www.byzcath.org Forums General Discussions Town Hall Union thugs attack conservatives protesting socialized healthcare

My previous comment was intended as a response to the original post.

From a French journalist, writing in The Wall Street Journal [mobile2.wsj.com]

AUGUST 7, 2009

France Fights Universal Care's High Cost
By DAVID GAUTHIER-VILLARS

When Laure Cuccarolo went into early labor on a recent Sunday night in a village in southern France, her only choice was to ask the local fire brigade to whisk her to a hospital 30 miles away. A closer one had been shuttered by cost cuts in France's universal health system.

Ms. Cuccarolo's little girl was born in a firetruck.

France claims it long ago achieved much of what today's U.S. health-care overhaul is seeking: It covers everyone, and provides what supporters say is high-quality care. But soaring costs are pushing the system into crisis. The result: As Congress fights over whether America should be more like France, the French government is trying to borrow U.S. tactics.

In recent months, France imposed American-style "co-pays" on patients to try to throttle back prescription-drug costs and forced state hospitals to crack down on expenses. "A hospital doesn't need to be money-losing to provide good-quality treatment," President Nicolas Sarkozy thundered in a recent speech to doctors.

And service cuts -- such as the closure of a maternity ward near Ms. Cuccarolo's home -- are prompting complaints from patients, doctors and nurses that care is being rationed. That concern echos worries among some Americans that the U.S. changes could lead to rationing.

The French system's fragile solvency shows how tough it is to provide universal coverage while controlling costs, the professed twin goals of President Barack Obama's proposed overhaul.

French taxpayers fund a state health insurer, Assurance Maladie, proportionally to their income, and patients get treatment even if they can't pay for it. France spends 11% of national output on health services, compared with 17% in the U.S., and routinely outranks the U.S. in infant mortality and some other health measures.

The problem is that Assurance Maladie has been in the red since 1989. This year the annual shortfall is expected to reach €9.4 billion ($13.5 billion), and €15 billion in 2010, or roughly 10% of its budget.

France's woes provide grist to critics of Mr. Obama and the Democrats' vision of a new public health plan to compete with private health insurers. Republicans argue that tens of millions of Americans would leave their employer-provided coverage for the cheaper, public option, bankrupting the federal government.

Despite the structural differences between the U.S. and French systems, both face similar root problems: rising drug costs, aging populations and growing unemployment, albeit for slightly different reasons. In the U.S., being unemployed means you might lose your coverage; in France, it means less tax money flowing into Assurance Maladie's coffers.

France faces a major obstacle to its reforms: French people consider access to health care a societal right, and any effort to cut coverage can lead to a big fight.

For instance, in France, people with long-term diseases get 100% coverage (similar to, say, Medicare for patients with end-stage kidney diseases). The government proposed trimming coverage not directly related to a patient's primary illness -- a sore throat for someone with diabetes, for example. The proposal created such public outcry that French Health Minister Roselyne Bachelot later said the 100% coverage rule was "set in stone."

"French people are so attached to their health-insurance system that they almost never support changes," says Frédéric Van Roekeghem, Assurance Maladie's director.

Both patients and doctors say they feel the effects of Mr. Sarkozy's cuts. They certainly had an impact on Ms. Cuccarolo of the firetruck birth.

She lives near the medieval town of Figeac, in southern France. The maternity ward of the public hospital there was closed in June as part of a nationwide effort to close smaller, less efficient units. In 2008, fewer than 270 babies were born at the Figeac maternity ward, below the annual minimum required of 300, says Fabien Chanabas, deputy director of the local public hospital.

"We were providing good-quality obstetric services," he says. "But at a very high cost." Since the maternity closed, he says, the hospital narrowed its deficit and began reallocating resources toward geriatric services, which are in high demand.

In the Figeac region, however, people feel short-changed. "Until the 1960s, many women delivered their babies at home," says Michel Delpech, mayor of the village where Ms. Cuccarolo lives. "The opening of the Figeac maternity was big progress. Its closure is perceived as a regression."

For Ms. Cuccarolo, it meant she would have to drive to Cahors, about 30 miles away. "That's fine when you can plan in advance," she says. "But my little girl came a month earlier than expected."

France launched its first national health-care system in 1945. World War II had left the country in ruins, and private insurers were weak. The idea: Create a single health insurer and make it compulsory for all companies and workers to pay premiums to it based on a percentage of salaries. Patients can choose their own doctors, and -- unlike the U.S., where private health insurers can have a say -- doctors can prescribe any therapy or drug without approval of the national health insurance.

