I was once a believer in socialized medicine. As a Canadian, I had soaked up the belief that government-run health care was truly compassionate. What I knew about American health care was unappealing: high expenses and lots of uninsured people.Dr. Gratzer summarizes his position with this point:
My health care prejudices crumbled on the way to a medical school class. On a subzero Winnipeg morning in 1997, I cut across the hospital emergency room to shave a few minutes off my frigid commute.
Swinging open the door, I stepped into a nightmare: the ER overflowed with elderly people on stretchers, waiting for admission. Some, it turned out, had waited five days. The air stank with sweat and urine. Right then, I began to reconsider everything that I thought I knew about Canadian health care.
...Government researchers now note that more than 1.5 million Ontarians (or 12% of that province's population) can't find family physicians. Health officials in one Nova Scotia community actually resorted to a lottery to determine who'd get a doctor's appointment.
These problems are not unique to Canada -- they characterize all government-run health care systems.
Consider the recent British controversy over a cancer patient who tried to get an appointment with a specialist, only to have it canceled -- 48 times. More than 1 million Britons must wait for some type of care, with 200,000 in line for longer than six months. In France, the supply of doctors is so limited that during an August 2003 heat wave -- when many doctors were on vacation and hospitals were stretched beyond capacity -- 15,000 elderly citizens died. Across Europe, state-of-the-art drugs aren't available. And so on.
...One often-heard argument, voiced by the New York Times' Paul Krugman and others, is that America lags behind other countries in crude health outcomes. But such outcomes reflect a mosaic of factors, such as diet, lifestyle, drug use and cultural values. It pains me as a doctor to say this, but health care is just one factor in health.
Americans live 75.3 years on average, fewer than Canadians (77.3) or the French (76.6) or the citizens of any Western European nation save Portugal. Health care influences life expectancy, of course. But a life can end because of a murder, a fall or a car accident. Such factors aren't academic -- homicide rates in the U.S. are much higher than in other countries.
In The Business of Health, Robert Ohsfeldt and John Schneider factor out intentional and unintentional injuries from life-expectancy statistics and find that Americans who don't die in car crashes or homicides outlive people in any other Western country.
And if we measure a health care system by how well it serves its sick citizens, American medicine excels. Five-year cancer survival rates bear this out. For leukemia, the American survival rate is almost 50%; the European rate is just 35%. Esophageal carcinoma: 12% in the U.S., 6% in Europe. The survival rate for prostate cancer is 81.2% here, yet 61.7% in France and down to 44.3% in England -- a striking variation.
Like many critics of American health care, though, Krugman argues that the costs are just too high: health care spending in Canada and Britain, he notes, is a small fraction of what Americans pay. Again, the picture isn't quite as clear as he suggests. Because the U.S. is so much wealthier than other countries, it isn't unreasonable for it to spend more on health care. Take America's high spending on research and development. M.D. Anderson in Texas, a prominent cancer center, spends more on research than Canada does.
...In the coming years, with health expenses spiraling up, it will be easy for some to give in to the temptation of socialized medicine. In Washington, there are plenty of old pieces of legislation that like-minded politicians could take off the shelf, dust off and promote: expanding Medicare to Americans 55 and older, say, or covering all children in Medicaid.Read the whole thing.
But such initiatives would push the U.S. further down the path to a government-run system and make things much, much worse. True, government bureaucrats would be able to cut costs -- but only by shrinking access to health care, as in Canada, and engendering a Canadian-style nightmare of overflowing emergency rooms and yearlong waits for treatment.
America is right to seek a model for delivering good health care at good prices, but we should be looking not to Canada, but close to home -- in the other four-fifths or so of our economy. From telecommunications to retail, deregulation and market competition have driven prices down and quality and productivity up. Health care is long overdue for the same prescription.