. 3: A single-payer system would save money on administrative costs.
· Myth No. 4: Single-payer will provide fair and quality care for everyone.
· Myth No. 5: Single-payer leaves medical decisions to patients & doctors.
· Myth No. 6: Single-payer systems achieve better health outcomes.
· Myth No. 7: The U.S. systems also engages in rationing.
· Myth No. 8: A single-payer system will not hamper medical research.
· Myth No. 9: Single-payer will save money as patients seek care earlier.
· Myth No. 10: The free market in health care has failed in the U.S.
Myth No. 1: Everyone has access to health care a single-payer system.
Everyone in a single-payer system has health insurance, not necessarily health care.
While the government in a single-payer system will pay for everyone's health care, it limits the access to health care. In a single-payer system, citizens often believe that "the government" is paying for their health care. When people perceive that someone else is paying for something, they tend to over-use it. In a single-payer health care system, people over-use health care. This puts strain on government health care budgets, and to contain costs governments must ration care.
Governments in a single-payer system ration care using waiting lists for surgery and diagnostic procedures and by canceling surgeries. As the Canadian Supreme Court said upon ruling unconstitutional a Quebec law that banned private health care, "access to a waiting list is not access to health care." [Back to Top]
Myth No. 2: Claims of rationing are exaggerated.
Jonathan Cohn, author of Sick, wrote that the "stories about [rationing in] Canada are wildly exaggerated." Yet advocates of single-payer never say what they mean by "exaggerated."
The fact is that people often suffering great pain and anxiety while they spend months on a waiting list for surgery. Others spend months waiting for a surgery, only to have it cancelled, after which they will spend even more time waiting for another surgery. Sometimes people even die while on the waiting list.
Media in foreign nations are full of stories about people suffer while on a waiting list. In Canada, Diane Gorsuch twice had heart surgery cancelled; she suffered a fatal heart attack before her third surgery. In Great Britain, Mavis Skeet had her cancer surgery cancelled four times before her cancer was determined to have become inoperable. In Australia, eight-year-old Kyle Inglis has lost 50 percent of his hearing while waiting nearly 11 months for an operation to remove a tumor in his ear. Kyle is one of over 1,000 children waiting over 600 days for ear, nose and throat surgery in Warnbro, a suburb in Western Australia.
These are not mere anecdotes. Much academic literature has examined the impact of waiting lists on health. A study in the Canadian Medical Association Journal found that 50 people died while on a wait list for cardiac catheterization in Ontario. A study of Swedish patients on a wait list for heart surgery found that the "risk of death increases significantly with waiting time." In a 2000 article in the journal Clinical Oncology, British researchers studying 29 lung cancer patients waiting for treatment further found that about 20 percent "of potentially curable patients became incurable on the waiting list." [Back to Top]
Myth No. 3: A single-payer system would save money on administrative costs.
Single-payer advocates often claim that the U.S. private sector health care system is wasteful, spending far more on administrative costs than do government-run single-payer systems. According to single-payer advocates David Himmelstein and Steffie Woolhandler, "Streamlining administrative overhead to Canadian levels would save approximately $286.0 billion in 2003, $6,940 for each of the 41.2 million Americans who were uninsured as of 2001."
Yet comparisons of private sector administrative costs with those of government are misleading. Many government administrative expenses are excluded in such comparisons, such as what it costs employers and government to collect the taxes needed to fund the single-payer system, and the salaries of politicians and their staff members who set government health-care policy (the salary costs of executives and boards of directors who set company policy are included in private sector administrative costs).
But even if the U.S. would save money on administrative costs by switching to a single-payer system, the savings would prove temporary. The main cause of rising health care costs is not administrative costs, but over-use of health care. A single-payer system would not solve that problem. Indeed, it would make it worse. [Back to Top]
Myth No. 4: Single-payer will provide fair and quality care for everyone.
Leftist Dave Zweifel claims that the U.S. "could make the system so much more fair by enacting a national single-payer health plan." Jonathan Cohn, when asked why he had faith that the government could run the health care system for all when it didn't do it very well for the poor, responded, "My answer is that they do it, and do it well, abroad."
