By E. Roberts Musser –
The current political mantra at both the federal level and here in the state of California is the perceived need for “universal health care”. It is seen as the solution to the crucial issue of health care reform. Rather the more important question should be: “Is universal health care the answer to rising health care costs and the ever increasing number of uninsured, or are there other options to consider that might be better?”
Medicare
Medicare is essentially “universal health coverage” for the elderly throughout the United States. Medicare coverage is provided to those 65 years of age and older, and the disabled (according to federal government standards). So the obvious inquiry is how is the Medicare arrangement working? According to an April 2009 article in the New York Times, Medicare has its dark side.
Just as those who become eligible for Medicare hunt for a doctor willing to take government insurance, they find physicians will not take on new Medicare patients. The following reasons provide the explanation for this alarming trend: 1) reimbursement rates from Medicare are too low to cover actual costs, 2) Medicare paperwork is not worth the aggravation; 3) there is a shortage of doctors nationally.
So what is a patient to do? Many are flocking to urgent care centers, staffed by doctors who perform simple services. The majority of these centers will take Medicare patients. Another, more expensive option is concierge care, where physicians taking Medicare patients charge the patient an annual retainer to get a foot in the doctor’s door. Annual retainers can range anywhere from $1,500 to $15,000 a year, depending on the level of service contracted for.
Massachusetts Model
In April 2006, the state of Massachusetts became the first state in the country to require mandatory health insurance for its citizens. It was hailed by analysts as an “innovative bipartisan plan” representing the centerpiece for “universal” health care law. The purpose of this legislations was twofold: reduction of health care costs, and guaranteeing coverage for all Massachusetts residents.
As indicated in a Fall, 2008 article in The Objective Standard, the Massachusetts plan consisted of the following elements:
- Establishment of a quasi-governmental authority, to serve as a clearinghouse through which individuals could purchase state-approved plans;
- Every resident would be required to purchase a health insurance plan, either from a private insurer or through the state;
- Residents who could not afford insurance would have their expenses subsidized by the state in part or full, depending on level of income;
- Employers with more than ten employees would be required to provide health insurance for their workers or pay a special fee to subsidize coverage of low income individuals.
How has the Massachusetts model fared? The results are grim at best. The plan has increased costs for individuals and the state; reduced revenues for doctors and hospitals to the point where patients cannot obtain adequate care; and left officials admitting “universal coverage is not likely to be universal any time soon”. Why did this happen?
Costs of health insurance for Massachusetts residents has risen dramatically because the government was allowed to define what constitutes an acceptable policy. In consequence, special interest groups lobbied politicians to include their pet benefits as part of the government approved plan, typified by in vitro fertilization and alcoholism therapy. These more exotic mandated benefits raised the costs of health insurance in Massachusetts from 23% to 56%, 85% more than originally projected.
Because of increasing costs, the state government cut payments to doctors and hospitals. Often state insurance reimbursement payments do not cover expenses. As a result of rising costs and falling revenues to the state, access to medical care has dwindled for many patients. Fewer doctors are willing to take on new patients with government insurance for fear of losing money. State reimbursement paperwork is a veritable “nightmare”. Thus patients face long waits for basic medical care.
These problems are only going to worsen with time. Massachusetts insurance prices will rise 10 percent or more next year, twice the rate of increase for the national average. State subsidies are expected to double over the next three years. Accordingly, the state has asked the federal government for assistance w its shortfall. State tax increases are in the offing, with businesses and insurers soon required to pay more to fund the program. Payments to doctors and hospitals will be slashed again, making it that much harder to obtain access to medical care.
Canadian System
Based on a Summer 2007 piece in the City Journal, written by Canadian author David Gratzer, Canada has a single-payer system, in which the government finances and provides all health care, often referred to as “socialized medicine”. Similar socialized medicine structures are found throughout Europe, such as in France, Great Britain, and Sweden. The myth is that Canada’s health care system is entirely government run. And how well is the Canadian system working?
A new trend in Canadian health care has appeared on the scene: to find needed treatment in another country (particularly the United States), then sue Canadian bureaucrats to pay for it. Why? Because at a time when Canada’s population is aging and needs more care rather than less, the bean counters in the Canadian government have drastically cut costs, reducing the size of medical school classes, closed hospitals, and capped doctor’s fees. Patients are suffering and dying from the severe delays. This unfortunate state of Canadian health care is chronicled in Mr. Gratzer’s 1999 book, Code Blue.
