Saturday, June 3, 2017

Nicholas Kerr: US health care problems – universal health care is not the solution

Shortly after Bernie Sanders’s recent and weakly argued Twitter pic in support of universal health care, I photoshopped it into a similarly weak counter-argument and Tweeted back. However, it’s a serious topic and deserves a more thorough response.

It goes without saying that the U.S. health care system is far from perfect. But the focus should be addressing the problems without throwing out what’s exceptional about it. 

The good things include (but are not limited to): excellent care, particularly in complex or life threatening conditions; good to great patient outcomes (cancer survival rates, for instance); access to the best and most modern equipment; and prompt care (i.e. low to no waiting times) for almost every condition.

Universal health care systems inevitably ration care and are resource poor (limited amounts of and limited access to technology). Canada has fewer MRI machines in the country than all the U.S. cities within 100 miles of its border. The U.K.’s NHS has fewer MRI scanners than almost any other Western country, and the numbers are even worse for CT scanners.

A big issue with the U.S. system, of course, is ensuring that insurance provides good coverage and is affordable. Obamacare hasn’t solved that problem – individual coverage is now worse. Premiums, co-pays and deductibles have all gone up to the point where insurance covers essentially nothing except in catastrophic circumstances, and even then most people are left with large bills to pay.

Universal health care would be harmful to all that is good about the U.S. system. Let me illustrate with a couple of personal anecdotes.

Our three-year-old recently had surgery for a non-urgent condition. When he was diagnosed and treatment was discussed, we asked when his doctor could operate. Her response was essentially, “What are you doing tomorrow?” In countries with universal health coverage, we would have had to get in line and wait several months, if not longer.

While his surgery didn’t have to be done ‘tomorrow’, it did need to happen before he got older. Post-surgery he also had to have casts on both arms for several weeks following the surgery. As parents and human beings, we wanted to get it done before summer kicked in to avoid him suffering with casts in the hot sun, and missing out on water sports. That seemed like the right choice to make.

In most universal health care systems, we’d not have that choice. We’d have had to get in line and wait, hoping he could receive treatment relatively soon. Or alternatively, we could have gambled and put off getting in line until later in summer, hoping the line hadn’t grown and it would be taken care of before next summer.

Thankfully our son wasn’t suffering in any way, unlike countless people in universal health care systems with chronic, but not urgent conditions, who are experiencing various degrees of pain and/or have limited mobility because they are waiting often more than a year for their surgeries. Friends with parents or relatives who have needed knee or hip surgery in countries with socialized medicine have had to live in considerable pain and waited 18 months or more for care. They’ve also missed out on major life moments of their relatives, such as a daughter’s wedding, because they’ve been unable to travel due to the pain and/or fear of losing their place in line. To me that borders on inhumane and immoral, and is not something the U.S. should emulate.

Until 2005 it was illegal for Canadians to use their own money to pay for private health care in the country. Fortunately for its citizens, a landmark decision of Canada’s Supreme Court struck down that law and wrote at the time, “Access to a waiting list is not access to health care.”

Indeed, it is not, but that’s what you get when you have a universal health care system. In the U.K., even GP visits routinely require a wait of three weeks, which the British Medical Association describes as a crisis at “breaking point”. Doctors there are demanding to be allowed to charge patients – in other words they want to use pricing and the free market – to solve the crisis. As other writers have noted, pets in countries like Canada and New Zealand get better and prompter health care than humans.

While my Photoshopped illustration was not a solid argument against universal health care, it’s instructive to ask who the people are that come to the U.S. for care. Certainly many are wealthy, but a large number are brought here by communities who have raised money for them, or even that U.S. citizens have sponsored.

There are countless examples of the latter. My uncle is one of them. He was born in New Zealand with a rare condition that required surgery its health care system wasn’t able to treat. My grandmother was a solo mother on welfare. She left my mother at a boarding school run by nuns and traveled by boat with my uncle to Johns Hopkins for multiple rounds of surgery. The hospital performed them using charitable donations to the hospital. The entire ordeal took months and was a huge strain on the family.

But imagine for a moment that it is only the wealthy that come to the U.S. for health care. This highlights one of the core problems with universal systems. The wealthy are fine, because they routinely opt out, by going private in their own country or by leaving it altogether. That’s not an option for the poor who, as the Canadian Supreme Court noted, get waiting lists instead of health care.

Whether its health or other public policy issues, the focus should be what’s best for the poor, or better yet getting the poor out of poverty. The wealthy will be fine no matter what the system is – they’ll always work around or through it.

It’s instructive to note another common feature of the countries on Bernie Sanders’s list. Most have stagnant economies and a core segment of poor citizens with few prospects of moving from the bottom rung of the societies in which they live. Contrast that with America and its historically more dynamic economy that has moved millions of people out of poverty into the middle class and beyond, year in and year out. Universal health care tends to be a drag on economies and is usually accompanied by government-run solutions or regulations in other sectors.

The U.S. still has plenty of health care problems to tackle, but universal health care isn’t the way to solve them.

Nicholas Kerr, who grew up in New Zealand, is a marketing consultant in Seattle, where he lives with his wife and two small children. In his spare time he blogs at The Kerrant.


Anonymous said...
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Canada has about a tenth of the population of the USA and frankly the number of machines is not the issue. The productivity and efficient utilisation of the of the machines is what is important.

Ray said...
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I think you largely miss the point on universal health care. It is true you can get anything you want in the USA BUT you must be able to pay or hope you can get it as charity. Under the universal system in NZ you may have to wait and some things are not available. We are however only 4.5m people. Does the USA have every type of healthcare in every place?
As for MRI and CT scanner numbers we should also ask how many are required. I know we don't have many in NZ but surely having one in every town could be a waste of resource. In NZ you can, and many do, buy top-up private cover but even those without get pretty good universal coverage. Millions of americans have no access to healthcare other than through private charity in the country with the most expensive care in the western world. If I was rich the USA system would be great but not otherwise.

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