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Universal
healthcare's dirty little secrets
Patients in countries that provide government insurance
often experience hurdles to care such as extremely long
waitlists.
SOURCE:
Michael Tanner and Michael Cannon, Los Angeles Times; April
5, 2007.
AS THEY TACK left and right
state by state, the Democratic presidential contenders can't
agree on much. But one cause they all support — along with
Republicans such as former Massachusetts Gov. Mitt Romney
and California's own Gov. Arnold Schwarzenegger — is
universal health coverage. And all of them are wrong.
What these politicians and
many other Americans fail to understand is that there's a
big difference between universal coverage and actual access
to medical care.
Simply saying that people
have health insurance is meaningless. Many countries provide
universal insurance but deny critical procedures to patients
who need them. Britain's Department of Health reported in
2006 that at any given time, nearly 900,000 Britons are
waiting for admission to National Health Service hospitals,
and shortages force the cancellation of more than 50,000
operations each year. In Sweden, the wait for heart surgery
can be as long as 25 weeks, and the average wait for hip
replacement surgery is more than a year. Many of these
individuals suffer chronic pain, and judging by the numbers,
some will probably die awaiting treatment. In a 2005 ruling
of the Canadian Supreme Court, Chief Justice Beverly
McLachlin wrote that "access to a waiting list is not access
to healthcare."
Supporters of universal
coverage fear that people without health insurance will be
denied the healthcare they need. Of course, all Americans
already have access to at least emergency care. Hospitals
are legally obligated to provide care regardless of ability
to pay, and although physicians do not face the same legal
requirements, we do not hear of many who are willing to deny
treatment because a patient lacks insurance.
You may think it is
self-evident that the uninsured may forgo preventive care or
receive a lower quality of care. And yet, in reviewing all
the academic literature on the subject, Helen Levy of the
University of Michigan's Economic Research Initiative on the
Uninsured, and David Meltzer of the University of Chicago,
were unable to establish a "causal relationship" between
health insurance and better health. Believe it or not, there
is "no evidence," Levy and Meltzer wrote, that expanding
insurance coverage is a cost-effective way to promote
health. Similarly, a study published in the New England
Journal of Medicine last year found that, although far too
many Americans were not receiving the appropriate standard
of care, "health insurance status was largely unrelated to
the quality of care."
Another common concern is
that the young and healthy will go without insurance,
leaving a risk pool of older and sicker people. This results
in higher insurance premiums for those who are insured. But
that's only true if the law forbids insurers from charging
their customers according to the cost of covering them. If
companies can charge more to cover people who are likely to
need more care — smokers, the elderly, etc. — then it won't
make any difference who does or doesn't buy insurance.
Finally, some suggest that
when people without health insurance receive treatment, the
cost of their care is passed along to the rest of us. This
is undeniably true. Yet, it is a manageable problem.
According to Jack Hadley and John Holahan of the
left-leaning Urban Institute, uncompensated care for the
uninsured amounts to less than 3% of total healthcare
spending — a real cost, no doubt, but hardly a crisis.
Everyone agrees that far
too many Americans lack health insurance. But covering the
uninsured comes about as a byproduct of getting other things
right. The real danger is that our national obsession with
universal coverage will lead us to neglect reforms — such as
enacting a standard health insurance deduction, expanding
health savings accounts and deregulating insurance markets —
that could truly expand coverage, improve quality and make
care more affordable
As H. L. Mencken said: "For
every problem, there is a solution that is simple, elegant,
and wrong." Universal healthcare is a textbook case.
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