Private insurers, both for-profit and not-for-profit, continued to exist, providing optional benefits such as prescription sunglasses, orthodontics care or individual hospital rooms.

At a time when the U.S. is considering ways of providing coverage for its entire population, France's blending of public and private medical structures offers important lessons, says Victor Rodwin, professor of health policy and management at New York University's Wagner School. The French managed to design a universal system incorporating physician choice and a mix of public and private service providers, without it being "a monolithic system of Soviet variety," he says.

It took decades before the pieces fell into place. Only in 1999 did legislation mandate that anyone with a regular residence permit is entitled to health benefits with no strings attached. Also that year, France clarified rules for illegal residents: Those who can justify more than three months of presence on French territory, and don't have financial resources, can receive full coverage.

That made the system universal.

In the U.S., health-overhaul bills don't attempt to cover illegal immigrants. Doing so would increase costs and is considered politically difficult.

Today, Assurance Maladie covers about 88% of France's population of 65 million. The remaining 12%, mainly farmers and shop owners, get coverage through other mandatory insurance plans, some of which are heavily government-subsidized. About 90% of the population subscribes to supplemental private health-care plans.

Proponents of the private-based U.S. health system argue that competition between insurers helps provide patients with the best possible service. In France, however, Assurance Maladie says its dominant position is its best asset to manage risks and keep doctors in check.

"Here, we spread health risks on a very large base," says Mr. Van Roekeghem of Assurance Maladie.

“Even with all its disadvantages, the French national health-care plan is glaringly better and more cost effective than ours.”

The quasi-monopoly of Assurance Maladie makes it the country's largest buyer of medical services. That gives it clout to keep the fees charged by doctors low. About 90% of general practitioners in France have an agreement with Assurance Maladie specifying that they can't charge more than €22 (about $32) for a consultation. For house calls they can add €3.50 to the bill.

By comparison, under Medicare, doctors are paid $91.97 for a first visit and $124.97 for a moderately complex consultation, according to the American College of Physicians.

In France, "If you are in medical care for the money, you'd better change jobs," says Marc Lanfranchi, a general practitioner from Nancy, an eastern town. On the other hand, medical school is paid for by the government, and malpractice insurance is much cheaper.

In 2000, the World Health Organization ranked France first in a one-time study of the health-care services of 191 countries. The U.S. placed 37th.

Financial pain has long dogged the French plan. As in the U.S., demand for care is growing faster than the economy as people take better care of themselves and new treatments become available.

Since the 1970s, almost all successive French health ministers have tried to reduce expenses, but mostly managed to push through only minor cost cuts. For instance, in 1987, patients were required to put a stamp on letters they mailed to the national health insurer. Previously, postage was government-subsidized.

In 2004, France introduced a system under which patients must select a "preferred" general practitioner who then sends them onward to specialists when necessary. Under that policy -- similar to one used by many private U.S. health-care plans -- France's national health insurance reimburses only 30% of the bill, instead of the standard 70%, if patients consult a doctor other than the one they chose.

At the start, patients balked, saying it infringed on their right to consult the doctors of their choice. But the system is now credited for helping improve the coordination between primary and specialty care, which remains one of the main weakness in the U.S. health-care system.

In recent years, Assurance Maladie has focused on reducing high medicine bills. Just like U.S. insurers and pharmacy-benefit managers, France's national health insurer is promoting the use of cheaper generic drugs, penalizing patients when they don't use them by basing reimbursements on generic-drug prices.

The most important aspect of Mr. Sarkozy's latest health-care legislation, passed this summer, focuses on reducing costs at state hospitals. About two-thirds of France's hospitals are state-run, and they are seen as ripe for efficiency savings. Among other things, Mr. Sarkozy has asked them to hire more business managers and behave more like private companies, for instance, by balancing their budgets.

The proposals didn't go down well.

In April, some of France's most famous doctors signed a petition saying they feared Mr. Sarkozy would turn health care into a "lucrative business" rather than a public service.

In the U.S., hospitals are paid for each individual procedure. This system, called fee-for-service, is suspected of contributing to runaway costs because it doesn't give hospitals an incentive to limit the number of tests or procedures.

Ironically, France is actually in the midst of shifting to a fee-for-service system for its state-run hospitals. The hope is that it will be easier for the government to track if the money is being spent efficiently, compared with the old system of simply giving hospitals an annual lump-sum payment.