Things have gotten so out of hand another new phenomenon has emerged in Canada – “medical brokers”. Canadians will often pay a broker to set up medical services quickly – private medical services found not only outside Canada but within the country itself. Fed up with the situation, Canadian doctors are setting up their own private clinics. This privatizing trend in socialized medicine is reaching Europe as well. Ironically, as the United States heads toward socialized medicine, socialized medicine is heading towards privatization!
According to a March 2005 CBS News article, Ontarians spend about 40% of every tax dollar on health care. As maintained by the Canadian Taxpayers Federation, the Canadian health care system is going broke. The federal government and virtually every province acknowledges there is a national crisis in Canadian health care: lack of doctors, nurses, equipment, funding. Those with connections jump to the head of the medical queue, and those that can afford it get treated in the U.S.
Health Care in the United States
Canadian author Gratzer points out that if we measure a health-care system by how well it serves its sick citizens, American health wins hands down. The American five year cancer survival rate for leukemia is 50 percent, whereas the European rate is just 35 percent. The survival rate for prostate cancer in the United States is 81.2 percent, yet only 61.7 percent in France and a mere 44.3 percent in England.
The life expectancy rate for Americans may be slightly lower (75.3 years) than that of Canadians (77.3 years) or the French (76.6 years). However we don’t kill off our ill, as other countries do – when socialized medicine systems fail to provide necessary health care. The interesting thing is Americans who don’t die in car crashes or homicides outlive people in any other Western country. One wonders if American politicians shouldn’t be more aggressively addressing the problem of drunk driving and unacceptably high crime rates in this country.
A panel of health care professionals and analysts discussed health care reform at Baldwin-Wallace College in March of 2009. Many ideas were offered, but it became clear caregivers, patients and insurers may not be willing to make the sacrifices necessary to support quality health care for all. The conclusions reached are listed below:
- Doctors would have to accept less payment and do more to keep patients well;
- Patients would have to take responsibility for living healthier lifestyles and pay for some of their care;
- Private insurers would have to accept lower profits and executive compensation. All insurers, including Medicare/Medicaid, would have to find ways to get everyone in the system to minimize cost and maximize benefits.
- Drug and device makers would have to accept reasonable payments for their products and develop products that save money.
The Objective Standard offers the following thoughts for health care reform:
- Eliminate insurance benefit mandates and other laws that prohibit individuals from purchasing insurance across state lines.
- Permit all individuals to establish Health Savings Accounts to pay for small routine expenses, so insurers can offer lower cost, catastrophic-only insurance policies.
- Allow individuals to purchase health insurance with pretax dollars, which would eliminate the tax penalty incurred when health insurance is purchased separate from employer offerings.
Conclusion
There is an old adage which comes to mind, which I think applies in the naïve and frantic scurry to institute “universal health care“: “Fools rush in where angels fear to tread.” It is obvious, if one does the requisite research, currently existing forms of universal health care have serious, inherent problems. I believe this is why some politicians, such as our very own Senator Lois Wolk, are hesitant to jump on the universal health care bandwagon. It would seem imprudent to introduce a scheme into the equation, that doesn’t pencil out as effective.
Lesson to be learned: With any plan of action, the devil is in the details. There must be more than just a wish list, when creating a program. It is imperative proper examination be undertaken – to determine what has worked, what hasn’t done well, and analyze why.
I found the Massachuset analysis very interesting; I don’t have any other knowledge of that state’s health care plan, but I’m not surprised that private enterprise has found ways to open the government money spigot. That is the mission of private enterprise and governments are easy prey.
The Canadian system, similarly, has generated private profiteers. Well, one can always opt to pay more. Why shouldn’t those who can buy more, buy more? The important isssue is whether basic health care is available to all Cancadians. The level of health care provided would, necessarily, be determined by what the economy can support. “Basic” requires minmal cost, prolongs life without extreme, invasive techniques. “Basic” should include prenatal care, pediatric clinics, preventive health for all and routine care of chronic diseaes as hypertension and diabetes. This will go a long way towards improving the quality of life and prolonging life. Difficult medical/ethical decisions will have to be made for care that is beyond what the economy can support.
I strongly object to the “cherry picking” of US health statistics. Don’t tell me we do a good job of caring for all our citizens. I know we rank among third world contries in infant mortality and that is a disgrace. Our system provides health to the hilt and above for the wealthy and good luck to everyone else. Private inusrers and phrmaceutical companies profit at the expense of the nations’ health. Preventive medicine and evidence based medicine do not generate the obscene profits demanded by these industries. We can do a lot better than this.
Finally, I do believe that universal coverage is essential because this spreads the differing health costs across the population. Costs for medical care change throughout the life cycle.
