Ardis Hoven is chair-elect of the American Medical Association. Dr. Hoven will take office as AMA chair in June of 2010. She told EarthSky that her organization, which consists of more than a quarter million physicians and medical students in the U.S., believes the health care system in the U.S. needs reform.
Ardis Hoven: The American Medical Association is working very hard to make sure that health system reform is accomplished for our patients and the dedicated physicians that provide their care. Clearly, in this country, we have 46 million people who are uninsured, and that is unacceptable. The status quo must change.
Dr. Hoven also spoke of the current policy of many insurance companies on pre-existing conditions.
Ardis Hoven: Pre-existing conditions, which prohibit people from getting or purchasing health insurance, or health coverage, is unacceptable in this country. Let’s get some of this regulatory stuff out of the way so that, not only the doctors, but also the patients who fight to get their coverage paid for, get their care paid for. People fighting cancer shouldn’t be fighting the insurance company at the same time.
Dr. Hoven spoke of what she sees as misconceptions about health care today.
Ardis Hoven: Healthcare is very personal. When we begin to hear that something may be taken away from us, or that something else may get in the way of my relationship as a patient to my doctor, I become fearful. That is the sort of myth that we need to get removed. That relationship, that space between the doctor and the patient must be maintained. That is a protected, sacred space. As physicians, we are doing everything that we can do to protect that space.
In late 2009 the U.S. Congress will most likely consider legislation that could significantly change the health care system, which includes patients, insurance providers, and the medical industry. Dr. Hoven spoke more of the changes she’d recommend.
Ardis Hoven: First and foremost, we need to address the universal coverage issue, the 46 million uninsured, in making sure that all Americans have access to quality health care. That is the imperative. We do have to address the cost issue. We need to talk about medical liability reform. And the other part of this is insurance reform. Pre-existing conditions, which prohibit people from getting or purchasing health insurance, or health coverage, is unacceptable in this country.
Working in medical research (perinatology) and owning my own business, I directly observe some of the reasons why we need to fix our current system from the perspective of the doctor providing services and businesses providing health care for employees.
Perinatology is a field that ranks one of the highest in frivolous law suits. Patients come to a perinatologist because the baby is already at significant risk yet they sue if the baby is born with the slightest imperfection.
To show you how unreasonable it gets, one patient presented with a twin-twin transfusion, a condition not compatible with either baby making it to delivery. She was treated with a new advanced laser ablation procedure which saved both babies yet the center was sued because twin “B” weighed one pound less than twin “A” at birth. It is fairly common for healthy twins to have different birth weights. The patient lost the law suit but it doesn’t matter. The doctor and the center had to foot the bill to defend themselves, added to which the lawsuit raised the center’s insurance rates.
All of the doctors I work around are opposed to the current legislation as it will serve to lower the quality of health care for all and does not properly address the doctor / patient interface. It will serve to drive many doctors out of practice if enacted because it completely fails to address doctor’s needs. In Nevada we already have an acute shortage of doctors. Many have already been driven out by bureaucratic bungling and an unwillingness of state and federal policy makers to challenge the attorneys and legal system that encourages frivolity.
In short, we need to fix the current system which is, for the most part, one of the best in the world. Changing out the whole system to a government run – eventually to become single payor – will be a disaster. The government can’t solve a one piece puzzle with instructions let alone manage anything in the private sector without overburdening it to its demise. Fix what is broke: implement workable tort reform, promote more competition among insurance companies, allow for larger pooling concepts, allow national plans, bring malpractice insurance under control, better protect drug patents to reduce pharmaceutical costs to the patient, eliminate preexisting condition and termination clauses in health insurance policies, and target the interested portion of the 46 million uninsured through programs in the private sector.
I forgot to mention that in the twin-twin transfusion case mentioned, aside from the difference in birth weight, both babies were entirely healthy. How such a nonsense case even made it to a hearing is beyond comprehension. Yet it happens all the time. In short, the attorneys got paid and that’s all that mattered in the end.
Hank, ridiculous hyperbole does nothing to help the situation. Single Payor will NOT be a disaster, if done correctly. It works fine in France, Japan, Britain, Sweden, Canada, among others (even Luxembourg and Malta). (All places with longer average lifespans and lower infant mortality rates than here in the U.S.) It’s simply not true that the “government can’t solve a one piece puzzle with instructions”. The government does do some things well. Social Security works fine. It would have no problems, if the President and Congress would keep their hands off the SS Trust Fund. And I don’t hear you calling for the dismantling of the military, because the gov’s so inept. Or the Fire Dept. Or the Police Dept. The fact is, the gov’s the ONLY entity qualified to handle the health care payment system. Because there’s no PROFIT motive involved. As long as there’s profit involved, there is incentive NOT to pay for medical procedures. There’s incentive to DROP people who get too sick or too often. There’re ins execs being paid tens of $millions/year. THAT’S what has to change. Profit has to be removed from the health care payment system. Far from being a disaster, Single Payor is exactly what we need.