France's private hospitals are more cost-efficient. But state hospitals say it is unfair to compare the two, because state hospitals often handle complex cases that private hospitals can't.

"When a private hospital has trouble with a newborn baby, we are here to help, night and day," says Pascal Le Roux, a pediatrician at the state hospital in Le Havre, an industrial city in northern France. "Having people standing by costs money."

In theory, Assurance Maladie should be able to contain hospital costs the same way it does with doctors: by harnessing its position as the dominant payer in the health-care system. In practice, it doesn't work that way.

The state hospital of Le Havre, called Groupement Hospitalier du Havre, or GHH, has nearly 2,000 beds and is one of the most financially strapped in France. A 2002 report by France's health-inspection authority found that the hospital had a track record of falsifying accounts in order to obtain more state funds.

Philippe Paris was hired about two years ago to help fix the hospital's spiraling costs. He is cutting 173 jobs out of the staff of 3,543.

And he is trying to enforce working hours. "People don't work enough," he said. "If consultations are scheduled to begin at 8 a.m., that means 8 a.m. and not 11 a.m."

Yet even the smallest budget moves are proving controversial. Local residents are up in arms over a cost-cutting measure that makes patients pay €1.10 an hour to park at the hospital. "It's a scandal," says retired local Communist politician Gérard Eude. "It goes against the very idea of universal health care."

Write to David Gauthier-Villars at David.Gauthier-Villars@wsj.com

From National Review Online [article.nationalreview.com]

Government Medicine Kills
The U.K. and Canada prove it.

By Deroy Murdock

Imagine that your two best friends are British and Canadian tobacco addicts. The Brit battles lung cancer. The Canadian endures emphysema and wheezes as he walks around with clanging oxygen canisters. You probably would not think: “Maybe I should pick up smoking.”

The fact that America is even considering government medicine is equally wacky. The state guides health care for our two closest allies: Great Britain and Canada. Like us, these are prosperous, industrial, Anglophone democracies. Nevertheless, compared to America, they suffer higher death rates for diseases, their patients experience severe pain, and they ration medical services.

Look what you’re missing in the U.K.:

Breast cancer kills 25 percent of its American victims. In Great Britain, the Vatican of single-payer medicine, breast cancer extinguishes 46 percent of its targets.

Prostate cancer is fatal to 19 percent of its American patients. The National Center for Policy Analysis reports that it kills 57 percent of Britons it strikes.

Organization for Economic Cooperation and Development data show that the U.K.’s 2005 heart-attack fatality rate was 19.5 percent higher than America’s. This may correspond to angioplasties, which were only 21.3 percent as common there as here.

The U.K.’s National Institute of Health and Clinical Excellence (NICE) just announced plans to cut its 60,000 annual steroid injections for severe back-pain sufferers to just 3,000. This should save the government 33 million pounds (about $55 million). “The consequences of the NICE decision will be devastating for thousands of patients,” Dr. Jonathan Richardson of Bradford Hospitals Trust told London’s Daily Telegraph. “It will mean more people on opiates, which are addictive, and kill 2,000 a year. It will mean more people having spinal surgery, which is incredibly risky, and has a 50 per cent failure rate.”

“Seriously ill patients are being kept in ambulances outside hospitals for hours so NHS trusts do not miss Government targets,” Daniel Martin wrote last year in London’s Daily Mail. “Thousands of people a year are having to wait outside accident and emergency departments because trusts will not let them in until they can treat them within four hours, in line with a Labour [party] pledge. The hold-ups mean ambulances are not available to answer fresh 911 calls. Doctors warned last night that the practice of ‘patient-stacking’ was putting patients’ health at risk.”

Things don’t look much better up north, under Canadian socialized medicine.

Canada has one-third fewer doctors per capita than the OECD average. “The doctor shortage is a direct result of government rationing, since provinces intervened to restrict class sizes in major Canadian medical schools in the 1990s,” Dr. David Gratzer, a Canadian physician and Manhattan Institute scholar, told the U.S. House Ways & Means Committee on June 24. Some towns address the doctor dearth with lotteries in which citizens compete for rare medical appointments.

“In 2008, the average Canadian waited 17.3 weeks from the time his general practitioner referred him to a specialist until he actually received treatment,” Pacific Research Institute president Sally Pipes, a Canadian native, wrote in the July 2 Investor’s Business Daily. “That’s 86 percent longer than the wait in 1993, when the [Fraser] Institute first started quantifying the problem.”

