National health insurance won't cure what ails us

John Goodman

December 13, 1990|By John Goodman

AS THE United States wrestles with the problems of its own health care system, it is tempting to look to programs of socialized medicine in Europe and Canada for solutions. This would be a mistake, however, since experience has shown that it is impossible to control health care costs through national health insurance without any loss of health care benefits.

A very cruel aspect of socialized medicine is the degree to which health care services must be rationed. Faced with a vast overload of patients, hospitals simply place people on long waiting lists. This is why Great Britain -- one of the most technically advanced nations on Earth -- has nearly 800,000 of its 55 million people on waiting lists for surgery. New Zealand, with a population of 3 million, has a waiting list of about 50,000.

In Newfoundland, Canada, the wait for a hip replacement is six to 10 months, five months for something as routine as a pap smear and two months for CAT scans. The Canadian press frequently reports episodes of heart patients dying while languishing on a waiting list.

Under socialized health care, low-income people generally see physicians less often and for shorter visits, and are in and out of hospitals much quicker than perhaps they should be. Widespread inequities also exist across geographical boundaries. For example, people in rural, poorer regions of Britain have less access to physicians and hospitals on a per-capita basis than people living in more densely populated, wealthy areas.

If the experience of other countries is any guide, elderly Americans would have the most to lose from national health insurance programs. In general, when lifesaving care is rationed to both young and old, the young are more likely to get preferential treatment.

Consider chronic kidney failure, for example. In 1978, 35 percent of British dialysis centers refused to treat patients over the age of 55, 45 percent refused to treat patients over the age of 65, and British patients over the age of 75 rarely received treatment at all.

National health insurance schemes also spend millions to PTC provide a vast array of non-essential services. While tens of thousands classified by their physicians as being in "urgent need" of surgery wait for hospital beds, the British National Health Service (NHS) spends more than $70 million each year on tranquilizers, sedatives and sleeping pills; almost $19 million on antacids; and about $21 million on cough medicine.

If the NHS did nothing more than charge patients the full costs of sleeping pills and tranquilizers, enough money would be freed to treat 10,000 to 15,000 additional cancer patients each year, and to save the lives of an additional 3,000 kidney patients.

National health insurance plans skimp on expensive treatments because services provided to the marginally ill benefit millions of people (many of whom vote), while acute and intensive care services concentrate large amounts of money on a handful of patients. Democratic political pressures in this case dictate the redistribution of resources from the few to the many.

Socialized medicine "works" in other countries because those who have the ability to change the system are the ones who are best served by it. If a member of the British Parliament, the CEO of a large British company or the head of a major British trade union had no greater opportunity to obtain renal dialysis than any other British citizen, the British National Health Care Service would not survive for a week.

In the United States, we have widespread access to information about modern medical technology, a legal system that protects the rights of those without political power or money and a strong devotion to the basic rights of due process. National health insurance as it operates in other countries simply would not survive in the U.S. cultural and legal system.

John Goodman is president of the National Center for Policy Analysis, a Dallas-based research institute.

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