Well, no they don't. According to Canada's Fraser Institute:
... a profusion of research reveals that cardiovascular surgery queues are routinely jumped by the famous and politically-connected, that suburban and rural residents confront barriers to access not encountered by their urban counterparts, and that low-income Canadians have less access to specialists, particularly cardiovascular ones, are less likely to utilize diagnostic imaging, and have lower cardiovascular and cancer survival rates than their higher-income neighbours.
It isn't much better in Great Britain. Take a look at the Saga 'Good Hospital Guide' for British hospitals. Compare the ones in Inner London, which tend to be in wealthier areas, to the ones in Outer London, which tend to be in poorer areas. You'll notice that in general, the ones in Inner London have more doctors and nurses per bed, shorter wait times for MRIs and hip replacements, and lower mortality ratios. [Back to Top]
Myth No. 5: A single-payer system will leave medical decisions to a patients and his or her doctor.
According to Physicians for a National Health Program (PNHP), a group pushing for a single-payer system in the U.S.:
There is a myth that, with national health insurance, the government will be making the medical decisions. But in a publicly-financed, universal health care system medical decisions are left to the patient and doctor, as they should be. This is true even in the countries like the UK and Spain that have socialized medicine.
Yet PNHP seems to be talking out of both sides of its mouth. Here is how PNHP addresses the question of how to keep doctors from doing too many procedures in a single-payer system:
[Doing too many procedures] is a problem in systems that reimburse physicians on a fee-for-service basis. In today's health system, another problem is physicians doing too little for patients. So the real question is, "how do we discourage both overcare and undercare"? One approach is to compare physicians' use of tests and procedures to their peers with similar patients. A physician who is "off the curve" will stand out. Another way is to set spending targets for each specialty. This encourages doctors to be prudent stewards and to make sure their colleagues are as well, because any doctor doing unnecessary procedures will be taking money away from other physicians in the same specialty.
In practice what this will mean is medical decisions will be left up to you and your doctor as long as your doctor isn't doing too many (or too few) procedures and is within a spending target.
The truth is that single-payer systems often interfere with treatment decisions. For example, most single-payer systems have bureaucracies that delay the approval of new drugs, preventing patients from using them. Alice Mahon, a former member of the British parliament, needed the drug Lucentis to slow her macular degeneration. Because of delays due to the National Health Service not yet having approved Lucentis at the time of her diagnosis, Mahon lost much of the sight in her left eye.
In 1999, Canadian patient Daniel Smith, a cystic fibrosis sufferer, and his doctors agreed that he needed a lung transplant. But his surgery was cancelled by administrators because an open hospital bed could not be found.
So much for medical decisions being left to patients and their doctors. [Back to Top]
Myth No. 6: Single-payer systems achieve better health outcomes.
Most single-payer advocates point to life expectancy and infant mortality as evidence that single-payer systems produce better health outcomes than the U.S. And, indeed, the U.S. has lower life expectancy and higher infant mortality than many nations with a single-payer system.
The problem is that life expectancy and infant mortality tell us very little about the quality of a health care system. Life expectancy is determined by a host of factors over which a health care system has little control, such as genetics, crime rate, gross domestic product per capita, diet, sanitation, and literacy rate.
The primary reason is that the U.S. has lower life expectancy is that we are ethnically a far more diverse nation than most other industrialized nations. Factors associated with different ethnic backgrounds -- culture, diet, etc. -- can have a substantial impact on life expectancy.
A good deal of the lower life expectancy rate in the U.S. is accounted for by the difference in life expectancy of African-Americans versus other populations in the United States. Life expectancy for African-Americans is about 72.3 years, while for whites it is about 77.7 years. What accounts for the difference? Numerous scholars have investigated this question. The most prevalent explanations are differences in income and personal risk factors. For example, one study found that about one-third of the difference between white and African-American life expectancies in the United States was accounted for by income; another third was accounted for by personal risk factors such as obesity, blood pressure, alcohol intake, diabetes, cholesterol concentration, and smoking and the final third was due to unexplained factors.
Infant mortality is also impacted by many of the same factors that affect life expectancy -- genetics, GDP per capita, diet, etc. -- all of which are factors beyond the control of a health care system. Another factor that makes U.S. infant mortality rates higher than other nations is that we have far more pregnant women living alone; in other nations pregnant women are more likely to be either be married or living with a partner. Pregnant women in such households are more likely to receive prenatal care than pregnant women living on their own.