Such sloth includes a median 9.7-week wait for an MRI exam, 31.7 weeks to see a neurosurgeon, and 36.7 weeks — nearly nine months — to visit an orthopedic surgeon.

Thus, Canadian supreme court justice Marie Deschamps wrote in her 2005 majority opinion in Chaoulli v. Quebec, “This case shows that delays in the public health care system are widespread, and that, in some cases, patients die as a result of waiting lists for public health care.”


Obamacare proponents might argue that their health reforms are neither British nor Canadian, but just modest adjustments to America’s system. This is false. The public option — for which Democrats lust — would fuel an elephantine $1.5 trillion overhaul of this life-and-death industry. Having Uncle Sam in the room while negotiating drug prices and hospital reimbursement rates will be like sitting beside Warren Buffett at an art auction. Guess who goes home with the goodies?

A public option is just the opening bid for eventual nationalization of American medicine. As House Banking Committee chairman Barney Frank (D., Mass.) told SinglepayerAction.Org on July 27: “The best way we’re going to get single payer, the only way, is to have a public option to demonstrate its strength and its power.”

Barack Obama seconds that emotion.

“I don’t think we’re going to be able to eliminate employer coverage immediately,” Obama told a March 24, 2007 Service Employees International Union health-care forum. “There’s going to be potentially some transition process. I can envision [single payer] a decade out or 15 years out or 20 years out.” As he told the AFL-CIO in 2003: “I happen to be a proponent of single-payer, universal health-care coverage. . . . That’s what I’d like to see.”

And why a public option just for medicine? Wouldn’t government clothing stores be best suited to furnish the garments Americans need to survive each winter? And why not a public option for restaurants? Shouldn’t Americans have universal access to fine dining?

All kidding aside, government medicine has proved an excruciating disaster in the U.K. and Canada. Our allies’ experiences with this dreadful idea should horrify rather than inspire everyday Americans, not to mention seemingly blind Democratic politicians.

— Deroy Murdock is a columnist with the Scripps Howard News Service and a media fellow with the Hoover Institution on War, Revolution and Peace at Stanford University.

What I don't understand is why we can't get both sides to drop this as an issue around which to rally their respective bases and agree to fix the problem. Alas, I suppose that is the nature of the beast.

I personally have no ideological opposition to a government financed program; however, I do agree with John when he says that he supports government financed but not government run programs. But do we really need a government financed program that is universal in scope? Probably not.

Many full-time workers have adequate group coverage through their employers. Often these plans leave a bit to be desired, but I believe that they are generally adequate. There is the Medicare option for those 65 and older. Medicare certainly has problems that need to be fixed, but like the employer sponsored plans so many American workers have, it is generally adequate. Colleges and universities often offer group coverage to students who are enrolled full-time or even half-time. I had this sort of coverage for the five years I was a student at Duke Divinity School, and it was certainly adequate. Then we have the Medicaid option for the poor. Like any other option, it is not perfect, but I believe it to be generally adequate.

So who's left out? Those who are self-employed, those who are employed only on a part-time basis, and some who are employed full-time but whose employers choose not to offer health insurance. Why can't we focus on helping people in these categories, rather than trying to force universal coverage when there are so many who don't want it?

Buying private coverage is often not much of an option. For example, my wife and I have a combined annual gross income of around $90,000. If our employers did not offer us health insurance, private coverate would not be a realistic option for us, as I've explained in an earier post in this thread. For me, this is just one of several reasons why I have no desire to be self-employed or to work for a small business. However, small businesses play a very important role in our communities, and I don't like the idea that small businesses might be forced out of the market due to the issue of health care. Why not provide a government sponsored option comparable to Medicare for people under age 65 whose incomes are too high to qualify for Medicaid but for whom individual, private coverage is an unrealistic option?

Ryan

This assumes that both sides see the problem in the same way. Liberals tend to see the problem as a lack of universal access to health care, while conservatives see the problem as government distortions of the free market that tend to make health care too expensive for everyone to afford.

Specifically, conservatives believe that the current tax system encourages third party payment through subsidization of employer provided health care, which in turn removes any sort of price discipline (as well as forcing employees to adopt non-portable, one-size fits all policies).

To make health care more affordable and to control costs, conservatives advocate making individuals responsible for their own health care expenses through such approaches as individual deductions for health insurance, interstate competition among health insurance providers, tax-exempt health savings accounts with employer matching (with which individuals can buy insurance and meet out-of-pocket expenses, pocketing and carrying over from year to year any surplus they may accrue).

