Oh Babs.,.you are such a wanker...snicker
http://www.health--savings--accounts.com/article-8-john.htm
By Dr. John C. Goodman
President & CE0
National Center for Policy Analysis
Five Myths to Socialized Medicine
In the United States there are about 14 million people - more than a
third of the uninsured - who are, in principle, eligible to get free
medical care by joining either the Medicaid program or the State
Children�s Health Insurance Program. And yet they don�t bother to
enroll.
To understand why they don�t, you might go to the emergency room of
Parkland Hospital in my hometown of Dallas. The uninsured and Medicaid
patients come there to get their medical care. They all see the same
doctors. They get the same treatment. If they�re admitted to the
hospital, they stay in the same beds. From the patient�s point of view,
there is no real reason to join Medicaid, because they get the same care
whether or not they are formally insured. The doctors and nurses get
paid the same regardless of who is enrolled in what plan. The only
people who really care whether or not someone is enrolled in Medicaid
are the hospital administrators, because that determines how they get
their money. So they actually have paid employees who go through the
emergency room and try to get people to sign up for Medicaid. Over half
the time they fail. Then they literally go hospital room by hospital
room, trying to get admitted patients to enroll in Medicaid. And even
then they don�t always succeed. Now, it�s not that unusual for people
to go to hospital emergency rooms for their care. It�s a common feature
of health systems around the world. It may not be an efficient way to
deliver health care, but the same thing happens in Toronto and London.
Canadians take pride in the fact that patients who get free care in
Toronto emergency rooms are �insured.� But in Dallas, we�re ashamed to
say that our patients are �uninsured", even though the care they receive
in Dallas is probably better than the care they get in Toronto.
MYTH: �A RIGHT TO HEALTH CARE�
People who believe in socialized medicine have come to believe many
myths. One is that socialized medicine gives you a right to health
care. If you ask the head of Parkland Hospital and his counterpart in
Toronto or London what the difference is in these systems, I think all
three would say that in Toronto and London people have a �right� to
health care, whereas in Dallas they do not. That is just not true. If
you�re a citizen of Canada, you don�t really have a right to any
particular health care service. You don�t have a right to heart
surgery. You don�t even have a right to a place in the waiting line. If
you�re the hundredth person waiting for heart surgery, you�re not
entitled to the hundredth surgery. Other people can and do get in ahead
of you. From time to time, even Americans go to Canada and jump the
queue, because Americans can do something that Canadians cannot -
Americans can pay for care. Canadian hospitals love to admit American
patients, because that means cash into their budgets. The British
government says that, at any one time, there are about a million people
waiting to get into hospitals. According to the Fraser Institute,
almost 900,000 Canadian patients are on the waiting list at any point in
time. And, according to the New Zealand government, 90,000 people are
on the waiting lists there. Those people constitute only about 1 to 2
percent of the population in those countries, but keep in mind that only
about 15 percent of the population actually enters a hospital each year.
Many of the people waiting are waiting in pain. Many are risking their
lives by waiting. And there is no market mechanism in these countries
to get care first to people who need it first.
MYTH: �HIGHER QUALITY�
Another myth has to do with the quality of care that patients receive.
British ministers of health have told British citizens for years that
their health system is the envy of the world. Canadian ministers of
health say much the same thing. In fact, Canadian and British doctors
see 50 percent more patients than American doctors do, and, as a
consequence, they have less time to spend with each patient. In
Britain, the typical general practitioner barely has time to take your
temperature and write a prescription. And even if they discover
something wrong with you, they may not have the technology to solve your
problem. Among people with chronic renal failure, only half as many
Canadians as Americans get dialysis, and only a third as many Britons on
a per capita basis. The American rate of coronary bypass surgeries is
three or four times what it is in Canada, and five times what it is in
Britain. Britain is the country that invented the CAT scanner, back in
the 1970s. For awhile it exported more than half the CAT scanners used
in the world. Yet they bought very few for their own citizens. Today,
Britain has half the number of CAT scanners per capita as we do in the
United States. A similar problem exists in Canada.
MYTH: �MORE BANG FOR THE BUCK�
Yet another myth is that although the United States spends more on
health care, we don�t get more. That argument is often supported by
pointing to life expectancy, which is not that much different among
developed countries, and infant mortality, which is actually higher in
the United States than it is in most other developed countries. What do
we get for our money? The first thing we need to do is separate those
phenomena that have little to do with health care from those that do.
In the United States, life expectancy at birth for African American men
is 68 years, while for Asian American men it�s 81 years. We find wide
differences in life expectancy among women, too. Nobody thinks that
those differences are due to the health care system. What, then, would
we want to look at if we really wanted to compare the efficacy of health
care systems? We would look at those conditions for which we know
medical services can make a real difference. Among women who are
diagnosed with breast cancer, only one fifth die in the United States,
compared to one third in France and Germany, and almost half in the
United Kingdom and New Zealand. Among men who are diagnosed with
prostate cancer, fewer than one fifth die in the United States, compared
to one fourth in Canada, almost half in France, and more than half in
the United Kingdom.
