About those "better" health care systems elsewhere

By Wes Vernon

Let's stipulate this up front: The U.S. health care system has its problems, and we cannot ignore them. It does not follow, however, that the answer is the poison pill of socialism — a la Canada, Britain, and most of Europe.

Replace a flawed system with a proven disaster?

This column has been building a file on the entitlement crisis America faces and what can be done about it. In the future, we intend to address that broader issue of entitlements.

The biggest hurdles to doing something constructive are primarily three factors: (1) cheap political demagogues whose response to every proposed reform is to accuse the reformers of wanting to toss Grandma out in the snow; (2) endless propaganda leaning on America to "join the world" in an alleged "single payer" paradise, while ignoring/covering up that system's failures; and (3) organized brainwashing here and abroad using the dishonest euphemism "single payer," instead of calling it by its accurate name — government-controlled health care.

From the frying pan into the fire

Meanwhile, there are some disconcerting facts about the so-called "up-to-date" or moderne systems elsewhere. Part of our research on this question has focused on the recent book The Cure: How Capitalism Can Save American Health Care. The author, Dr. David Gratzer, a physician, is a senior fellow at the Manhattan Institute for Policy Research. He is widely cited on health policy issues in such publications as the New England Journal of Medicine. He divides his time between Toronto and New York.

Socialist paradise

Before considering Dr. Gratzer's book, let me say that my own biggest hang-up with the systems in Canada and Europe is that they tend to ration care for the elderly sick. They don't throw Grandma out into the snow. They just let Grandma die. They might as well say, "Die, old woman." As cruel as it would be to come out and say that, it would at least be more honest than "single payer."

First the statistics

We could regale you with plenty of anecdotes about the failures of government-run health care abroad. And there are some horror stories which we will address. But first, let's get to some absolute undeniable figures.

First, Dr. Gratzer (whose work is one of many in our file) cites the common error of assuming that health insurance and health care go hand in hand.

There are those who will argue that because life expectancy — for example in England and Japan — surpasses that of the United States, the fault must lie with America's health care system. But life expectancy, as with the infant mortality rate, reflects "a mosaic of factors such as parental diet, marital status, drug use, and cultural values." Thus, according to The Cure, "judging American health care only by such statistics is like declaring Cuban democracy stronger than America's based on voter turnout."

Obesity: Whose fault is that?

Gratzer might also have cited the recent concerns about obesity in America. If two-thirds of Americans are overweight, it hardly reflects on the health care they are getting. At the risk of sounding profoundly out of date, there is such a thing as personal responsibility. That may not appeal to the political opportunists peddling the snake oil that anyone who is not a millionaire is being cheated, but who can deny that the Japanese (as the most glaring example) have more healthy eating habits than we do? Of course they will live longer.

The proof

Dr. Gratzer makes no claim that cannot be backed up by facts.

1 — Women who get breast cancer in Europe are four times as likely to be diagnosed after the cancer is spread and are less likely to survive the disease than women in the United States — 95% in the early stages in the U.S., 80% in Europe.

2 — Cancer patients in the United States have markedly higher survival rates than their European counterparts. Survival for stage 1 colorectal cancer is 90% in the U.S. That compares with 80% in Germany and 70% in Britain. First stage breast cancer has a U.S. survival rate of 97 %, but only 78% in Britain. Datamonitor finds that patients tend to be diagnosed earlier in the U.S. 70 percent of prostate cancers are caught in the early stages in America, but only 58% in Britain.

3 — On survival rates for various forms of cancer, the U.S. consistently bests Europe. The Cure presents charts comparing the U.S. rate favorably with Australia, Canada, Germany, France, the United Kingdom, and New Zealand.

4 — The percentage of patients having to wait more than 4 months for non-emergency surgery is far smaller in the U.S. than in Australia, New Zealand, Canada, or Britain.

The anecdotes

This is the story of two women with similar problems. Donna Longmoore and Christina Alcorn are both diabetics. Rather than the endless insulin injections, they opted for an insulin pump which is fastened to the stomach and injects insulin that way The device was not cheap: $5,000.

For Alcorn, acquiring the pump was no problem, and it was covered by her insurance company. Longmoore had to struggle just to get one. It involved thousands of dollars in out-of-pocket expenses. She found out about it by accident, not through her doctor, who did not mention it.

Alcorn sees a nearby specialist for monthly follow-up treatment. Longmoore is lucky to see a far-away specialist just twice a year.