When people are responsible for buying something, they insist upon value for money and make rational decisions about alternative choices. It's called, um, "freedom".

Liberals, on the other hand, really do believe that people are too stupid to look out for their own interests (as a fellow at a liberal think tank in Washington, I get to hear what these people say when out of earshot of cameras and microphones), and that only government can ensure the public good. Actually, this has been tried, in many places, in many forms, and it has never worked, but the real reason they insist on a governmental approach is, put bluntly, power. By regulating health care, they can insert themselves into the minutiae of personal life on an unprecedented scale, and believe me, these people are inveterate meddlers. Their personal lives may be a wreck, they may be incapable of balancing their own checkbooks, buying their own groceries, or fixing their own faucets, but they know what's best for you, and they are determined to do so. Not having any other discernible skills than interfering in the lives of others, this is the only think they know how to do, and not to do it would go against their very natures.

Stuart:

Although I don't consider myself to be a conservative, I'm certainly willing to listen to and be open to being persuaded by strong, rational arguments from the conservative side. Your previous post would stand a much better chance of doing that without the final insulting paragraph.

Ryan

I think that at some point America might need to get away from employer-provided coverage altogether. Such coverage arose more-or-less as an employer response to FDR socialism/taxes in the decades after WWII. Taxes were high, so giving employees benefits were a substitute for higher wages. The down side is that insurance was not portable and some people stayed tied to jobs they didn't like because of the health insurance it provided. I'd prefer a much more open competition, with Americans having the ability to purchase health insurance from not just BC/BS but also places like Duke Divinity School, the Elks Club and even Walmart. It is true that there will always be some corruption, but there is less in captialisim when companies compete then there is with socialism when the government monopoly destroys private companies.

We can. But those who want single-payer socialist health care are fighting it tooth and nail. There was a good bill in Congress back in the late 1980s but Sen. Ted Kennedy was too powerful and hijacked it to create HMOs (which he now lambasts becase they did not work out the way he expected). The current debate has little to do with health care and everything to do with power. Some in Congreess want the power that comes with controlling the health care of everyone. Imagine being told you cannot eat those potato chips because you are too fat. And because you ate those potato chips and are too fat you will not get health care coverage. That is happening in England where some are denied their national health coverage because they smoke or are alcoholics.

Such can be done without the government running it. Right now many rules and regulations prohibit small businesses from forming groups to obtain better rates for health care. The best thing the government could do would be to allow full competition - including across state lines (meaning that if you are stuck in Maine with almost no companies offering health insurance due to very restrictive regulations you can buy your health insurance from a company in another state where there are 30 companies looking for your business). I agree with Ryan that there is a lot that can be done, but unfortunately the current debate is less about health care and more about power. If you watch the videos of President Obama he says that the "public option" is a necesary step to single payer because they could never get Americans to give up their current health care. Barny Frank reaffirmed this just a few weeks ago.

As to Stuart's final paragraph I do not think it is directed at Ryan or anyone here. The "liberal elite" is certainly on record as stating that most Americans are too stupid to manage their own interests. Why do you think the blue areas along both coasts refer to the rest of the country as "flyover territory"?

I said government sponsored, not government run, but I have no objection to John's proposal. My concern is with making health care accessible for everyone. I have no ideological commitment to a government program.

Yes, I should have been clearer. It is the President and many of those people in Congress who want government-run health care.

Here is an interesting white paper from The National Center for Policy Analysis (NCPA) [ncpa.org] .

10 Surprising Facts about American Health Care
No. 649
Tuesday, March 24, 2009
by Scott Atlas

Medical care in the United States is derided as miserable compared to health care systems in the rest of the developed world. Economists, government officials, insurers and academics alike are beating the drum for a far larger government rôle in health care. Much of the public assumes their arguments are sound because the calls for change are so ubiquitous and the topic so complex. However, before turning to government as the solution, some unheralded facts about America's health care system should be considered.

Fact No. 1: Americans have better survival rates than Europeans for common cancers.[1] Breast cancer mortality is 52 percent higher in Germany than in the United States, and 88 percent higher in the United Kingdom. Prostate cancer mortality is 604 percent higher in the U.K. and 457 percent higher in Norway. The mortality rate for colorectal cancer among British men and women is about 40 percent higher.

Fact No. 2: Americans have lower cancer mortality rates than Canadians.[2] Breast cancer mortality is 9 percent higher, prostate cancer is 184 percent higher and colon cancer mortality among men is about 10 percent higher than in the United States.