By the way, we HAVE tort reform here in Texas, and medical malpractice rates have gone down. But health care costs are STILL going up. My insurances premiums and copays are STILL going up. We consumers have not seen one dime in savings since tort reform. Tort reform is just a red herring.
Charlie, I believe you conveniently overlook the \”real\” numbers behind your favored health care system. While a country\’s average lifespan is affected by quality of healthcare, it is not a proper indicator because it is equally affected by lifestyle, diet, economics, and crime (cultural contributors). If you factor out cultural contributors, the United States leads the world in best overall population health. That fact hardly makes your argument salient.
When you grade the quality of a health care system, you need to look at the percentage ranking of deaths by disease by population. Many of the counties you mention actually rank highest in the world, indicating poorer testing and less access to proper care. Most alarming is that almost all have a significantly higher mortality rates from cancer as compared to the United States. Denmark ranks highest in the world in death from breast cancer with the United Kingdom a close second, followed by Belgium and the Netherlands (all single payor socialized, government run health care). Curiously, France has ranks the highest in the world in depression related disorders (maybe they\’re unhappy about their taxes to pay for their healthcare).
Don\’t take my word for it. Look at these statistics: http://www.worldlifeexpectancy.com/top_10_causes.php
One of the greatest single contributor to infant morbidity and mortality in the United States is obesity and its associated risks. We have an unacceptably high rate of gestational diabetes. This speaks more to a super size me, fast food lifestyle than quality of health care issues.
I\’m sorry to hear that you didn\’t benefit from Texas\’ tort reform. Unfortunately, the pharmaceuticals and insurance companies are jacking up the price to Texans to cover their costs for lack of it at the national level where they do the greater percentage of their business.
There\’s nothing ridiculous about making solid suggestions on how to improve our already excellent health care system. To be certain, health care reform is much needed to improve our system but it will require a multifaceted set of improvements, many of which I detailed. You make the point that profit needs to be removed from our system but then espouse a philosophy of throwing government money at the problem. How does that make sense? To simply throw out a proven superior system as ours and adopt an even more expensive system that is clearly inferior in overall quality of patient access and care seems ridiculous.
Hank, Single Payor is *not* a more expensive system than ours. Every one of the countries I mentioned spends less than 2/3 per capita what Americans do for health care. (Denmark does, too.) Canada spends less than HALF: http://www.nationmaster.com/graph/hea_spe_per_per-health-spending-per-person. Also, you’re (inadvertently, I hope) conflating health care quality with health care access. The problem isn’t that the quality of health care is so much better in those countries, it’s that the ACCESS to health care is so much better. In those countries, people don’t have to put off visits to the doctor or hospital out of fear that they can’t afford it. People here DO. People in those countries don’t have to fear falling into financial ruin just because they get sick. Over a MILLION people here declare bankruptcy each year, due to medical expenses. Not even one person does so in those countries. By the way, 62% of those US medical bankruptcies happenned to people who HAVE health insurance. A report just came out this past week, showing that the current figure is that almost 45,000 Americans die each year because they don’t have health insurance: http://www.reuters.com/article/healthNews/idUSTRE58G6W520090917. This doesn’t make the US system seem “superior” to *me*. All the current system has “proven” is that we can make health insurance executives obscenely rich, while over 3500 Americans are left to die each month untreated or under treated for their illnesses.
Hank, I’m not proposing “throwing government money” at the problem. I’m proposing using government funds to pay LESS than the money we’re already throwing to the health insurance companies. Denmark achieves that same end (lifespan 78.1 years: http://www.worldlifeexpectancy.com/sort.php) as our system, while spending almost $1500/year less per person. That would save us $450 billion/year. ($1500 x 300 million Americans) If we adopted the Canadian system, we could save almost $700 billion/year, AND live over 3 years longer each (81.2 vs 78.1). These are the facts that make Single Payor vastly superior to our current health insurance payment system.
Charlie, the Reuters article you referenced is so pro socialized medicine that it drips with spin. The article states that the study was “released by Physicians for a National Health Program [PNHP], which favors government-backed or “single-payer” health insurance.” It presents the PNHP as a respected group while failing to mention the PNHP is a small far left leaning advocacy group of doctors, students, and university professors that hardly represent the sediments of the medical profession. They’re more a fringe political group guised as medical professionals than a respected society of physicians. It might interest you to know that they are such far left zealots that they don’t even support the current plan proposed by Obama and are on record as stating that if the U.S. won’t adopt a full on socialized, single payer system, they will not support any form of a more moderate, centrist plan. David Himmelstein, associate professor of medicine at Harvard Medical School and co-author of the report said that he would prefer we keep status quo [the current health care system] over Obama’s proposed plan. So what makes you think their study isn’t blindly biased by their agenda? You’re basing your position on a fringe far left activist group that is ideologically committed to undermine the current plan proposed by Obama and a group that is grossly out of touch with the general medical profession. It’s ironic that Obama’s worst enemies in the push for health care reform are those on the far left.
