With Democrats convinced 2008 is their year, the campaign trail is awash with promises to make universal health care a reality by the end of the next president’s first term.
The basic argument of those who support a government takeover of the health care system is familiar. As New York Times columnist Paul Krugman once put it, “America’s health care system spends more, for worse results, than that of any other advanced country.”
Krugman’s line has been repeated so often it’s considered gospel truth in most public debates — people rarely check to see if it matches the facts. As the American humorist Josh Billings quipped, “the problem with the world ain’t ignorance, it’s the things people know that just ain’t so.”
If they did, they’d probably be surprised. Socialized health care isn’t all it’s cracked up to be.
Take the much-vaunted Canadian system. More than 825,000 Canadian citizens are currently on waiting lists for surgery and other necessary treatments. Fifteen years ago, the average wait between a referral from a primary-care doctor to treatment by a specialist was around nine weeks. Today, that wait is over 18 weeks.
That’s almost double what doctors consider clinically reasonable. As Canadian physician Brian Day explained to The New York Times, Canada “is a country in which dogs can get a hip replacement in under a week and in which humans can wait two to three years.”
In part, these waits are due to a doctor shortage. According to the Organization for Economic Cooperation and Development, Canada ranks 24th out of 28 countries in doctors per thousand people.
Why so few doctors? Over the past decade, about 11 percent of physicians trained in Canadian medical schools have moved to the United States. That’s because doctors’ salaries in Canada are negotiated, set and paid for by provincial governments and held down by cost-conscious budget analysts. Today, in fact, the average Canadian doctor earns only 42 percent of what a doctor earns in the United States.
Canada also limits access to common medical technologies. When compared with other OECD countries, Canada is 13th out of 24 in access to magnetic resonance imagings, 18th of 24 in access to computed tomography scanners, and seventh of 17 in access to mammograms.
The problems plaguing Canada are characteristic of all universal health care systems.
In Britain, more than 1 million sick citizens are currently waiting for hospital admission. Another 200,000 are waiting just to get on a waiting list. Each year, Britain’s National Health Service cancels around 100,000 operations.
Britain even has a government agency explicitly tasked with limiting people’s access to prescription drugs. Euphemistically called the National Institute for Health and Clinical Effectiveness, the agency determines which treatments the British health care system covers. More often than not, saving money takes priority over saving lives.
In 2008, for instance, NICE refused to approve the lung cancer drug Tarceva. Despite numerous studies showing that the drug significantly prolongs the life of cancer patients — and the unanimous endorsement of lung cancer specialists throughout the United Kingdom — NICE determined that the drug was too expensive to cover relative to its effectiveness. As of August 2008, England is one of only three countries in Western Europe that denies citizens access to Tarceva.
Britain’s behavior is typical — every European government rations drugs to save money. Eighty-five new drugs hit the U.S. market between 1998 and 2002. During that same time period, only 44 of those drugs became available in Europe.
The evidence clearly indicates that patients under socialized medicine are suffering. Why, then, do countries with government-run health care consistently outrank the United States on international quality surveys?
It’s not because the American health care system is inferior. It’s because these surveys use deeply flawed metrics that don’t reflect health care quality.
Case in point: The World Health Organization rankings of overall health system performance placed the United States 37th out of 191 countries. That’s behind not only Canada, Britain and France, but even countries like Costa Rica, Morocco and Cyprus.
Life expectancy accounted for 25 percent of a nation’s WHO ranking. But life expectancy is the function of a variety of factors. Medical care is just one of them. Just as important are a nation’s homicide rate, the number of accidents, diet trends, ethnic diversity and much more.
Another factor accounting for 25 percent of a nation’s ranking was “distribution of health,” or fairness. By this logic, treating everyone exactly the same is more important than treating people well. So long as everyone is equal — even if they’re equally miserable — a nation will do quite well in the WHO rankings.
In measuring the quality of a health care system, what really matters is how well it serves those who are sick. And it’s here that America really excels.
According to an August 2008 study published in Lancet Oncology, the renowned British medical journal, Americans have a better than five-year survival rate for 13 of the 16 most prominent cancers when compared with their European and Canadian counterparts.
With breast cancer, for instance, the survival rate among American women is 83.9 percent. For women in Britain, it’s just 69.7 percent. For men with prostate cancer, the survival rate is 91.9 percent here but just 73.7 percent in France and 51.1 percent in Britain.
American men and women are more than 35 percent more likely to survive colon cancer than their British counterparts.
It’s no wonder then that foreign dignitaries living in countries with socialized health care systems routinely come to this country when they need top-flight medical treatment.
When Italian Prime Minister Silvio Berlusconi needed heart surgery in 2006, he traveled to the Cleveland Clinic — often considered America’s best hospital for cardiac care. When Canadian Member of Parliament Belinda Stronach, who had denounced a two-tier health care system for Canadians, needed breast cancer surgery herself in 2007, she headed to a California hospital and paid out of pocket.
So much for the “free” health care they could have received at home.
As for the supposed cost advantages of socialized medicine? Those are illusory, too. True, other developed nations may spend less on health care as a percentage of gross domestic product than the United States does — but so does Sudan. Without considering value, such statistical evaluations are worthless.
And one of the primary reasons health care costs more in America is that we are a wealthy country that demands the best. And, we’re investing a lot more in medical research.
The United States produces over half of the $175 billion in health care technology products purchased globally. In 2004, the federal government funded medical research to the tune of $18.4 billion. By contrast, the European Union — which has a significantly larger population than the United States — allocated funds equal to just $3.7 billion for medical research.
Between 1999 and 2005, the United States was responsible for 71 percent of the sales of new pharmaceutical drugs. The next two largest pharmaceutical markets — Japan and Germany — account for just 4 percent each.
While no one can deny that there are significant problems in the American health care system, overall it provides exceptional value. The ideologues who claim we’d be better off under socialized medicine are massively wrong. Government-run health care has proven to be heartless and uncaring — and the inferior treatments it provides come with a very steep price tag.
Sally C. Pipes is president and CEO of the Pacific Research Institute. Her next book, “The Ten Myths of American Health Care,” will be released this fall.