The Ugly Truth About Canadian Health Care

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A Hard Lesson About Socialized Medicine

By Michael D. Tanner
September 23, 1996
Europeans are now learning some hard facts of life about socialized medicine: there’s no such thing as a free lunch. The question is whether Congress will learn from Europe’s mistakes as it takes the next steps in reforming the American health care system.

For many years advocates of government-run health care pointed to Europe as an ideal, noting that America was the “only industrialized country without a national health care system.” Now, however, the European welfare states are slashing benefits in the face of rising health care costs.

A recent front-page story in the New York Times detailed the European cutbacks. According to the article, Britain, France and Germany are all being forced to limit access to care. Rationing, already extensive, is increasing.

The Europeans have run into a very simple economic rule. If something is perceived as free, people will consume more of it than they would if they had to pay for it. Think of it this way: if food were free, would you eat hamburger or steak? At the same time, health care is a finite good. There are only so many doctors, so many hospital beds and so much technology. If people overconsume those resources, it drives up the cost of health care.

The same problem is besetting the American health care system. The vast majority of American health care is not directly paid for by the person consuming those goods and services. Instead, a third party, either the government or an insurance company, pays the bill.

Medicare is exhibit one. Medicare beneficiaries pay almost nothing out of their own pockets for health care. Under Medicare Part B, for example, the deductible is an absurdly low $100. (There is, however, a 20 percent copayment.) The deductible under Part A is higher, $716 on the first 60 days of hospital care for each spell of illness. There is also a copayment required for hospitalization of longer than 60 days. However, nearly 70 percent of the elderly have some form of “medigap” insurance that covers all or part of the deductibles and copayments.

Thus, recipients have little incentive to be good consumers and avoid unnecessary expenses or seek the best deal for their dollar. Guy King, former chief actuary for the Health Care Financing Administration, says that third-party payment is one of the primary causes of the rapid growth in Medicare expenditures. As King explains, “When people, either patients or doctors, are spending other people’s money, they do not worry about the cost or number of services consumed.”

The establishment has responded to this problem by trying to force seniors into managed care, thereby allowing insurance companies to ration care. But managed care does not change the underlying incentive structure created by pervasive third-party payment. Any reduction in costs is achieved by limiting access to treatment.

A report by the Department of Health and Human Services’ inspector general found “pervasive” quality problems throughout managed care programs for Medicare, including difficulties in gaining access to care. Managed care programs are significantly less likely to use diagnostic tests, such as MRI and CAT scans, than are fee-for-service plans. Doctors report that managed care organizations pressure them to save money even at the cost of quality. One-third of doctors surveyed by the American Medical Association in 1988 stated that patients were harmed by delays or nontreatment as a result of managed care.

Although the election season has temporarily taken Medicare off the table, the issue will be back to haunt the president and Congress next year. Indeed, the most recent report of the Medicare system’s Board of Trustees warns that the program faces bankruptcy in just five years.

The question is whether we will recognize the problems of third-party payment and restore consumer incentives by increasing deductibles and allowing recipients to choose medical savings accounts or follow the European example and ration the health care that our seniors depend on.

For years we’ve been told to look to Europe for lessons about health care. This time, maybe we should.

http://www.cato.org/publications/commentary/hard-lesson-about-socialized-medicine

 

[Robo]

Default Leftist Lies About Healthcare Comparisons
Irredeemably Flawed?

In making the case that the American health care system is irredeemably flawed, advocates for a national plan sometimes play fast and loose with the facts. They overlook major difficulties in foreign systems while exaggerating the problems with our own.

In “Sicko,” Moore cites a study released in 2000 by the World Health Organization that ranks the U.S. health care system 37th in the world — behind countries like Saudi Arabia, Morocco and the United Arab Emirates and barely ahead of Slovenia. But the study has serious problems in evaluating the success of the American system. As Michael Tanner of the Cato Institute notes, the WHO report utilizes subjective criteria such as “fairness” which are not strictly related to a country’s health care system. For example, one of the criteria is “tobacco control.” Others include the lack of a sufficiently progressive tax system. Moreover, the WHO study penalizes the U.S. for adopting Health Savings Accounts and for the fact that patients pay out of pocket for health care. Other WHO criteria, such as life expectancy, are heavily distorted by factors such as violent crime, tobacco use, and obesity—factors resulting from behavior, individual choice, and other influences unrelated to the functioning of the health care system.