Trying to maintain some common ground here, I think we both agree on the intended goal in health care reform. We disagree sharply on how to get there. A single payer system is not a reasonable solution. It’s not even in the political discussion because it has no support among moderate Democrats, Independents, and Republicans. It has only fringe support in groups like PNHP who will do more harm to reform than any right leaning opposition. We need to be searching for a solutions rooted in improving our current system, framed in a policy dialog that has broad centrist support.
Hank, I can’t help but notice that you’ve neglected to address any of my points. You attacked the messenger of the news that 45,000 people die each year from lack of health insurance (PNHP), but presented no evidence that refutes that figure. You can’t deny that SOME number of people die that way (we all know people who put off medical care for financial reasons), so your argument must with be how high the figure is. So what’s *your* number (and source)? Frankly, if it’s more than 0, then that’s too many (in my opinion). In the richest country in the world, NO ONE should die because they can’t afford treatment.
Furthermore, you erroneously state that I’m basing my pro Single Payor position on a “fringe far left activist group”. Even if PNHP really were a fringe far left activist group, I had my beliefs long before that study was released. Just the hundreds of $billions in saving alone (which you neglected to address, as noted before) would be enough for me to advocate Single Payor. Just the fact the people live longer lives in countries that have Single Payor systems, would be enough for me. Just the fact that NOT ONE PERSON ever has to file bankruptcy due to medical expenses in those countries would be enough. What’s *your* solution to the health care crisis, that addresses these issues *without* Single Payor or some other Public Option? I’d really like to hear it.
You’re intent upon “improving” our current system, instead of changing it. To me that like saying, “Gosh, so many of our houses are burning down. We need to reform our home building processes. It’s too radical a change to just build with cheaper, non-flammable materials. No, we have to protect the current building materials suppliers by trying to find some way to paint their materials so that they’re not so flammable, even if that’s more expensive.” This is “reasonable”? No country that has adopted Single Payor has ever dropped it. If Single Payor is so “disastrous”, then why is it political suicide in those countries, for anyone to suggest changing it? Sometimes, when your car breaks down, it’s not worth fixing. You just have to get a new car.
As for Obama’s plan, the far left’s so against it because it does nothing to fix these problems (except for getting coverage for SOME of those who don’t have it now). How does it “compete” with the insurance companies, if you can’t opt into it unless you’ve been rejected by the insurance companies? How does it encourage insurance companies to lower costs, if it subsidizes the costs for those who can’t afford them? How is it going to be affordable, if it only covers the most expensive users of medical care? And you want the left to “compromise” by accepting this plan? Obama’s plan is designed for failure. A car-less person might as well compromise by getting a car with square wheels.
Charlie, I’ve addressed your key points as best I can understand them. You’ve thrown out a bunch of supportive information which I don’t see as points that need to be addressed. If I can condense what I see as your main points, they would be:
1) People live longer in said countries because they have socialized, single payer medicine.
I pointed out that lifespan is a gauge of both health care and cultural contributions. When you factor out cultural contributors, this argument doesn’t make a solid case. I further pointed out that most of the countries you listed have much higher death rates from cancer as compare to the U.S. by virtue of the fact that testing and access to care is a take a number and wait for months to see a specialist proposition.
2) Our country has a bad health care system as witnessed by the PNHP report.
I disagree. We have one of the best health care system in the world but it isn’t perfect. It is indeed a system that needs improvement. We need to address, with in the context of our free enterprise society and private sector, those problems that make it less accessible and cost prohibitive for many. Irrespective of what you think of PNHP, single payer has no hope of flying because there is no support for it with core Democrats, Independents, and Republicans. So, the fix needs to be a multifaceted centrist set of policies that can work.
3) People are dying in the streets due to no access to lack of access to health care.
People are dying in the hospitals with socialized medicine. I’m sure if I were to do some research on this issue, we’ll find that more die from denial of procedures and long waiting lists in Great Britain, for example, than those who die on the streets here. Just look at the cancer death rates in countries with socialized medicine. The numbers are speaking. That said, I agree that anyone who dies from lack of access to care is one too many. There are too many in our country who don’t have insurance but also too many in other countries who are dying because they have insurance but can’t get the procedure due to long waits or disqualification.
I’m not in favor of Obama’s plan. Nobody knows what Obama’s plan is. He put it in the hands of congress to determine what his plan was going to be. Congress has no plan other than set up the next huge tax and spend scheme then write the actual plan only after it has been approved. It’s people like Dr. Hoven who are in the trenches and understand the problems and disconnects of the current system. Obama needs to be listening to the experts like her and not a bunch of career politicians. Hopefully he’ll start doing that now that his plan is in trouble.
If I can address another one of your original points. You state that “Social Security works fine. It would have no problems, if the President and Congress would keep their hands off the SS Trust Fund.” BINGO! You make my point. They won’t keep their hands off the money, they change the rules after the fact, and can’t resist seeing anything that pays for itself as a cash cow for other pet projects. To that end, they’ll justify running it broke as SSI is today. It wasn’t a failure of the SSI concept. It was a failure of government to keep their hands off of it. These are the same folks who will run a single payer health care system. I rest my point.
