In response to the recent letter to the Colorado Medical Society written by Denver nephrologist Dr. Bruce Fisch arguing that European and Canadian health care systems could not be applied to the US, the Colorado Health Insurance Insider blog asked, "Why not?"
I won't presume to speak for Dr. Fisch, but I will offer an answer of my own:
Americans are far more used to having personal control over many of their health care decisions, as opposed to the government having this degree of say. So if an average middle-class American were told by the government, "Sorry, you can't have an MRI this week for your knee injury -- the waiting time is 6 months" (as may be the case for an average Canadian), he would be far more likely to be outraged, rather than accepting that as the price to pay for "free" health care. According to the New York Times, a government system of health care "has long been considered politically sacrosanct in Canada, and even central to the national identity". This is clearly not the case in the US -- instead, the issue is one of contentious debate, and far from politically sacrosanct.
Similarly, the government system in the UK regards it as more important that citizens have equal access to health care (even if that care is bad) than that people be able to freely seek what's in their best interest although it might lead to inequalities. This is typically expressed by UK politicians as a rejection of any "two-tier" system.
Americans don't have the same degree of visceral dislike of a two-tier (or multi-tier) system as Canadians and Western Europeans. Nor should they. One marvelous advantage of the free market is that it respects and facilitates the right of an individual to purchase better goods and services from willing sellers according to his judgment and priorities. Those who want to pay extra for gold-plated health care can do so, whereas those who want to go with a minimal degree of coverage (and spend the money on other priorities) can do so as well. Or they can pick anything in between. No one is forced into a "one size fits all" system.
In summary, Dr. Fisch is right: American values such as "liberty and free thought with regard to one's health and health care are paramount". As they should be. As a result, government-run medical systems that necessarily infringe upon those liberties would stick in the craw of most Americans.
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As a side point, the Colorado Health Insurance Insider blog also repeats the commonly cited figure, "47 million of our people to be without health care - without access to any sort of quality health care". There are two serious problems with that citation:
First, the "47 million" figure exaggerates the problem by a huge amount, as discussed in this short video, "Uninsured in America" as well as in numerous articles such as "The '47 Million' Uninsured Myth" in the August 29, 2007 issue of Investors Business Daily.
Second, it assumes the common error of equating health insurance with health care. The nature and significance of this error is covered in much more depth in the article co-author by Lin Zinser and myself, "Moral Health Care vs. 'Universal Health Care'".
The blog of Freedom and Individual Rights in Medicine (FIRM)