Advocates for a national plan also skew U.S. infant mortality data, which are often used in cross-country comparisons. For example, in the U.S., some high-risk pregnancies have a greater chance of being brought to term using the latest medical technologies. However, some of these infants die soon after birth, boosting the infant-mortality rate. But in European countries such as Austria, Germany, and Switzerland, fetuses must weigh at least one pound to count as a live birth; in Switzerland, the fetus must be at least a foot long to be counted.

In “Sicko,” Moore cites low infant mortality rates in Cuba, suggesting that the Communist nation is a model for the U.S. to adopt. But Tanner notes that Cuba has “one of the world’s highest abortion rates, meaning that many babies with health problems that could lead to early deaths are never brought to term.”” READ MORE AT http://www.jewishpolicycenter.org/20...ized-medicine/

 

[Robo]

https://www.wsws.org/en/articles/2016/01/15/nzhe-j15.html

New Zealand’s healthcare crisis
By Tom Peters
15 January 2016
A number of recent reports illustrate the growing crisis resulting from chronic underfunding of New Zealand’s public health system.
The National Party government repeatedly claims that it has made no cuts to health spending since the 2008 financial crisis. The reality is that public hospitals and other medical services throughout the country have been subject to severe austerity measures. Along with cuts to welfare and education, the underfunding of the health system is designed to transfer the burden of the economic crisis onto the backs of the working class, particularly the most vulnerable and in need of care.
Successive health budgets, while technically providing more money, have failed to fund the system to cope with population growth, ageing and inflation. Last year’s budget, according to the doctors’ union, the Association of Salaried Medical Specialists, had a shortfall of $260 million in operational funds and the figure for previous years is similar.
On January 7, the Press interviewed elderly people in the Canterbury region who have been denied operations such as knee and hip surgery. Jean Hodges, 77, who lives in constant pain due to arthritis and had asked for a knee replacement, said: “I got a letter to say I’m not even going to be assessed let alone treated. How urgent have you got to be, do you have to be crawling around on the floor?” Her husband Ted added: “The worst part is if you’ve got the money you can have it done tomorrow” in the private system.
Canterbury District Health Board chief executive David Meates told the newspaper that funding was a “constraint.” Following the 2010 and 2011 earthquakes that struck the region around the city of Christchurch, “Overwhelming demand for mental health has taken away any ability for us to increase spending on electives [surgeries] above what is required to meet the [government’s] health target,” he said.
Research published in November 2014 in the New Zealand Medical Journal found that one in three people in need of surgery were not even placed on hospital waiting lists. Figures released in August 2015 showed 140,000 people had been denied a surgery assessment since 2010. Phil Bagshaw, who runs the Canterbury Charity Hospital, told Fairfax Media the number of assessments had increased by an average of 3.8 percent per year, but there needed to be a 6–8 percent increase to keep up with population growth, “let alone to make any impact on the backdated need that we’ve got.”
Children are also suffering due to a lack of services, combined with high levels of illnesses linked to poverty. Asthma and Respiratory Foundation medical director Kyle Perrin told Radio NZ on January 7 that the government’s failure to reduce rates of respiratory disease was “an absolute scandal,” particularly among Maori and Pacific Island children who are disproportionately affected.
Dr Innes Asher from Starship Children’s Hospital highlighted the link between poverty and hospitalisations for diseases such as asthma, bronchiolitis and bronchiectasis. She called for more “basic resources to the families, around income resources, housing adequacy, and access to healthcare,” adding that also “educational achievement needs to be improved in all these populations ... we should be quite ashamed that we have such marked disparities.”
Price rises mandated by the government have reduced access to essential medicines. A University of Otago study, published in December, involving 17,000 people found that 10 percent were at times unable to afford needed prescription drugs. Some poor patients were skipping meals and cutting their doses.
Every District Health Board is under government pressure to reduce spending. Doctors, nurses and other staff are increasingly overworked and have seen a drop in their standard of living. According to the Association of Salaried Medical Specialists, public health workers’ wages have not kept pace with inflation over the past five years: pay increased 6.4 percent while prices have gone up 9.4 percent. Last year, health workers had a 0.5 percent pay increase.
In November, over 3,000 Auckland health workers took part in several two-hour work stoppages to protest under-staffing and a proposed new roster. The region’s three District Health Boards are seeking to cut costs by imposing time-and-a-half weekend rates for new employees. Currently workers are paid double time for weekend work after midday Saturday.
The opposition Labour Party’s health spokesperson Annette King has criticised the government for what she says is a shortfall of $1.7 billion in health spending over the past five years. At the party’s conference in November, King declared that over the past 80 years “five Labour governments sought to build a public health system based on affordability, and accessibility for all New Zealanders. Five National governments have sought to corporatise, privatise, and dismantle it.”
In reality both parties are responsible for the present crisis. From 1981 to 1991, according to researcher Jane Kelsey’s book The New Zealand Experiment, waiting lists for surgery lengthened by 61 percent, while “[f]unding from public health sources as a proportion of total health spending [fell] from 88 percent in 1980 to 81.7 percent in 1991.” This period included the 1984–1990 Labour government of David Lange, which introduced patient fees for prescription medicines in 1985.
During the 1990s the National-led government further restructured the health system along business lines, with tight caps on spending. The 1999–2008 Labour government retained essentially the same system. According to a 2010 Statistics New Zealand report, Measuring government sector productivity in New Zealand: a feasibility study, the publicly-funded share of health care had dropped to 77 percent.
The Labour Party, notwithstanding King’s hypocritical and false statements, essentially agrees with the current government’s austerity agenda. Labour has repeatedly called for slashing the levies charged to workers and businesses to run the state-owned Accident Compensation Corporation, which supports people with debilitating injuries. In her November speech, King made no pledge to increase overall health funding and attacked the government for failing to reduce the “cost to ... the tax-payer.” She declared that Labour “will commit to addressing cost pressures in health”—i.e., further reduce spending.