Charlie, I believe at this point, we’ve expressed our opinions for what they’re worth. I agree that the current system needs improvement for many of the reasons that concern you. I’ve enumerated some key areas that need to be addressed from my perspective. You obviously feel a single payer system can work. I don’t for reason that it has no support in our country, it would require sweeping changes in our education system, a union between doctors and government that most highly qualified doctors I know won’t accept, and it will require a major swing in our political system towards socialistic government with nationalizing of the entire health care system, pharmaceuticals, hospitals, clinics, and all – a notion most Americans reject. If you can show how socialized, single payer medicine can work in that environment then you’ll solve the concerns most people see as too impractical to overcome. We need to fix the current system, not throw it out.
Hank, Let me address what I see as *your* points:
1) It doesn’t matter that people in countries with Single Payor systems live up to 3 years longer than we do, because they tend to die from cancer more often than we do. In other words, what ones dies of is more important than how long one lives.
I’m very sceptical of this position. Personally, I’ll gladly die of cancer, if it will let me live an extra 3 years. Especially if it will save me $700 billion/year. (By the way, the cost savings is one of my points that you have failed to address.) I would be amazed if even 30% of Americans would agree with your apparent position here. The vast majority of the people *I* know would like to live as long as possible.
2) We have one of the best health care systems in the world, and Charlie is wrong for saying that we don’t.
Again, you are conflating health care QUALITY with health care ACCESS. I repeat, I do not argue that Single Payor countries have better health care QUALITY than we do. They have better health care ACCESS. I maintain that it’s that better ACCESS that allows them to live longer. They are not prone to postponing visits to medical facilities because of financial considerations, as many of us are here. Therefore, that pain in the side is discovered to be a treatable kidney infection, BEFORE it festers long enough to completely destroy their kidneys. (As an example) A $billion (not to mention, the best health care) does you no good at all, if you don’t have ACCESS to it.
3) People are dying in Single Payor countries, because they can’t get the life-saving procedures they need due to long waiting lines.
This is simply NOT TRUE. Documented cases of people dying in Britain, or France, or Japan, or other countries with socialized medicine, are EXTREMELY rare. FAR more people die here in the U.S. from insurance companies dragging their feet on approving payment for covered procedures. Just the fact that they live longer proves that. Canadians could not possibly live an average of 3 years longer than us, if health care was rationed as poorly as you claim. And the people wouldn’t be so overwhelmingly in favor of continuing their Single Payor system. If you’ve got some reputable documentation to back your claim, I’d certainly like to see it. But, as far as I can see, Canadians are so happy with their socialized system, that even the most staunchly conservative politician would never even THINK of suggesting scrapping it. Especially not for a U.S. style payment system. Yes, they may have to wait longer than we do for a facelift ot tummytuck, but NOT for a heart bypass or chemotherapy. You’re right, the numbers are speaking. They’re saying that other countries have figured out how give such better access to health care that their citizens can live longer than we do, for half what we spend, while ensuring that no one undergoes fanancial ruin just because they got sick.
Yes, Hank. Single Payor can work here. It does NOT require nationalizing the entire health care system. Doctors, hospitals, clinics, pharmacies, etc., can STILL be privately run. All it takes is to nationalize the health care PAYMENT system. To take the profit and greed out of it. But I agree that we have little chance to get Single Payor with the current Congress. They are more interested in protecting the insurance companies, than what’s best for the American people. (Because they need the $millions in donations from those companies, for the next election cycle.) We’ll just have to elect NEW Senators and Congressmen over the next few cycles, until we get a group who WILL do what’s best for us. And we will get Single Payor, eventually. Because our premiums, copays, and deductibles keep going up, while the insurance companies find more and more reasons to deny payments. And we’ll get fed up with it.
Charlie, I think, in the interest of not turning this comment section into a debate forum (as I fear we already have), I’m going to agree to disagree. I think we’ve both expressed our views adequately and respectfully. We both desire a better health care system than what we presently have but differ in opinion on what’s the best approach to achieving that goal. I appreciate your candor and sincerity and offer you my best regards.
“3) People are dying in Single Payor countries, because they can’t get the life-saving procedures they need due to long waiting lines.
This is simply NOT TRUE. Documented cases of people dying in Britain, or France, or Japan, or other countries with socialized medicine, are EXTREMELY rare”
Lie. Its quite common.