For the other side of the story you can listen to me interview Jessica Rothhaar from Health Access last night on Vanguard Radio ([url]https://davisvanguard.org/index.php?option=com_content&view=article&id=2745:vanguard-radio-april-15-health-care&catid=45:radio&Itemid=72[/url]).
“The Canadian system, similarly, has generated private profiteers. Well, one can always opt to pay more. Why shouldn’t those who can buy more, buy more? The important isssue is whether basic health care is available to all Cancadians. The level of health care provided would, necessarily, be determined by what the economy can support. “Basic” requires minmal cost, prolongs life without extreme, invasive techniques. “Basic” should include prenatal care, pediatric clinics, preventive health for all and routine care of chronic diseaes as hypertension and diabetes. This will go a long way towards improving the quality of life and prolonging life. Difficult medical/ethical decisions will have to be made for care that is beyond what the economy can support.”
But that is the exact problem with the Canadian system. It cannot afford to provide basic health care. Here are excerpts from research articles written by Canadians –
“…people like the elderly woman who needed vascular surgery for a major artery in her abdomen and was promised prompt care by one of the most senior bureaucrats in the government, who never called back”. (The woman obtained the necessary surgery in the United States.)
“Then there was the 8 year old badly in need of a procedure to help correct her deafness. After watching her surgery get bumped three times, her parents called [a medical broker to have her surgery done outside Canada)… She’s now back at school, her hearing partly restored.”
“Another sign of transformation: Canadian doctors, long silent on the health care system’s problems, are starting to speak up”. “[Brian] Day [President of the national medical association in Canada] has nevertheless become perhaps the most vocal critic of Canadian public health care…”This is a country in which dogs can get a hip replacement in under a week”, he fumed to the New York Times, “and in which humans can wait two to three years.””
“Another watershed lawsuit was filed last year against 12 Quebec hospitals on behalf of 10,000 breast-cancer patients in Quebec who had to wait more than 8 weeks for radiation therapy…”
In point of fact, Canadians are turning to health care in the United States, because they cannot get BASIC CARE in their own country.
“I strongly object to the “cherry picking” of US health statistics. Don’t tell me we do a good job of caring for all our citizens.”
I suspect statistics showing America is poorer in health care standards than those with socialized medicine has been “cherry picked”, and I will explain why. When you have a health care system that is determined to save life at whatever the cost (America), then lives are saved that will most certainly have future medical problems and a shorter life span. Those less healthy lives are factored into the statistics. Lets take the example you gave, infant mortality. I suspect that we do more to save marginal babies with severe health problems than other countries do. But because we do, it probably drives up our infant mortality rate. Statistical analysis is a tricky business, and can be twisted to prove whatever assumption the author is trying to bolster.
“Finally, I do believe that universal coverage is essential because this spreads the differing health costs across the population.”
But what do you mean by “universal coverage”? A Medicare style system? A Massachusetts style system? A Canadian style system? All of them are very problematic, with serious deficiencies. In fact there is a common thread that runs through all of them – a shortage of doctors and long waits for basic health care. People are suffering and dying waiting for proper medical care in Canada, France, Great Britian, Sweden.
Do I think we have problems with our health care system? Yes, I do. I’m just not certain “universal health coverage” is the answer to the problem. The research just doesn’t bear out the theory that universal health care is better than what we already have. I want IMPROVEMENT to our health care system, not a worsening of it.
I strongly object to the “cherry picking” of US health statistics. Don’t tell me we do a good job of caring for all our citizens. I know we rank among third world contries in infant mortality and that is a disgrace.
The Musser woman brought up a good point I think. She touched up on how complicated health care is. I’m not going to say absolutely that I’m against universal health care, but one thing is for sure: before any of our politicians touch it, they damn better well know what they are doing and think through all of the issues before they go messing around with the system, which I admit is not perfect. If our politicians really want universal health care, they have work to do, not simply pump billions of dollars into a managed health system that may or may not be effective. I take issue with your comment: you say she cherry picked the statistics about cancer and lukemia, but then you cherry pick the infant mortality rate.
“I’m not going to say absolutely that I’m against universal health care, but one thing is for sure: before any of our politicians touch it, they damn better well know what they are doing and think through all of the issues before they go messing around with the system, which I admit is not perfect.”
This is exactly right. Massachusetts tried universal health insurance, and ended up with a mess that the federal government may have to bail them out of. As a nation, we are in no position to try social experiments that may end up costing more than they are worth. If we want to make changes, we had better be sure they are likely to work to solve the problems and will be fiscally feasible/responsible. What I see is a rush to make changes, changes that have not been well thought out or investigated.