 

[Robo]

Chris Sabatini is an adjunct professor at Columbia University’s School of International and Public Affairs and director of Global Americans, a research institute focused on the foreign policy of human rights and social inclusion.

But while Cuba made great gains in primary and preventive care after the revolution, advanced health care is flagging. In the famously closed country, reliable statistics and rigorous studies are impossible to come by, but anecdotally, it appears that the health system used by average Cubans is in crisis. According to a report by the Institute for War & Peace Reporting, hospitals “are generally poorly maintained and short of staff and medicines.” The writer visited facilities in Havana such as the Calixto García, 10 de Octubre and Miguel Enrique hospitals and describes them in an advanced state of neglect and deterioration. In the 10 de Octubre, “the floors are stained and surgeries and wards are not disinfected. Doors do not have locks and their frames are coming off. Some bathrooms have no toilets or sinks, and the water supply is erratic. Bat droppings, cockroaches, mosquitos [sic] and mice are all in evidence.”

One reason Cuba still sends doctors abroad despite findings like that: Its foreign medical program is a huge moneymaker, bringing approximately $2.5 billion per year to the cash-strapped government. With more than 50,000 Cuban health professionals working in 68 countries other than Cuba, the doctor export program has created a shortage of medical practitioners in Cuba.

https://www.washingtonpost.com/opin...647fcce95e0_story.html?utm_term=.bae1400b3755

 

[Robo]

Default NHS Socialized Medicine In Britain: Unmitigated Failure
EDITORIALS
NHS Socialized Medicine In Britain: Unmitigated Failure

7/17/2013
Health Care: A new report on Britain's National Health Service notes that as many as 13,000 needless deaths have occurred in 14 NHS hospital trusts since 2005. This is no fluke. It's the result of socialized medicine, done by experts.


Britain's much vaunted public medical system, accountable for 82% of all health care spending, according to the OECD, is in shambles.


A warning shot was fired a few months ago when one hospital, Mid-Staffordshire, was found to be a veritable death trap of neglect, misspent funds and starved investment. Now a new report on 14 NHS trusts, released by government-appointed Prof. Sir Bruce Keogh this week, finds that neglect and "needless" deaths are pretty much a characteristic of the entire system.


"We hear of A&E departments 'in meltdown', GP services 'on the verge of failure,' the Welsh HNHS being 'on its knees,'" wrote Simon Jenkins in the left-leaning Guardian. "The 111 non-emergency telephone service is reportedly useless. On one evening, Cornwall was said to have just one agency GP to cover the entire county. Last week's Cavendish report on frontline nursing told of wards left in the hands of untrained assistants for hours, indeed whole weekends," Jenkins wrote.

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Then there was the "Liverpool Care Pathway" — an Orwellian death panel operation, where nurses shouted to visitors to not give their dying relatives sips of water for fear it would interfere with the hospital's death target. "No one was doing anything 'wrong' since everything was done by the book," wrote Jenkins.


Keogh found that as many as 13,000 "needless" deaths were the result, about 3 per day in each hospital district.


The U.K. has seen reform after reform of its health care system, but none has made much difference.