Fact No. 3: Americans have better access to treatment for chronic diseases than patients in other developed countries.[3] Some 56 percent of Americans who could benefit are taking statins, which reduce cholesterol and protect against heart disease. By comparison, of those patients who could benefit from these drugs, only 36 percent of the Dutch, 29 percent of the Swiss, 26 percent of Germans, 23 percent of Britons and 17 percent of Italians receive them.

Fact No. 4: Americans have better access to preventive cancer screening than Canadians.[4] Take the proportion of the appropriate-age population groups who have received recommended tests for breast, cervical, prostate and colon cancer:

Nine of 10 middle-aged American women (89 percent) have had a mammogram, compared to less than three-fourths of Canadians (72 percent).

Nearly all American women (96 percent) have had a pap smear, compared to less than 90 percent of Canadians.

More than half of American men (54 percent) have had a PSA test, compared to less than 1 in 6 Canadians (16 percent).

Nearly one-third of Americans (30 percent) have had a colonoscopy, compared with less than 1 in 20 Canadians (5 percent).

Fact No. 5: Lower income Americans are in better health than comparable Canadians. Twice as many American seniors with below-median incomes self-report "excellent" health compared to Canadian seniors (11.7 percent versus 5.8 percent). Conversely, white Canadian young adults with below-median incomes are 20 percent more likely than lower income Americans to describe their health as "fair or poor."[5]


Fact No. 6: Americans spend less time waiting for care than patients in Canada and the U.K. Canadian and British patients wait about twice as long - sometimes more than a year - to see a specialist, to have elective surgery like hip replacements or to get radiation treatment for cancer.[6] All told, 827,429 people are waiting for some type of procedure in Canada.[7] In England, nearly 1.8 million people are waiting for a hospital admission or outpatient treatment.[8]

Fact No. 7: People in countries with more government control of health care are highly dissatisfied and believe reform is needed. More than 70 percent of German, Canadian, Australian, New Zealand and British adults say their health system needs either "fundamental change" or "complete rebuilding."[9]

Fact No. 8: Americans are more satisfied with the care they receive than Canadians. When asked about their own health care instead of the "health care system," more than half of Americans (51.3 percent) are very satisfied with their health care services, compared to only 41.5 percent of Canadians; a lower proportion of Americans are dissatisfied (6.8 percent) than Canadians (8.5 percent).[10]

Fact No. 9: Americans have much better access to important new technologies like medical imaging than patients in Canada or the U.K. Maligned as a waste by economists and policymakers naïve to actual medical practice, an overwhelming majority of leading American physicians identified computerized tomography (CT) and magnetic resonance imaging (MRI) as the most important medical innovations for improving patient care during the previous decade.[11] [See the table.] The United States has 34 CT scanners per million Americans, compared to 12 in Canada and eight in Britain. The United States has nearly 27 MRI machines per million compared to about 6 per million in Canada and Britain.[12]

Fact No. 10: Americans are responsible for the vast majority of all health care innovations.[13] The top five U.S. hospitals conduct more clinical trials than all the hospitals in any other single developed country.[14] Since the mid-1970s, the Nobel Prize in medicine or physiology has gone to American residents more often than recipients from all other countries combined.[15] In only five of the past 34 years did a scientist living in America not win or share in the prize. Most important recent medical innovations were developed in the United States.[16] [See the table.]
[Linked Image]


Conclusion. Despite serious challenges, such as escalating costs and the uninsured, the U.S. health care system compares favorably to those in other developed countries.

Scott W. Atlas, M.D., is a senior fellow at the Hoover Institution and a professor at the Stanford University Medical Center. A version of this article appeared previously in the February 18, 2009, Washington Times.


[1] Concord Working Group, "Cancer survival in five continents: a worldwide population-based study,.S. abe at responsible for theountries, in s chnologies, " Lancet Oncology, Vol. 9, No. 8, August 2008, pages 730 - 756; Arduino Verdecchia et al., "Recent Cancer Survival in Europe: A 2000-02 Period Analysis of EUROCARE-4 Data," Lancet Oncology, Vol. 8, No. 9, September 2007, pages 784 - 796.

[2] U.S. Cancer Statistics, National Program of Cancer Registries, U.S. Centers for Disease Control; Canadian Cancer Society/National Cancer Institute of Canada; also see June O'Neill and Dave M. O'Neill, "Health Status, Health Care and Inequality: Canada vs. the U.S.," National Bureau of Economic Research, Working Paper No. 13429, September 2007. Available at http://www.nber.org/papers/w13429.