Injured Japanese Man Dies After 14 Hospitals Refuse to Admit Him
Kidney cancer patients denied life-saving drugs by NHS rationing body NICE
- April 29, 2009 [Daily Mail (UK)]
Girl, 3, has heart operation cancelled three times because of bed shortage
- David Rose, April 23, 2009 [Times Online]
NHS ‘failings’ over elderly falls
- March 25, 2009 [BBC]
Cancer survivor confronts the health secretary on 62-day wait
- Lyndsay Moss, March 21, 2009 [The Scotsman]
Our cancer shame: Survival rates still lag behind EU despite spending billions
- Jenny Hope, March 20, 2009 [Daily Mail(UK)]
Failing hospital ’caused deaths’
- March 17, 2009 [BBC]
Government procrastination blamed for HIV-contaminated blood tragedy
- February 23, 2009 [Guardian Unlimited]
Stroke services are ‘UK’s worst’
- February 17, 2009 [BBC]
Heart patients dying due to poor hospital care, says report
- Sarah Boseley, June 8, 2008 [Guardian Unlimited]
Cancer patients ‘betrayed’ by NHS
- Sarah-Kate Templeton, June 1, 2008 [The Times]
NHS scandal: dying cancer victim was forced to pay
- Sarah-Kate Templeton, June 1, 2008 [The Times]
Lung patients ‘condemned to death as NHS withdraws their too expensive drugs’
- Jenny Hope, March 24, 2008 [Daily Mail(UK)]
NHS chiefs tell grandmother, 61, she’s ‘too old’ for £5,000 life-saving heart surgery
- Chris Brooke, February 28, 2008 [Daily Mail(UK)]
Patient ‘removed’ from waiting list to meet target
- January 31, 2008 [The Scotsman]
NHS patients told to treat themselves
- James Kirkup, January 4, 2008 [Telegraph UK]
Smokers and the obese banned from UK hospitals
- May 2, 2007 [Healthcare News]
Cancer patients told life-prolonging treatment is too expensive for NHS
- Lyndsay Moss, February 13, 2007 [The Scotsman]
UK health service “harms 10 percent of patients”
- Kate Kelland, July 7, 2006 [Reuters]
5,000 elderly ‘killed each year’ by lack of care beds
- June 26, 2006 [Telegraph UK]
Life-saving cancer drugs ‘kept from NHS patients by red tape’
- Sam Lister, September 20, 2005 [The Times]
Heart patients die on waiting lists
- Peter Sharples, October 18, 2004 [Manchester Online]
“2) We have one of the best health care systems in the world, and Charlie is wrong for saying that we don’t.
Again, you are conflating health care QUALITY with health care ACCESS. I repeat, I do not argue that Single Payor countries have better health care QUALITY than we do. They have better health care ACCESS. I maintain that it’s that better ACCESS that allows them to live longer.”
Better access? Now thats a laugh. In the US, the hospitals cant turn you away by law, but those with this single payer systems, they can. And they do. Those who dont turn you away make you wait.
The Ugly Truth About Canadian Health Care
David Gratzer
Socialized medicine has meant rationed care and lack of innovation. Small wonder Canadians are looking to the market.
Mountain-bike enthusiast Suzanne Aucoin had to fight more than her Stage IV colon cancer. Her doctor suggested Erbitux—a proven cancer drug that targets cancer cells exclusively, unlike conventional chemotherapies that more crudely kill all fast-growing cells in the body—and Aucoin went to a clinic to begin treatment. But if Erbitux offered hope, Aucoin’s insurance didn’t: she received one inscrutable form letter after another, rejecting her claim for reimbursement. Yet another example of the callous hand of managed care, depriving someone of needed medical help, right? Guess again. Erbitux is standard treatment, covered by insurance companies—in the United States. Aucoin lives in Ontario, Canada.
When Aucoin appealed to an official ombudsman, the Ontario government claimed that her treatment was unproven and that she had gone to an unaccredited clinic. But the FDA in the U.S. had approved Erbitux, and her clinic was a cancer center affiliated with a prominent Catholic hospital in Buffalo. This January, the ombudsman ruled in Aucoin’s favor, awarding her the cost of treatment. She represents a dramatic new trend in Canadian health-care advocacy: finding the treatment you need in another country, and then fighting Canadian bureaucrats (and often suing) to get them to pick up the tab.
But if Canadians are looking to the United States for the care they need, Americans, ironically, are increasingly looking north for a viable health-care model. There’s no question that American health care, a mixture of private insurance and public programs, is a mess. Over the last five years, health-insurance premiums have more than doubled, leaving firms like General Motors on the brink of bankruptcy. Expensive health care has also hit workers in the pocketbook: it’s one of the reasons that median family income fell between 2000 and 2005 (despite a rise in overall labor costs). Health spending has surged past 16 percent of GDP. The number of uninsured Americans has risen, and even the insured seem dissatisfied. So it’s not surprising that some Americans think that solving the nation’s health-care woes may require adopting a Canadian-style single-payer system, in which the government finances and provides the care. Canadians, the seductive single-payer tune goes, not only spend less on health care; their health outcomes are better, too—life expectancy is longer, infant mortality lower.
Thus, Paul Krugman in the New York Times: “Does this mean that the American way is wrong, and that we should switch to a Canadian-style single-payer system? Well, yes.” Politicians like Hillary Clinton are on board; Michael Moore’s new documentary Sicko celebrates the virtues of Canada’s socialized health care; the National Coalition on Health Care, which includes big businesses like AT&T, recently endorsed a scheme to centralize major health decisions to a government committee; and big unions are questioning the tenets of employer-sponsored health insurance. Some are tempted. Not me.
