People keep telling me how great it would be if we had a nice, organized system of nationalized healthcare here in the US, but I've always been skeptical. I keep hearing horror stories of people dying while waiting for basic operations or even not being able to get simple tests in Canada or Germany. All of this anecdotal evidence has made me leery of the concept. Clearly I'm not alone given the extremely negative reaction to Hillary Clinton's attempt to socialize our healthcare system in the 90s. Yet people keep telling me how great it would be and how so many Americans are uninsured and don't get adequate healthcare.
It turns out that people in Europe are thinking about this issue too, but apparently they're trying to figure out why their nice, efficient socialized medical systems are killing them while our chaotic mess of a system is keeping us alive longer and getting the typical patient enormously better care much faster. I ran into a fascinating article on this subject by James Bartholomew in the current issue of Britains The Spectator. To read the whole article you have to register, but there's no cost and it's well worth the few minutes to sign up.
The genesis of the article is that Bartholomew noticed statistics showing that the death rates for the most common forms of cancer were shockingly higher in Britain than in the United States. For example, women with breast cancer in Britain have a 46% death rate as opposed to 25% in the US. Men with prostate cancer in Britain have a 57% mortality rate while in the US only 19% die and the death rate is declining rapidly because of early detection. It's the same with colon cancer. In Britain there's a 40% survival rate and in the US there's a 60% survival rate. With cancer of the esophagus only 7% survive while in the US 12% survive, although it's still one of the most deadly forms of cancer.
This pattern seems to hold true across the board. For virtually every form of cancer your chance of living is 50-100% better if you live in the US than if you live in Britain. I did some research of my own on the topic to see if Britain just had particularly bad healthcare and discovered that the statistics are similar for the socialized medical systems in the rest of Europe. While there were some variations for individual forms of cancer, the overall pattern in Germany, France and the other major European nations was that the death rate for most cancers is close to double what it is in the United States. Britain actually has some of the best survival rates in Europe for breast cancer. Get breast cancer in other European countries and you might as well just dig a hole and jomp in. The same is true for colon cancer where the survival rate in most of europe is less than 1/7 of the survival rate in the US.
Bartholomew lays this problem at the feet of diagnostic practices in Britain. He points to the fact that they have half as many MRI and Catscan machines per capita as the US has, and that even their x-ray equipment is 20 years out of date in most hospitals and in many cases past the recommended use-life suggested by the manufacturer. In Britain if you go in to the doctor you're lucky to get an x-ray when in the US a much more detailed test like an MRI would be likely. The is vital because x-rays just aren't effective in detecting many forms of cancer. They're find for broken bones, but for anything in the soft-tissue they're really not the right kind of test. The shortage of more advanced testing equipment results in long waits - as much as six months in many cases - and in doctors just not choosing to prescribe more advanced testing at all. With many forms of cancer early detection makes all the difference in survival. Six months can be the difference between life and death, or as demonstrated by the statistics the difference between a 50% survival rate and a 20% survival rate.
Bartholomew points out a related problem with treatment of heart disease. There is an apparent reluctance to prescribe surgery for common heart conditions, with long delays to see a surgeon and reliance on pharmaceutical treatment when surgery would be more effective. In the US almost anyone with blocked arteries around the heart gets almost immediate bypass surgery. I can't count all the people I've known who go into the hospital with minor chest pain and find themselves getting a multiple bypass that afternoon. In Britain there's more of a wait and see attitude, which means giving medication and waiting for six months, or usually until the patient has a full-out heart attack and dies. The rate of heart bypass treatment in the US is almost triple what it is in Britain with a correspondingly higher survival rate for heart disease.
In my my further research on this subject I ran into another fascinating article by Rebecca Goldsmith of Newhouse News which gives some good evidence to suggest that faced with such a high probability of unnecessary death in countries with socialized medicine the public is forcing those systems to go through radical changes. Alarming numbers of patients are looking for solutions outside of the European healthcare system, even travelling to the US or Eastern Europe for treatment. In Britain there's even been a remarkable growth in private supplemental health insurance which is now a 7.7 billion dollar industry there. In response, Britain, Germany and the Scandinavian countries are apparently introducing more and more privatization into their systems, finding ways to sub-contract healthcare to private institutions and borrowing ideas from the system we have here in the US. Germany and Britain are even selling off publicly owned hospitals to private management firms to increase efficiency. These changes have already shown some results, reducing wait times for non-critical operations (joint replacements and the like) by half - from 18 months to 9 months in Britain - and already showing a few percentage points reduction in death rates for some cancers.
So while we consider what to do about the problems in our healthcare system here in America - and there are some genuine problems - remember that patients in the countries with socialized medicine which some of us seem to envy are looking at us and wishing they were as well off as we are. The fact that their governments are moving away from socialized medicine after being so devoted to it for so long is a very telling sign that we should move with extreme caution before trying to implement any kind of government managed healthcare here in the US.
The main shortcomings of the US system appear to be the high cost of insurance and the portion of the population which is too well off to be covered by Medicaire and too poor to afford insurance - or more typically younger Americans who choose not to make paying for health insurance a priority. To solve these problems through socializing a remarkably successful private system is like trying to fix a chipped plate by hitting it with a hammer. The solution is to find a way to get health coverage to these people under the current system and bring overall costs down, not to ruin everyone's healthcare so that we can bring equally inadequate care to those not handled well by the current system. Raising the income limits on medicaire is not a good solution, because medicaire is expensive, inefficiently run and already abused by unscrupulous doctors and hospitals. A more practical answer might be to find ways to bring costs down with more effective regulation - if we could avoid the problem of overregulation. Another alternative might be a system of health care insurance vouchers, similar to the idea of school vouchers, or healthcare savings accounts funded off of a payroll tax like Social Security and then used to either pay insurance or cover catastrophic costs. None of these solutions is terribly attractive, but they are solutions that work within the current system.
Or there might be a simpler solution that just never occurs to many people. Find a way to reduce the cost of your health insurance. By raising the deductible and taking a plan with some limitations on it health insurance can be lowered to a relatively reasonable level. You can get perfectly adequate, functional health insurance for under $100 a month if you're willing to pay $50 for each doctor visit or a reasonable co-payment or have a yearly deductible of $1500 or more or a combination of some of these elements. Try going to ehealthinsurance.com and getting a quote or two. You might be surprised at what a reasonable price you can get for perfectly adequate health insurance if you're willing to cut a few frills. Maybe our system isn't in as much trouble as we all think, because if you're not poor enough for Medicaire, you ought to be able to afford $1000 a year for health insurance unless you just choose not to.
