Thursday, April 05, 2007

Cato Institute Gremlins: Universal Health Insurance Doesn't Equal Universal Health Care

SWNID has lived a portion of our life in a highly civilized, prosperous nation that provides universal health insurance. We have lived most of our life in a less civilized but more prosperous nation that does not provide universal health insurance. With a few exceptions, we find the latter situation preferable as far as health care is concerned.

Why that paradoxical conclusion should be utterly and undeniably true even for those who haven't experienced both is made clear in a delightful piece by Cato Institute scholars Michael Tanner and Michael Cannon (who apparently prove that all young Americans of a certain age are named Michael) in the LA Times of all places.

As usual, we tantalize with a quotation, one that speaks volumes of economic, medical and political sense:

Simply saying that people have health insurance is meaningless. Many countries provide universal insurance but deny critical procedures to patients who need them. Britain's Department of Health reported in 2006 that at any given time, nearly 900,000 Britons are waiting for admission to National Health Service hospitals, and shortages force the cancellation of more than 50,000 operations each year. In Sweden, the wait for heart surgery can be as long as 25 weeks, and the average wait for hip replacement surgery is more than a year. Many of these individuals suffer chronic pain, and judging by the numbers, some will probably die awaiting treatment. In a 2005 ruling of the Canadian Supreme Court, Chief Justice Beverly McLachlin wrote that "access to a waiting list is not access to healthcare."

Supporters of universal coverage fear that people without health insurance will be denied the healthcare they need. Of course, all Americans already have access to at least emergency care. Hospitals are legally obligated to provide care regardless of ability to pay, and although physicians do not face the same legal requirements, we do not hear of many who are willing to deny treatment because a patient lacks insurance.

We offer a brief and vague personal testimony: had our SWNIDish self persisted under universal health coverage, what was treated quickly and simply outside that "universal" system would perhaps, thanks to an outrageous waiting list for such a simple procedure, literally have turned deadly (and we use "literally" in its literal sense). This argument is not an abstraction.


JB in CA said...

I've seen numbers like these before, but I've never seen numbers on the waiting period or cancellation rate for equivalent procedures in the U.S. By themselves, these numbers don't tell us how much better off we are than those who have universal health care, or even if we are better off. And besides, is it really an either/or proposition--adopt the system "they" have or retain the one we have?

Jon A. Alfred E. Michael J. Wile E. SWNID said...

Of course, either/or is a false choice. But that the article is critiquing another fallacy in the debate: that universal health insurance necessarily improves access to health care and the general quality of health care. And there is an enormous body of data that suggests that single-payer, "universal" coverage systems ration care with long waiting lists in a way that actually excludes people from care more than the chaos of the American system does at present.

The article doesn't cite statistics on waits in the United States because, I would assume, the authors assume that their American audience doesn't experience much waiting. But the stats are available, as is the testimony of hospitals in cities like Buffalo that provide care for patients without the patience to wait for procedures in Canada.

I think my experience was typical. In the UK I would have waited five months to have a cancerous lesion examined and another six months to have it removed. Here, I called for an appointment on Thursday, was examined on Friday and had surgery on Tuesday, with a second surgery after the biopsy just a week later. If I hadn't had insurance, I could have gone to an emergency room, and after waiting several hours, received the same treatment in about the same net time.

JB in CA said...

I agree that what passes nowadays for universal health care is neither universal nor health care much (most?) of the time. But remember, what goes for universal health care at present does not exhaust the possibilities. Given that our system has some serious problems of its own, we might do well to investigate some of those other possibilities.

Your observation that we already--by default and haphazzardly--provide universal care for emergencies suggests itself as one direction we might pursue as a matter of policy in an attempt to extend the benefits of our system to those who can't afford to buy into it.

Another would be to inject a little more competition into the health care profession. As it stands, it's the least competitive institution in our society (apart from government itself, of course). The number of physicians produced each year is kept artificially low, Congress routinely enacts laws protecting the pharmaceutical industry from financial loss, Medicare is consistently overcharged for services rendered, etc. Systematic changes in these areas could well lead to more affordable and available health care for everyone.

Wouldn't the result of such changes to our system qualify as a form of universal health care? If so, the issue shouldn't be universal health care vs. something else but, rather, poor universal health care vs. better universal health care.

Jon A. Alfred E. Michael J. Wile E. SWNID said...

Agreed completely. What we deride is not positive steps toward better, more universal access to good health care (who would?), and what we assert is not that Americans live in the best of all possible health-care worlds. We object to the identification of European-socialist-style, single-payer, state-run, "universal" health insurance as universal health care.