This has nothing to do with wealth. Though the two women live close to each other, geography is the factor. Longmoore lives in Canada, Alcorn is across the river in the USA.

Up close and personal

Gratzer's own father — a Canadian citizen — had intense pain radiating down his legs. He was referred to a neurologist. The earliest appointment he could get was for three months later. Meanwhile he had increasing pain and decreased mobility. A university professor with an active life, he became housebound. Seeking a second opinion, he went to an emergency room, and was told, "This isn't an emergency. You just need to see a neurologist." Thus we see how the Canadian system can take you around in circles.

The rough equivalent of "You can't get there from here."

Gratzer's father had more than a cold, but economist David Henderson who grew up in Canada says that in his native land, "If you have a cold and are willing to wait in your family doctor's office for three hours, this is the best health-care system in the world."

This is one reason why a 2000 survey involving 1500 people suggested that 8 out of 10 Canadians consider their health-care system "in crisis."

But wait, it gets worse

In Canada, (1) total wait times from initial visit to a GP through to surgical therapy was 17.7 weeks, deemed by physicians to exceed "clinically reasonable" delays; (2) 63 percent of x-ray equipment was out of date. So too was a majority of all diagnostic machinery; and (3) Canadian heart attack survivors have a dramatically lower quality of life than their U.S. counterparts.

Shortages were also a factor. On Vancouver Island, for example, only one — just 1 — MRI machine was available to serve 600,000 people. Compounding that problem was that the scanner was allowed to operate only on bankers' hours, performing no more than 3000 scans per year.

Where have we heard this before?

Dr. Gratzer concludes, "Therein lies the dirty truth of Canadian health care. It is just like the old Soviet system: everything is free, but nothing is readily available." That may sound like a bad joke. But Canadians with MS waiting for an MRI today are not laughing.

These are just examples of how Canadian and European health systems suffer from politicization, bureaucratization, and (perhaps worst of all) anti-innovation.

But there is hope

The Canadian Supreme Court — arguably so liberal as to make the U.S. Ninth Circuit (immersed in the San Francisco culture where it is located) look conservative by comparison. Recently Canada's high court justices agreed to hear the case of man who waited almost a year for a hip replacement.

In so doing, the judges decided that the province of Quebec had no right to restrict the freedom of a person to purchase his own health care or health insurance. That overturned a 30-year ban on private medicine in the province. Gratzer calls this the "the hip that changed history."

Well, maybe. We'll believe it when we see it, though the doctor also cites stirrings of change elsewhere in the industrialized world, inching away from the much heralded socialized medicine as the cure-all. But change is slow. Socialism is the political equivalent of quicksand. The deeper you get into it, the harder it is to extricate yourself from it. That is precisely what is so insidious about it. Winston Churchill once equated trying to reverse socialism in Britain — or anywhere else — with trying to "unscramble an egg."

Insuring America

While touting the alleged glories of socialized medicine, the chicken-little alarmists have distorted and exaggerated the figures and problems of America's uninsured.

46 million American without insurance? Let's examine the details:

Number 1 — Roughly 20 percent of the uninsured in this country are not citizens. Ergo, 36 million Americans lack insurance. Immigrants without insurance are a serious problem. But that is an immigration issue, not a health insurance matter.

Number 2 — Only about half the uninsured Americans at any given time are without insurance 5 months later. In our mobile society, 84 percent of the uninsured are without coverage for less than 24 months.

Or as Gratzer puts it: "The executive who leaves his corner office at Citigroup to look for greener pastures may soon join the ranks of the uninsured...If the gentleman lands a vice presidency at a rival bank, we would consider that a success story. Yet, statistically speaking, he became apart of the group of "uninsured Americans."

Number 3 — The uninsured are not a relatively homogeneous group — poor. The single mom with three children is not uninsured — she has Medicaid — as do her children and their neighbors.

Number 4 — Many Americans are uninsured by choice. Some of these are eligible for Medicaid, but choose not to sign up.

And Number 5 (bottom line) — "A full 93 percent of Americans either are insured or could afford insurance."

Thus, to put it in perspective

Again, the U.S. health care system is flawed, but not the way the socialists — homegrown and otherwise — figure it. And those critics do not offer the cure.

There are ways to upgrade and improve our system, a topic with which we will deal in the future. But the next time someone rolls out "Hillarycare" or "single payer," it is well to bear in mind that while figures don't lie, they can distort and mislead.

© Wes Vernon