[3] Oliver Schoffski (University of Erlangen-Nuremberg), "Diffusion of Medicines in Europe," European Federation of Pharmaceutical Industries and Associations, 2002. Available at http://www.amchampc.org/showFile.asp?FID=126. See also Michael Tanner, "The Grass is Not Always Greener: A Look at National Health Care Systems around the World," Cato Institute, Policy Analysis No. 613, March 18, 2008. Available at http://www.cato.org/pub_display.php?pub_id=9272.

[4] June O'Neill and Dave M. O'Neill, "Health Status, Health Care and Inequality: Canada vs. the U.S."

[5] Ibid.

[6] Nadeem Esmail, Michael A. Walker with Margaret Bank, "Waiting Your Turn, (17th edition) Hospital Waiting Lists In Canada," Fraser Institute, Critical Issues Bulletin 2007, Studies in Health Care Policy, August 2008; Nadeem Esmail and Dominika Wrona "Medical Technology in Canada," Fraser Institute, August 21, 2008 ; Sharon Willcox et al., "Measuring and Reducing Waiting Times: A Cross-National Comparison Of Strategies," Health Affairs, Vol. 26, No. 4, July/August 2007, pages 1,078-87; June O'Neill and Dave M. O'Neill, "Health Status, Health Care and Inequality: Canada vs. the U.S."; M.V. Williams et al., "Radiotherapy Dose Fractionation, Access and Waiting Times in the Countries of the U.K.. in 2005," Royal College of Radiologists, Clinical Oncology, Vol. 19, No. 5, June 2007, pages 273-286.

[7] Nadeem Esmail and Michael A. Walker with Margaret Bank, "Waiting Your Turn 17th Edition: Hospital Waiting Lists In Canada 2007."

[8] "Hospital Waiting Times and List Statistics," Department of Health, England. Available at http://www.dh.gov.uk/en/Publication...T_FILE&dID=186979&Rendition=Web.

[9] Cathy Schoen et al., "Toward Higher-Performance Health Systems: Adults' Health Care Experiences In Seven Countries, 2007," Health Affairs, Web Exclusive, Vol. 26, No. 6, October 31, 2007, pages w717-w734. Available at http://content.healthaffairs.org/cgi/reprint/26/6/w717.

[10] June O'Neill and Dave M. O'Neill, "Health Status, Health Care and Inequality: Canada vs. the U.S."

[11] Victor R. Fuchs and Harold C. Sox Jr., "Physicians' Views of the Relative Importance of 30 Medical Innovations," Health Affairs, Vol. 20, No. 5, September /October 2001, pages 30-42. Available at http://content.healthaffairs.org/cgi/reprint/20/5/30.pdf.

[12] OECD Health Data 2008, Organization for Economic Cooperation and Development. Available at http://www.oecd.org/document/30/0,3343,en_2649_34631_12968734_1_1_1_37407,00.html.

[13] "The U.S. Health Care System as an Engine of Innovation," Economic Report of the President (Washington, D.C.: Government Printing Office, 2004), 108th Congress, 2nd Session H. Doc. 108-145, February 2004, Chapter 10, pages 190-193, available at http://www.gpoaccess.gov/usbudget/fy05/pdf/2004_erp.pdf; Tyler Cowen, New York Times, Oct. 5, 2006; Tom Coburn, Joseph Antos and Grace-Marie Turner, "Competition: A Prescription for Health Care Transformation," Heritage Foundation, Lecture No. 1030, April 2007; Thomas Boehm, "How can we explain the American dominance in biomedical research and development?" Journal of Medical Marketing, Vol. 5, No. 2, 2005, pages 158-66, U.S. Department of Health and Human Services, July 2002. Available at http://fraser.stlouisfed.org/publications/erp/page/8649/download/47455/8649_ERP.pdf .

[14] Nicholas D. Kristof, "Franklin Delano Obama," New York Times, February 28, 2009. Available at http://www.nytimes.com/2009/03/01/opinion/01Kristof.html.

[15] The Nobel Prize Internet Archive. Available at http://almaz.com/nobel/medicine/medicine.html.

[16] "The U.S. Health Care System as an Engine of Innovation," 2004 Economic Report of the President.