The problem is it's a socialized system. Unlike a private one — and in the OECD, only the U.S., Mexico and Chile have them — state priorities trump those of the consumer. That's why the NHS is celebrated as a patriotic duty — as it was during the absurd propaganda spectacle celebrating NHS at the 2012 London Olympics.


Big problems fester because the state can cover them up. Anyone criticizing the NHS is shouted down because bureaucracies resist change, Telegraph writer Daniel Hannan wrote.


So much for socialized medicine being a more "humane" form of health care. The Labour Party, which has touted and enshrined this socialism for decades, is now in crisis over the Keogh findings. Far from extending life, as private health care systems do, socialized health care is a reliable vehicle only for needless death. http://www.investors.com/politics/ed...gated-failure/

 

[Robo]

Socialized Medicine Elsewhere Shows Why It Is a Failure
January 22, 2008 International Health Systems Commentary

By Grace-Marie Turner

Britain’s system of socialized medicine is enough to make your teeth hurt – literally.

Its citizens rely upon the government-run National Health Service that is designed to provide free access to every medical service, including dental care. But like all socialized medicine schemes, it has produced long lines, a shortage of medical professionals, and shoddy care.

William Kelly, a resident of a working-class suburb of Manchester, represented the frustrations of many Britons when he plucked out one of his own teeth last year. Why? Because the pain had become intolerable, and the wait to see a dentist was unbearably long. When he spoke with The New York Times last summer, Kelly had been unable to get a dentist appointment for six years.

At the beginning of 2006, only 49 percent of British adults and 63 percent of children were registered with public dentists. Because dentists are paid on a per-patient basis, the government’s system encourages public dentists to treat as many patients as possible, often leading to inadequate care and roughshod work.

With pay tied directly to the number of patients a dentist sees, for example, it makes more sense — financially, at least — for a dentist to extract teeth rather than perform a more complex and time consuming root canal. And the pool of available dentists is shriking as more are leaving the National Health Service to work in the private sector where they can be paid more.

Last April, 2,000 dentists did just that, according to the British Dental Association. In understandable frustration, many Britons have resorted to “Do it Yourself Dentistry” kits sold in pharmacies.

Take the case of Gordon Cook, a 55-year-old security manager. After failing to find an NHS dentist, he resorted to fixing his front tooth with superglue, according to a November article in the Daily Mail. For three years, Cook constantly reapplied the glue to a loose crown before finally finding a dentist.

“You can't really taste it but you do have to be careful not to use too much, in case you glue your mouth shut,” said Cook.

But don’t expect advocates for socialized medicine to be honest about the major failings of the supposedly utopian English system.

Defenders of European-style healthcare will often observe that the United States spends a greater percentage of its GDP on healthcare than any other country in the world. And, with measures like life expectancy, America’s outcomes are often worse than those countries with socialized systems.

But these arguments fail to take into account the quality of care provided.

Because socialized medicine rejects the basic laws of supply and demand — and because state-administered systems do not pay doctors what the market determines they are worth — there is a serious discrepancy between the number of doctors and number of patients. This leads to the inevitable “waiting times” that one hears so much about in countries like Great Britain and Canada.

A report by the Canadian Fraser Institute found that the average wait time from referral by a general practitioner to a specialist is 18 weeks, the longest ever recorded in Canada.

Despite all the attempts made by the Canadian government to improve this problem, the average wait time actually rose by an astonishing 91% between 1993 and 2006. No matter how much money the Canadian government throws into the program, the problem does not go away. They just haven’t figured out how to repeal the laws of supply and demand.

Further, in the interest of national budgets, state-administered health systems have an incentive to put saving money before patients.

Japan, for example, spends only about half as much of its GDP on healthcare as the United States. But the comparatively low salaries doctors receive have caused a serious shortage of cancer specialists in a country where cancer rates are rising and the disease is the leading cause of death.

Indeed, “cancer refugees” — cancer patients desperately seeking care — have become a national crisis. At a recent event protesting the Japanese government’s lackadaisical approach to battling cancer, a cancer sufferer cried, “While Japan has become economically prosperous, cancer patients are in the same position as refugees who wander in search of food, water and someone who can help.” The patient died seven months later.

Those who advocate for universal healthcare may have their hearts in the right place, but they would do well to examine how the systems they support are actually performing around the world. So the next time you hear about the wonders of socialized medicine, remember Gordon Cook and his mouth full of superglue.

http://galen.org/topics/socialized-m...-is-a-failure/ A not-for-profit health and tax policy research organization