OK! A good discussion on epidemiology! So how does one measure the health status of a community? Speaking as someone who has a Masters in Epidemiology and who has taught the subject at the university level, I am not cherry picking in citing infant mortality rates. This measure is accepted in the public health field as an indicator of the health of a society (nutrition, education, the adquacy of its medical care). Other indicator are the cause specific death rates, cause specific morbidity rates (disease without death, life expenctancy. All of these indices can and should be subject to critical examinations of how the numbers were determined and whether the numberators and denomitators are appropriately paired and what they do and do not tell you. Numbers do not lie; it is people who do not understand what the numbers mean that find them useless. However tricky,the above indices are standard, well accepted measures of the health of a community.
The point that we have high infant deaths because we are saving very low weight newborns is appreciated. That is, exactly where are medical system is going a bit overboard. I question the extreme measures to save lives at the extreme ends of the life span. These are the difficult medical/ethical issues that I referred to. Is it wise for a society to use every new and expensive medical technology available in the first and last few of weeks/months of life?
Focusing on the adequacy of health covereage, I would add to this standard list of indicators, the proportion of people who are lack health insurance and the proportion of the national and individual budgets that is spent on health care. Never has so much money been spent on such poor results.
The US leads the developed world in those that lack medical insurance and in private and government medical costs. There are sharp and possibly worsening discrepancies in life expenctancy between blacks and whites in the US. This likely reflects, not only differences in access to medical care, but differences in education and life style choices. And life style choices are not entirely up to the individual, as many unhealthy habits are aggressively advertised (cigarettes, fast and fatty foods). It is this unfairness of our medical system that I object to and it is the increasing split between the haves and have nots of our nation that is leading to popular rage. Enough already!
I’m not impressed with anecdotal evidence. The vascualr surgery on an abdominal artery sounds like an aneurism; surgery is indicated dependent on the size of the aneurism.It is standard medical policy in the US to follow anuerisms with ultrasound until it reaches a concerning size and then surgery is indicated. There is not enough medical information in this anecdote to know what’s going on. As for the eight year old needed ear surgery, would an equivalent eight year old get immediate surgery in the US? It will, most likely, depend on her insurance. As for Canadian doctors being unhappy, do we know if it is their paychecks that hurt them? It is a fact that US docs who do invasive procedures are well rewarded in $$$, while US docs who provide primary care are barely able to afford their malpractice insurance and the enormous clerical staff required to process the paper work for insurnace claims. I had two Canadians in my medical school class who often said how disgusting their payment system is and that’s why they chose to practice in the US.
Finally, when I advocate universal health coverage, I explain that this will allow risks to be spread across the entire population. Dropping patietns for prior conditions is foul play. I am not advocating any one system of providing universal health care; that is certainly risky behavior. I don’t know that any country has figured this problem out and I’m not defending or campioning the Canadian model. I’m glad they’re trying; we can learn from their mistakes and those of other governments who are working on this problem. It’s not bee perfect anywhere yet.
This is such an enourmous topic and I am so concerned with sloppy thinking that much of the above just spilled out on the keyboard. Forgive me for not taking more time, but the morningis running away.
“The US leads the developed world in those that lack medical insurance and in private and government medical costs. There are sharp and possibly worsening discrepancies in life expenctancy between blacks and whites in the US.”
Just bcause someone is “insured” doesn’t amount to a hill of beans if that person cannot quickly get the problem fixed. If I have a major cancer or illness, what is the likelihood it will be removed efficently?
I don’t know why you brought up the race issue. Considering that many countries are more homogeneous societies than ours, this is misleading anyway. How can you measure blacks vs. whites in China for Example, India, Iraq,and Mexico since it is those countries that largely dont have black and white people?
“This likely reflects, not only differences in access to medical care, but differences in education and life style choices. And life style choices are not entirely up to the individual, as many unhealthy habits are aggressively advertised (cigarettes, fast and fatty foods).”
Even though those things are advertised, the individual has some responsibility for that. But it doesn’t matter. There are other factors which play into whether a person gets sick or not.
“It is this unfairness of our medical system that I object to and it is the increasing split between the haves and have nots of our nation that is leading to popular rage. Enough already!”
Yes. Rage in people like me who don’t want to turn a discussion on health care into a discussion on rich vs. poor. Next thing we’ll be talking about O.J. Simpson.
“However we don’t kill off our ill, as other countries do – when socialized medicine systems fail to provide necessary health care. “
This is an interesting point. I have never thought that.
I don’t know that any country has figured this problem out and I’m not defending or campioning the Canadian model. I’m glad they’re trying;
They are trying and failing. According to the article, the Canadians are using us to get their health care. That doesn’t sound like universal health care at all.