Perhaps the biggest drawback of infant mortality is that it is measured too inconsistently across nations to be a useful measure. Under United Nations' guidelines, countries are supposed to count any infant showing any sign of life as a "live birth." While the United States follows that guideline, many other nations do not. For example, Switzerland does not count any infant born measuring less than 12 inches, while France and Belgium do not count any infant born prior to 26 weeks. In short, many other nations exclude many high-risk infants from their infant mortality statistics, making their infant mortality numbers look better than they really are.
In areas where a health care system does have an impact, such as treating disease, the U.S. outperforms single-payer systems. For example, the U.S. has a higher five-year survival rate for victims of heart attacks than Canada, due to the fact that we do more bypass surgeries and angioplasties in the U.S. Hospitals in the U.S. also commit fewer errors than hospitals in countries with single-payer systems like Australia, Canada, New Zealand, and the United Kingdom. [Back to Top]
Myth No. 7: The U.S. systems also engages in rationing - 18,000 people die each year due to lack of insurance.
According to PNHP, "Rationing in U.S. health care is based on income: if you can afford care you get it, if you can't, you don't. A recent study by the prestigious Institute of Medicine found that 18,000 Americans die every year because they don't have health insurance."
The Institute of Medicine study purporting to show that 18,000 people die each year due to a lack of health insurance is actually a "meta-analysis," a study that summarizes the results of other studies. Yet many of the studies the Institute relied on have some rather odd results. One study in the New England Journal of Medicine found that women with private insurance were more likely to survive breast cancer than those uninsured. However, data in the study also showed that those who were uninsured had a higher survival rate than women covered by Medicaid. This suggests that factors other than health insurance, like education and income, were at play in determining breast cancer survival.
Furthermore, everyone in the U.S. can get care regardless of income. In 1986 the U.S. Congress passed the Emergency Medical Treatment and Active Labor Act. This requires emergency rooms to treat any person who shows up seeking medical treatment, regardless of their ability to pay. [Back to Top]
Myth No. 8: A single-payer system will not hamper medical research.
The PNHP claims:
Medical research does not disappear under universal health care system. Many famous discoveries have been made in countries that have national health care systems. Laparoscopic gallbladder removal was pioneered in Canada. The CT scan was invented in England. The new treatment to cure juvenile diabetics by transplanting pancreatic cells was developed in Canada.
While it is true that medical research will not "disappear," it will surely decline. Consider what has happened to pharmaceutical research in single-payer systems, where the government imposes price controls on prescription drugs. A study (PDF) conducted by U.S. Commerce Department found that drug price controls in other nations reduced annual investment in pharmaceuticals by $5-8 billion, resulting in 3 to 4 fewer drugs being launched each year. The Boston Consulting Group found (PDF) an even bigger effect of price controls, showing a loss of $17-22 billion annually in pharmaceutical research resulting in the loss of 10 to 13 new drug launches.
In a free market, producers make a profit by providing services that consumers find useful. Profits also act as a signal to research - research dollars go toward services that make more profit. This is desirable because services that make more profit are the ones that consumers find most useful. Medical services that make profit -- i.e., the ones that patients find most useful -- will attract more research dollars.
In a single-payer system, government sets the prices for medical services. Since government is not good at setting prices, it inevitably over-pays for some services. Research dollars will go not necessarily toward the services that patients find most useful but toward the services that government over-pays since those will be the ones that will be most profitable. [Back to Top]
Myth No. 9: Single-payer will save money because patients will seek care earlier (since they will no longer face financial barriers to health care) when it is easier and more affordable to treat diseases.
This assumes that patients will be able to get access to health care easily in a single-payer system. But as nations with single-payer have shown, even the most basic health care, like routine doctors visits, are rationed. According to a report by Statistics Canada:
· Despite the fact that most individuals had a regular family doctor, almost one in five individuals of those who required routine care experienced difficulties accessing care. The rates were significantly lower in Saskatchewan (12%), Alberta (13%) and British Columbia (12%), and significantly higher in Newfoundland and Labrador (20%) and Quebec (19%).