I was once a believer in socialized medicine. I don’t want to overstate my case: growing up in Canada, I didn’t spend much time contemplating the nuances of health economics. I wanted to get into medical school—my mind brimmed with statistics on MCAT scores and admissions rates, not health spending. But as a Canadian, I had soaked up three things from my environment: a love of ice hockey; an ability to convert Celsius into Fahrenheit in my head; and the belief that government-run health care was truly compassionate. What I knew about American health care was unappealing: high expenses and lots of uninsured people. When HillaryCare shook Washington, I remember thinking that the Clintonistas were right.
My health-care prejudices crumbled not in the classroom but on the way to one. On a subzero Winnipeg morning in 1997, I cut across the hospital emergency room to shave a few minutes off my frigid commute. Swinging open the door, I stepped into a nightmare: the ER overflowed with elderly people on stretchers, waiting for admission. Some, it turned out, had waited five days. The air stank with sweat and urine. Right then, I began to reconsider everything that I thought I knew about Canadian health care. I soon discovered that the problems went well beyond overcrowded ERs. Patients had to wait for practically any diagnostic test or procedure, such as the man with persistent pain from a hernia operation whom we referred to a pain clinic—with a three-year wait list; or the woman needing a sleep study to diagnose what seemed like sleep apnea, who faced a two-year delay; or the woman with breast cancer who needed to wait four months for radiation therapy, when the standard of care was four weeks.
I decided to write about what I saw. By day, I attended classes and visited patients; at night, I worked on a book. Unfortunately, statistics on Canadian health care’s weaknesses were hard to come by, and even finding people willing to criticize the system was difficult, such was the emotional support that it then enjoyed. One family friend, diagnosed with cancer, was told to wait for potentially lifesaving chemotherapy. I called to see if I could write about his plight. Worried about repercussions, he asked me to change his name. A bit later, he asked if I could change his sex in the story, and maybe his town. Finally, he asked if I could change the illness, too.
My book’s thesis was simple: to contain rising costs, government-run health-care systems invariably restrict the health-care supply. Thus, at a time when Canada’s population was aging and needed more care, not less, cost-crunching bureaucrats had reduced the size of medical school classes, shuttered hospitals, and capped physician fees, resulting in hundreds of thousands of patients waiting for needed treatment—patients who suffered and, in some cases, died from the delays. The only solution, I concluded, was to move away from government command-and-control structures and toward a more market-oriented system. To capture Canadian health care’s growing crisis, I called my book Code Blue, the term used when a patient’s heart stops and hospital staff must leap into action to save him. Though I had a hard time finding a Canadian publisher, the book eventually came out in 1999 from a small imprint; it struck a nerve, going through five printings.
Nor were the problems I identified unique to Canada—they characterized all government-run health-care systems. Consider the recent British controversy over a cancer patient who tried to get an appointment with a specialist, only to have it canceled—48 times. More than 1 million Britons must wait for some type of care, with 200,000 in line for longer than six months. A while back, I toured a public hospital in Washington, D.C., with Tim Evans, a senior fellow at the Centre for the New Europe. The hospital was dark and dingy, but Evans observed that it was cleaner than anything in his native England. In France, the supply of doctors is so limited that during an August 2003 heat wave—when many doctors were on vacation and hospitals were stretched beyond capacity—15,000 elderly citizens died. Across Europe, state-of-the-art drugs aren’t available. And so on.
But single-payer systems—confronting dirty hospitals, long waiting lists, and substandard treatment—are starting to crack. Today my book wouldn’t seem so provocative to Canadians, whose views on public health care are much less rosy than they were even a few years ago. Canadian newspapers are now filled with stories of people frustrated by long delays for care:
vow broken on cancer wait times: most hospitals across canada fail to meet ottawa’s four-week guideline for radiation
patients wait as p.e.t. scans used in animal experiments
back patients waiting years for treatment: study
the doctor is . . . out
As if a taboo had lifted, government statistics on the health-care system’s problems are suddenly available. In fact, government researchers have provided the best data on the doctor shortage, noting, for example, that more than 1.5 million Ontarians (or 12 percent of that province’s population) can’t find family physicians. Health officials in one Nova Scotia community actually resorted to a lottery to determine who’d get a doctor’s appointment.
Dr. Jacques Chaoulli is at the center of this changing health-care scene. Standing at about five and a half feet and soft-spoken, he doesn’t seem imposing. But this accidental revolutionary has turned Canadian health care on its head. In the 1990s, recognizing the growing crisis of socialized care, Chaoulli organized a private Quebec practice—patients called him, he made house calls, and then he directly billed his patients. The local health board cried foul and began fining him. The legal status of private practice in Canada remained murky, but billing patients, rather than the government, was certainly illegal, and so was private insurance.
Chaoulli gave up his private practice but not the fight for private medicine. Trying to draw attention to Canada’s need for an alternative to government care, he began a hunger strike but quit after a month, famished but not famous. He wrote a couple of books on the topic, which sold dismally. He then came up with the idea of challenging the government in court. Because the lawyers whom he consulted dismissed the idea, he decided to make the legal case himself and enrolled in law school. He flunked out after a term. Undeterred, he found a sponsor for his legal fight (his father-in-law, who lives in Japan) and a patient to represent. Chaoulli went to court and lost. He appealed and lost again. He appealed all the way to the Supreme Court. And there—amazingly—he won.
