Dangerous Delusions Corrode our Medical Services

Original at

Our national flirtation with the illusory benefits of “free” national health insurance corrodes our debate about improving the quality of health care in the United States.

Partly because of the allure of this delusion of free or single-payer national health insurance, we are slowly ceding our medical service system to government mismanagement at patient and taxpayer expense. The most dangerous delusion of all is that government-paid universal medical services are compassionate because they are supposedly “free” for everyone. This egalitarian theme sounds benevolent in theory, but is callous in practice.

When government gains a monopoly on payment for medical services, health care personnel must give priority to bureaucratic over patient needs if they want to get paid. This makes government, rather than the doctor, patient or his family, responsible for health care – and the ultimate arbiter of who lives and who dies. The outcome is fundamentally heartless.

The reasoning behind these delusions is explained and exposed in detail in a new book, Lives at Risk: Single-Payer National Health Insurance Around the World by John C. Goodman of the Dallas-based National Center for Policy Analysis (NCPA) and co-authors Gerald L. Musgrave, and Devon M. Herrick.

Although the book discusses twenty myths that underlie the push for single-payer national health insurance, the first three form its philosophical base.

The first myth is well expressed in this quote from the U.S. Physicians’ Working Group for Single-Payer National Health Insurance: “Access to comprehensive health care is a human right. It is the responsibility of society, through its government, to ensure this right.”

The authors point out that the so-called basic human right to health care in countries with national health insurance is “nothing more than the opportunity to get services for free (or at very little cost) as the government decides to make those services available. But government is under no obligation to provide any particular service.”

Government controls costs by imposing global budgets on hospitals and health authorities and limiting supply. As a result, demand exceeds supply for virtually every service and patients are forced to wait months and even years for treatment.

They are sometimes apologetic, however. An electrocardiogram appointment letter from the Moncton Hospital to a New Brunswick, Canada, heart patient said the examination would be in three months. It added: “If the person named on this computer-generated letter is deceased, please accept our sincere apologies.”

Rationing of health care occurs in the U.S. too, especially in public hospitals that provide care for the uninsured, and for those on Medicare and Medicaid. In spite of this, average wait times in the U.S. are far shorter than in countries with national health care systems.

For example, 27% of Canadian patients and 36% of British patients must wait more than four months for elective, non-emergency surgery. By contrast, only about 5% of American patients wait that long.

Aneurin Bevan, father of the National Health Service (NHS) established in Britain in 1948, articulated the second myth – equal access to health care for all people. He declared, “the essence of a satisfactory health service is that rich and poor are treated alike, that poverty is not a disability and wealth is not advantaged.”

In spite of this high-minded goal, studies in both Britain and Canada indicate that their socialized systems are far from fulfilling this goal. In an article on the problems of unequal access in Britain, Patrick Butler observed: “Generally speaking, the poorer you are and the more socially deprived your area, the worse your care and access is likely to be.”

Very significant disparities were also found in British Columbia, Canada, between services provided in rural areas compared with major cities.

For example, the amount spent on physician specialist services per patient, per year, was $610 in the Vancouver area and $232 in the rural Peace River area. As a result of these inequities, many people travel hundreds of miles for adequate treatment.

Disparities by region and wealth also exist in the U.S. But because emergency rooms cannot turn away any patient and the private medical sector is relatively robust, people in the U.S. have more actual access to health care services than is available in nationalized systems. We don’t want to lose this access.

The third myth is related to the above two: that care should be based on medical need rather than ability to pay. But people in countries with a socialized system are increasingly willing to pay outside the system for better and faster treatment. “Free” surgery isn’t worth much if you have to wait until you’re near death to receive it.

Somewhere lurking in all these myths is the delusion that cost is the only limiting factor in obtaining health care.

If government provides the medical services to everyone for “free,” then, as the British Medical Journal predicted so hopefully in 1942, a national health system will provide “a 100 percent service for 100 percent of the population.” After sixty years of trying, they haven’t even come close.

Rationing, inefficiencies, and lack of quality are the real fruits of this socialist experiment. And we need less, not more of it.

On the other hand, when patients decide and speak with their own resources, including private insurance and cash, hospitals and doctors pay attention to them – and meet their needs.

Editor’s Note: Robert J. Cihak wrote this week’s column.

Robert J. Cihak, M.D., is a Senior Fellow and Board Member of the Discovery Institute and a past president of the Association of American Physicians and Surgeons. Michael Arnold Glueck, M.D., is a multiple-award-winning writer who comments on medical-legal issues.

Dr. Robert J. Cihak, M.D.

Robert J. Cihak, M.D., was born in Yankton, South Dakota. He received his Bachelor's Degree from the University of Notre Dame, Indiana, where he studied under the philosopher Eric Voegelin. He earned an M.D. degree at Harvard Medical School (1962-66), and did postgraduate medical training and academic work as a surgical intern at Stanford Medical Center (1966-67), diagnostic radiology resident at the Massachusetts General Hospital (MGH) in Boston (1967-70) and Assistant Professor of Radiology, U. New Mexico Medical School, Albuquerque, (1970-71). He then practiced diagnostic radiology in Aberdeen Washington until his retirement in 1994.