· The top two barriers to receiving routine or on-going care were difficulties getting an appointment, and long waits for an appointment.
· Overall, 16% of Canadians who had required health information or advice indicated that they had experienced difficulties accessing care. The rates were significantly lower in Saskatchewan (13%) and Alberta (13%), and significantly higher in Ontario (18%).
Seeking care earlier will make little difference if patients have trouble getting a routine appointment with a doctor. [Back to Top]
Myth No. 10: The free market in health care has failed in the U.S.
What has failed in the U.S. is government micromanagement of the health care system. Over the past 40 years government's role in the health care system has continually expanded, from programs like Medicare, Medicaid and SCHIP, to regulations like HIPPA and COBRA. Like most government interventions, it has only made the problem worse.
The fact is we do not have a free market in health care in the U.S. Ask yourself: How many markets in the U.S. do you get a tax break for buying a product, but only if you buy it through your employer, as we do with health insurance? In how many markets are you prohibited from purchasing a product out of state, as we are with health insurance? In how many markets are employers prohibited from providing bonuses to employees for improving quality and productivity, as hospitals are prevented from doing with doctors? If government policy inhibited other markets that way, those markets would be dysfunctional too.
The solution to our health care problems is to reduce the role of government, not increase it by switching to a single-payer system. [Back to Top]
End quote
My only comment is that "myth" is a very polite and nice and friendly way of wording it. I would use other words
Friday, March 14, 2008
Very Weird Statements in the Health Care Discussion
"America is the only industrialized nation that does not have universal health care"
This is usually written and said with an undertone as if it was something bad, or as if there was something wrong with that fact.
And? So what?
Why should we be like all the rest? Is it bad to be different? Are we back on the school yard, where kids that were different get picked on and bullied? So, we can't be different? What is going on?
Maybe being different is just why the US health care system offers the best quality, maybe that is why people who can truly choose where to get care fly to the US, to Boston, New York, San Francisco, Houston...not to Canada or France or Cuba.
Maybe that is why we are the world leaders in quality and innovation.
Maybe different is good after all. Don't people come to the US because we are different? Because we are just NOT like all the "other industrialized countries"? Why do all those people come to the US, why do they want to immigrate to the US?
I believe we are the leading country in the world. Why should we look at those behind? Why should we choose a system of another country that has not proven its superiority?
Why should the lion copy what the sheep are doing?
But seriously, when I hear people advocating "universal health care" - I do not know if I should laugh or cry....
First, too many of those do not know the difference between "universal health coverage = everybody is covered, everybody has insurance and something very, very different, single payer health care= the government in its infinite wisdom and efficiency administers health care, the dreaded "Medicare for all", think compassion of the IRS combined with the efficiency of the DMV.
I feel like laughing, because it is incredibly nervy and gutsy to actually try to sneakily promote the conversion of a major sector of the economy of the most capitalistic country on the planet
into a socialistic system. The Chutzpah is unbelievable, the nerve, the balls, to even think that. That makes me laugh....
I feel like crying, because all these people are plain ignorant and fall for simplistic arguments that ignore the true causes of spiraling health care costs.
First they have forgotten or never learned and never experienced that the socialistic principle only sounds good on paper. Yes, it is a nice idea, but just an idea. That's all, and we should admire it as what it is. As soon as you turn this nice sounding idea into reality, disaster results. Enough said, just consult your closest history book, I do not need to repeat what is well known.
The sad part is, advocates of a single payer system are unaware (or in plain denial) of the reason for spiraling health care costs: as long as you spend other people's money, you overspend. Also called "Moral hazard" or the "Tragedy of the commons". Or you could call it overconsumption.
As long as everybody spends "other people's money" the increase in health care cost will never stop, not until we are bankrupt.
Someone, somehow has to ration. There are two possibilities:
1. We ourselves spend our health care dollars wisely, we ask our physicians " How can we diagnose and treat this cost effectively"? We make costs truly transparent, so that we can compare prices and quality and shop wisely, like in any other sector of our economy. We have to have a personal stake in health care costs, for example by owning Health Savings Accounts (HSAs), which allow you to keep your health care dollars in your own pocket instead of dumping them in the lap of insurance companies with the opportunities to accumulate money and interest - tax free.