Chaoulli was representing George Zeliotis, an elderly Montrealer forced to wait almost a year for a hip replacement. Zeliotis was in agony and taking high doses of opiates. Chaoulli maintained that the patient should have the right to pay for private health insurance and get treatment sooner. He based his argument on the Canadian equivalent of the Bill of Rights, as well as on the equivalent Quebec charter. The court hedged on the national question, but a majority agreed that Quebec’s charter did implicitly recognize such a right.
It’s hard to overstate the shock of the ruling. It caught the government completely off guard—officials had considered Chaoulli’s case so weak that they hadn’t bothered to prepare briefing notes for the prime minister in the event of his victory. The ruling wasn’t just shocking, moreover; it was potentially monumental, opening the way to more private medicine in Quebec. Though the prohibition against private insurance holds in the rest of the country for now, at least two people outside Quebec, armed with Chaoulli’s case as precedent, are taking their demand for private insurance to court.
Rick Baker helps people, and sometimes even saves lives. He describes a man who had a seizure and received a diagnosis of epilepsy. Dissatisfied with the opinion—he had no family history of epilepsy, but he did have constant headaches and nausea, which aren’t usually seen in the disorder—the man requested an MRI. The government told him that the wait would be four and a half months. So he went to Baker, who arranged to have the MRI done within 24 hours—and who, after the test discovered a brain tumor, arranged surgery within a few weeks.
Baker isn’t a neurosurgeon or even a doctor. He’s a medical broker, one member of a private sector that is rushing in to address the inadequacies of Canada’s government care. Canadians pay him to set up surgical procedures, diagnostic tests, and specialist consultations, privately and quickly. “I don’t have a medical background. I just have some common sense,” he explains. “I don’t need to be a doctor for what I do. I’m just expediting care.”
He tells me stories of other people whom his British Columbia–based company, Timely Medical Alternatives, has helped—people like the elderly woman who needed vascular surgery for a major artery in her abdomen and was promised prompt care by one of the most senior bureaucrats in the government, who never called back. “Her doctor told her she’s going to die,” Baker remembers. So Timely got her surgery in a couple of days, in Washington State. Then there was the eight-year-old badly in need of a procedure to help correct her deafness. After watching her surgery get bumped three times, her parents called Timely. She’s now back at school, her hearing partly restored. “The father said, ‘Mr. Baker, my wife and I are in agreement that your star shines the brightest in our heaven,’ ” Baker recalls. “I told that story to a government official. He shrugged. He couldn’t fucking care less.”
Not everyone has kind words for Baker. A woman from a union-sponsored health coalition, writing in a local paper, denounced him for “profiting from people’s misery.” When I bring up the comment, he snaps: “I’m profiting from relieving misery.” Some of the services that Baker brokers almost certainly contravene Canadian law, but governments are loath to stop him. “What I am doing could be construed as civil disobedience,” he says. “There comes a time when people need to lead the government.”
Baker isn’t alone: other private-sector health options are blossoming across Canada, and the government is increasingly turning a blind eye to them, too, despite their often uncertain legal status. Private clinics are opening at a rate of about one a week. Companies like MedCan now offer “corporate medicals” that include an array of diagnostic tests and a referral to Johns Hopkins, if necessary. Insurance firms sell critical-illness insurance, giving policyholders a lump-sum payment in the event of a major diagnosis; since such policyholders could, in theory, spend the money on anything they wanted, medical or not, the system doesn’t count as health insurance and is therefore legal. Testifying to the changing nature of Canadian health care, Baker observes that securing prompt care used to mean a trip south. These days, he says, he’s able to get 80 percent of his clients care in Canada, via the private sector.
Another sign of transformation: Canadian doctors, long silent on the health-care system’s problems, are starting to speak up. Last August, they voted Brian Day president of their national association. A former socialist who counts Fidel Castro as a personal acquaintance, Day has nevertheless become perhaps the most vocal critic of Canadian public health care, having opened his own private surgery center as a remedy for long waiting lists and then challenged the government to shut him down. “This is a country in which dogs can get a hip replacement in under a week,” he fumed to the New York Times, “and in which humans can wait two to three years.”
And now even Canadian governments are looking to the private sector to shrink the waiting lists. Day’s clinic, for instance, handles workers’-compensation cases for employees of both public and private corporations. In British Columbia, private clinics perform roughly 80 percent of government-funded diagnostic testing. In Ontario, where fealty to socialized medicine has always been strong, the government recently hired a private firm to staff a rural hospital’s emergency room.