MYTH: �EQUAL ACCESS�
Perhaps no notion is more closely tied to national health insurance than
the idea of equal access to health care. Every prime minister of health
in Britain, from the day the National Health Service started, has said
that is the primary goal of the NHS. Similar things are said in Canada
and in other countries. The British government - unlike most other
governments - studies the problem from time to time to see what kind of
progress they�re making. In 1980, they had a major report that said,
essentially: �We really haven�t made very much progress in achieving
equality of access to health care in our country. In fact, it looks
like things are worse today, in 1980, than they were 30 years ago when
the British National Health Service was started." Everybody deplored
the results of that report, and they all promised to do better. There
were a lot of articles written, a lot of conferences, and a lot of
discussions. Another 10 years passed and they pondered another report,
which said that things had deteriorated further. Today we are long
overdue for a third report, but no one expects the situation to have
improved. It�s true that racial and ethnic minorities are underserved
in the United States. But we are hardly alone. In Canada, the
indigenous groups are the Cree and the Inuits. In New Zealand, they are
Maoris. In Australia, the Aborigines. Those populations have more
health care problems, shorter life expectancies, higher infant
mortality, more health care needs, and they get less health care. When
health care is rationed, racial and ethnic minorities do not usually do
well in the rationing scheme. A Canadian study showed vast inequalities
among the health regions of British Columbia. In some cases, there were
spending differences of 10 to 1 in services provided in one area
compared to another. That probably would not surprise most health
policy analysts; you just don�t usually get this kind of data. But if
we had the data, we would probably find similar inequalities in access
to health care all over the developed world. I�m especially interested
in the elderly, because I find that - not only in Britain and Canada,
but also in the United States - when people have to make decisions about
who is going to get care and who is not, they frequently choose the
younger patient. Surveys of the elderly show that senior citizens in
the United States say it�s much easier to get surgery, see doctors, see
specialists, and enter hospitals, than say seniors in other countries.
MYTH: �LESS RED TAPE�
Then we have the myth that national health insurance is an efficient way
to deliver health care. I hear this frequently repeated by advocates in
the United States. Probably the most telling statistic for hospitals is
average length of stay. In general, efficient hospitals get people in
and out more quickly. By that standard, the U.S. hospital sector is the
most efficient in the world. And I think by many other standards it
would not be much in dispute that the U.S. hospital sector is far more
efficient than the hospital sectors of other countries. In Britain,
where at any one time there are a million people waiting to get into
British hospitals, 15 percent of the beds are empty, and another 15
percent are filled with chronic patients who really don�t need the
services of hospital; they�re simply using the hospital as an expensive
nursing home. So, effectively, almost one-third of the beds are closed
off to acute care patients. A study compared Kaiser in California with
the NHS and concluded that, after you make all of the appropriate
adjustments, Kaiser spends about the same per capita on its enrollees as
Britain spends on its population. But the Kaiser enrollees were getting
more care, more access to specialists, and other services. We often
hear that Medicare and Medicaid are efficient. The government says
Medicaid only spends about 2 percent of its budget on administration.
But that ignores all the costs that are shifted to doctors and
hospitals. When you incorporate all those costs, it turns out that
actually Medicare is not very efficient at all.
WHAT�S MISSING IS CAPITALISM
While our health care system is more market-oriented than in most
industrialized nations, we don�t really have a free market in health
care in the United States. Half the spending is done by government.
Most of the rest is done by bureaucratic institutions. The cosmetic
surgery market is about the only market where patients are really
spending their own money. And guess what? It works like a real market.
People get package prices. They can compare prices. And over the
decade of the 1990s, the average price of cosmetic surgery actually went
down in real terms, even as there were all kinds of technological
innovations that we are told drive up costs else where. Most of what
I�m telling you here today I learned, not from right-wing critics of
national health insurance, but from people who believe in it. If you
look at my book, there are probably a thousand different references, and
95 percent of them are references to government reports, academic
studies, and newspaper investigations. And in almost every case, the
author of those reports is someone who believes in national health
insurance. No matter how many problems they document, no matter how
many failures they write about, they don�t give up their faith in the
system.
They all believe that all the failures that they write about can be
reformed away. They all believe that we just haven�t tried hard enough
to reform the system and make it work. Sadly, they are wrong.
Virtually all of these problems are inevitable consequences of the
politicization of medicine. Why do these systems over provide to the
healthy and under provide to the sick? Well, in the United States,
about 4 percent of the patients spend half the money. If you�re a
politician allocating health care dollars, you cannot afford to spend
half your money on 4 percent of the voters - 4 percent who may be too
sick to go to the polls and vote for you anyway. Why is the hospital
sector so inefficient? Because it�s in the self-interest of hospital
managers to be inefficient. The chronic care patients and the empty
beds are the cheap beds. It�s the acute care patients that cost money.
Why can the rich and powerful jump to the head of the waiting lines?
Because those are the people who control the sys-tem. They can change
the system. If members of parliament, the wealthy, and the powerful had
to wait for care along with everyone else, these systems would not last
for a minute.