Copyright © 2009 National Center for Policy Analysis. All rights reserved

Can I add a chuckle to all of this? Something Ryan wrote reminded me. I recently read a murder mystery set in Venice, Italy in the late 1990s by author Donna Leon. The victim is at first unidentified. But the coroner at a glance identifies the victim as an American. Why? Because his teeth are in such great condition, and because no one in Europe has the dental care that Americans have. There is another series set in England where one of the people interviewed by the detective brags to a friend that she just received word that she managed to get on the National Health Care list for a knee replacement. Her friend says: "Yes, but you're gong to have to wait four years." And she had replied: "I know but I've been trying to get on that list now for over 2 years so this is progress." Yes, it is fiction, and not intended as a serious contribution to this discussion. But very reflective of reality in those countries. So reflective they laugh at it.

Looking over Stuart's post, one thing thing immediately comes to mind (which we've discussed before). Yes, health care in America does cost more. But look at the technology we use that simply isn't available in other countries! True, some (a lot of it) is defensive medicine (practiced by doctors who perform extra tests to avoid being sued if they make a mistake). But that is a reason for reasonable tort reform. Probably not going to happen anytime soon since Congress has a lot of lawyers (unless we take Shakespeare seriously! )

John:

I don't need to be persuaded that there is a certain "liberal elite" that believe "that most Americans are too stupid to manage their own interests." However, in Stuart's last paragraph, he began by speaking of liberals generally, stating "Liberals, on the other hand, really do believe that people are too stupid to look out for their own interests..." I don't think it at all unreasonable that people like me who identify as liberal would react by feeling insulted.

If I were to say "Liberals are compassionate people who wish to help the poor. Conservatives, on the other hand, are completely insensitive to the needs of the poor. They love money, are selfish, and have no sense of civic responsibility as is evidenced by their constant whining about taxes," I would be ripped apart on this forum.

Why? I can point out numerous examples of compassionate liberals who are zealous in their commitment to helping the poor. Furthermore, I can point out numerous examples of conservatives who are thoroughly selfish and who care not one iota for the poor.

Nevertheless, I would deserve to be ripped apart for having engaged in unfair and untruthful stereotyping. Just as there are numerous liberals who are good, caring people, there are many whose motives have nothing to do with their concerns for anyone other than for themselves. Furthermore, just as there are some conservatives who are thoroughly selfish people, there are many who are deeply compassionate people whose commitment to a very limited role of the government in matters of social welfare having nothing to do with selfishness, but rather, have to do with what they believe the best and most appropriate means for promoting the common good.

Sincerely,

Ryan

Ryan, I don't see it but I will accept your point and ask Stuart to better qualify his statements.

Moore's Law, though specific to information technology (computing power doubles every eighteen months while costs remain constant or decline) applies generally to all technology that relies on microprocessors--including most medical equipment. In all other areas of technology, prices have collapsed as capabilities increase (I am writing this on a desktop computer whose power compares favorably to million-dollar "supercomputers" of a decade ago), the cost of medical technology in this country has gone up, even as the availability of equipment has improved. If market forces applied, a doubling or tripling of the number of MRIs available should result in a decline in the price of an MRI scan. But it hasn't.

The reason is, as I noted, the absence of cost discipline from the market due to the use of intermediary payers. The employer who buys the policy doesn't care about the cost of an MRI. The doctor who orders one doesn't care. The patient only pays the co-payment, and he doesn't care. And the insurance company merely passes along the cost, amortized across its policy holders. As a result, the providers of MRIs are free to charge what they want. The makers of MRIs are free to charge what they want. And prices go up in an uncontrolled spiral.

A government run or government-funded (the difference in practice turns out to be negligible) will control these costs by limiting access and/or reimbursement for particular technologies and services (this is what is done in Europe and Canada). The result is less care for less money (though it would seem that the reality is less care for more money, as the bureaucracy absorbs the funds that drive the system).

The alternative is to give health care back to individuals through the ability to purchase individual policies through tax-exempt health savings accounts. The absolutely indigent (who account for a very small percentage of the uninsured) can (in fact are) covered by Medicare as it is now.

With people actually seeing the costs of goods and services, objections will be raised to paying six dollars for a band aid, twenty dollars of an OTC Tylenol, fifty dollars for a two dollar oxygen tube. When people pay, they ask for itemized receipts. When people are buying their own insurance, and their premiums rise or fall depending on their medical history, they also try to control prices, and in general, try to take better care of themselves, too.

Responsibility. Treating citizens as mature adults. Respecting their freedom to make choices, even if you disagree with those choices--this is not only American, it's Christian. Allowing the state to regulate the most intimate details of one's personal life, even in the name of protecting you from yourself, is not.