2. We give up on reform and hand it all over to the government, that then institutes cost savings in a one-size-fits-all way, and your health care is dominated by rules set by an anonymous distant "committee". Instead of denial by insurance you will hear "it's not in the budget" "it's not available" and the biggest issue in single payer health care: "get in the waiting line". The waiting line is the symbol of socialized care, for many reasons. Too many for today.
Look at the statistics, before you decide: the cost increase in all health care systems is the same - single payer is NOT the cure for spiraling costs
and look at the statistics for satisfaction of the people: single payer does neither get more nor less satisfaction than our system.
Ever thought why?
Think a little bit, do some research, read about what it really means before advocating something downright dangerous such as single payer health care.
This is usually written and said with an undertone as if it was something bad, or as if there was something wrong with that fact.
And? So what?
Why should we be like all the rest? Is it bad to be different? Are we back on the school yard, where kids that were different get picked on and bullied? So, we can't be different? What is going on?
Maybe being different is just why the US health care system offers the best quality, maybe that is why people who can truly choose where to get care fly to the US, to Boston, New York, San Francisco, Houston...not to Canada or France or Cuba.
Maybe that is why we are the world leaders in quality and innovation.
Maybe different is good after all. Don't people come to the US because we are different? Because we are just NOT like all the "other industrialized countries"? Why do all those people come to the US, why do they want to immigrate to the US?
I believe we are the leading country in the world. Why should we look at those behind? Why should we choose a system of another country that has not proven its superiority?
Why should the lion copy what the sheep are doing?
But seriously, when I hear people advocating "universal health care" - I do not know if I should laugh or cry....
First, too many of those do not know the difference between "universal health coverage = everybody is covered, everybody has insurance and something very, very different, single payer health care= the government in its infinite wisdom and efficiency administers health care, the dreaded "Medicare for all", think compassion of the IRS combined with the efficiency of the DMV.
I feel like laughing, because it is incredibly nervy and gutsy to actually try to sneakily promote the conversion of a major sector of the economy of the most capitalistic country on the planet
into a socialistic system. The Chutzpah is unbelievable, the nerve, the balls, to even think that. That makes me laugh....
I feel like crying, because all these people are plain ignorant and fall for simplistic arguments that ignore the true causes of spiraling health care costs.
First they have forgotten or never learned and never experienced that the socialistic principle only sounds good on paper. Yes, it is a nice idea, but just an idea. That's all, and we should admire it as what it is. As soon as you turn this nice sounding idea into reality, disaster results. Enough said, just consult your closest history book, I do not need to repeat what is well known.
The sad part is, advocates of a single payer system are unaware (or in plain denial) of the reason for spiraling health care costs: as long as you spend other people's money, you overspend. Also called "Moral hazard" or the "Tragedy of the commons". Or you could call it overconsumption.
As long as everybody spends "other people's money" the increase in health care cost will never stop, not until we are bankrupt.
Someone, somehow has to ration. There are two possibilities:
1. We ourselves spend our health care dollars wisely, we ask our physicians " How can we diagnose and treat this cost effectively"? We make costs truly transparent, so that we can compare prices and quality and shop wisely, like in any other sector of our economy. We have to have a personal stake in health care costs, for example by owning Health Savings Accounts (HSAs), which allow you to keep your health care dollars in your own pocket instead of dumping them in the lap of insurance companies with the opportunities to accumulate money and interest - tax free.
2. We give up on reform and hand it all over to the government, that then institutes cost savings in a one-size-fits-all way, and your health care is dominated by rules set by an anonymous distant "committee". Instead of denial by insurance you will hear "it's not in the budget" "it's not available" and the biggest issue in single payer health care: "get in the waiting line". The waiting line is the symbol of socialized care, for many reasons. Too many for today.
Look at the statistics, before you decide: the cost increase in all health care systems is the same - single payer is NOT the cure for spiraling costs
and look at the statistics for satisfaction of the people: single payer does neither get more nor less satisfaction than our system.
Ever thought why?
Think a little bit, do some research, read about what it really means before advocating something downright dangerous such as single payer health care.
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