This privatizing trend is reaching Europe, too. Britain’s government-run health care dates back to the 1940s. Yet the Labour Party—which originally created the National Health Service and used to bristle at the suggestion of private medicine, dismissing it as “Americanization”—now openly favors privatization. Sir William Wells, a senior British health official, recently said: “The big trouble with a state monopoly is that it builds in massive inefficiencies and inward-looking culture.” Last year, the private sector provided about 5 percent of Britain’s nonemergency procedures; Labour aims to triple that percentage by 2008. The Labour government also works to voucherize certain surgeries, offering patients a choice of four providers, at least one private. And in a recent move, the government will contract out some primary care services, perhaps to American firms such as UnitedHealth Group and Kaiser Permanente.
Sweden’s government, after the completion of the latest round of privatizations, will be contracting out some 80 percent of Stockholm’s primary care and 40 percent of its total health services, including one of the city’s largest hospitals. Since the fall of Communism, Slovakia has looked to liberalize its state-run system, introducing co-payments and privatizations. And modest market reforms have begun in Germany: increasing co-pays, enhancing insurance competition, and turning state enterprises over to the private sector (within a decade, only a minority of German hospitals will remain under state control). It’s important to note that change in these countries is slow and gradual—market reforms remain controversial. But if the United States was once the exception for viewing a vibrant private sector in health care as essential, it is so no longer.
Yet even as Stockholm and Saskatoon are percolating with the ideas of Adam Smith, a growing number of prominent Americans are arguing that socialized health care still provides better results for less money. “Americans tend to believe that we have the best health care system in the world,” writes Krugman in the New York Times. “But it isn’t true. We spend far more per person on health care . . . yet rank near the bottom among industrial countries in indicators from life expectancy to infant mortality.”
One often hears variations on Krugman’s argument—that America lags behind other countries in crude health outcomes. But such outcomes reflect a mosaic of factors, such as diet, lifestyle, drug use, and cultural values. It pains me as a doctor to say this, but health care is just one factor in health. Americans live 75.3 years on average, fewer than Canadians (77.3) or the French (76.6) or the citizens of any Western European nation save Portugal. Health care influences life expectancy, of course. But a life can end because of a murder, a fall, or a car accident. Such factors aren’t academic—homicide rates in the United States are much higher than in other countries (eight times higher than in France, for instance). In The Business of Health, Robert Ohsfeldt and John Schneider factor out intentional and unintentional injuries from life-expectancy statistics and find that Americans who don’t die in car crashes or homicides outlive people in any other Western country.
And if we measure a health-care system by how well it serves its sick citizens, American medicine excels. Five-year cancer survival rates bear this out. For leukemia, the American survival rate is almost 50 percent; the European rate is just 35 percent. Esophageal carcinoma: 12 percent in the United States, 6 percent in Europe. The survival rate for prostate cancer is 81.2 percent here, yet 61.7 percent in France and down to 44.3 percent in England—a striking variation.
Like many critics of American health care, though, Krugman argues that the costs are just too high: “In 2002 . . . the United States spent $5,267 on health care for each man, woman, and child.” Health-care spending in Canada and Britain, he notes, is a small fraction of that. Again, the picture isn’t quite as clear as he suggests; because the U.S. is so much wealthier than other countries, it isn’t unreasonable for it to spend more on health care. Take America’s high spending on research and development. M. D. Anderson in Texas, a prominent cancer center, spends more on research than Canada does.
That said, American health care is expensive. And Americans aren’t always getting a good deal. In the coming years, with health expenses spiraling up, it will be easy for some—like the zealous legislators in California—to give in to the temptation of socialized medicine. In Washington, there are plenty of old pieces of legislation that like-minded politicians could take off the shelf, dust off, and promote: expanding Medicare to Americans 55 and older, say, or covering all children in Medicaid.
But such initiatives would push the United States further down the path to a government-run system and make things much, much worse. True, government bureaucrats would be able to cut costs—but only by shrinking access to health care, as in Canada, and engendering a Canadian-style nightmare of overflowing emergency rooms and yearlong waits for treatment. America is right to seek a model for delivering good health care at good prices, but we should be looking not to Canada, but close to home—in the other four-fifths or so of our economy. From telecommunications to retail, deregulation and market competition have driven prices down and quality and productivity up. Health care is long overdue for the same prescription.
Hank, I, too, appreciate your candor and sincerity. Thank you for an open, honest, and (most of all) civil discussion. My best regards to you, as well.
If any of the proposed plans pass and the Federal Government gains control of the our health care industry several things are inevitable. First, supplies will dwindle. Second, costs will skyrocket. Government spending will increase forcing our country closer to economic collapse. There will be rationing and folks will die. Look at all of the other countries that are using a socialized healthcare system. It will be a disaster, Much worse than it is now. Socialism cannot work.
If any of the morons in congress actually wanted to fix things, they could start by closing the FDA and fixing the insane tort laws.
Government is inefficient and works for political expediency. Reality, human needs and economics will fall by the wayside.
Hank- You are debating someone who says “Social Security is a well run program, IF……)At that point anything they say is moronic. The Govt. does not run one program effectively and efficiently. No sane person wants the Govt. to run anything if they want it done effectively and effeciently. Case in point- Cash for Clunkers.
Do you really believe BP will EVER do right by these people? Seriously?