(Second in a seven-part series: Medicare for All – Quality and Accessible Care for None)
The core “moral” principle supporting the Medicare for All proposal is “health care is a right.” This is not so. Free health care is not a human right, no more than free food, clothing or shelter are human rights. An intrinsic right can only come from a transcendent being – God. Kings don’t have “divine rights,” they have “divinely gifted rights” – like all the rest of us do.
No human right can demand the involuntary servitude of another person – either by being forced to provide his or her medical expertise free of charge, or by having the state confiscate the private wealth of others to pay for the care of those who don’t pay. Intellectuals invoke the claim of “rights” even when they can cite no basis or reason. They just claim it, like saying everyone has the right to “affordable housing” or a “living wage.”
The two nations most prominently cited as the darling models of single-payer systems for the Medicare for All crowd are Canada and Great Britain.
When it was created immediately after WWII the British National Health Service (NHS), the United Kingdom’s socialized, state-run health care system was praised as the model for the industrialized world. With a homogeneous citizenry and little population growth from shortly before WWII until the early 1960s, the NHS functioned adequately well.
But as with any socialized system of any sort in any time or place, demand eventually soars, supply shrinks and either costs rise beyond expectations or supply — wait times in this case — skyrockets. In the U.K. today, the NHS simply can’t provide the British people the medical care they want when they need it.
Even after age discrimination laws were passed in Britain in October 2013, the Royal College of Surgeons warned that life-saving operations were still being denied older Brits. In many parts of the country, virtually no elderly patient over the age of 75 receives operations for gall bladders, breast cancers or even knee replacements. Proven life-extending procedures like colorectal surgery are denied or considerably delayed in many parts of England. Some charities have complained that many general practitioners were not even referring many “pensioners” (retirees) to specialists. They were simply writing them off.
Wealthier Britons have acted like a pressure release valve for the socialized system by buying private insurance and receiving treatment at privately-paid-for hospitals. About 4 million choose to buy separate insurance policies and hundreds of thousands more pay directly for private care when they can’t wait for the NHS.
During the 1990s, as the NHS’s annual budgets were growing considerably above the national inflation rate, Great Britain under Prime Minister Tony Blair, created the National Institute for Clinical Excellence (NICE). (The word, “Health” was added to the name in 2005 but the old acronym remained.)
This was another government agency designed to do exactly the opposite of what it was named. Its bureaucrats subjectively calculate and use what NICE calls the “quality of adjusted life years” to judge the cost and efficacy of life-saving or life-enhancing treatments. It exists purely to save money and reject, delay or ration medical treatment. It routinely rules against doctors and patients.
The London Daily Telegraph reported: “Specialists said when they did alert terminally ill patients to the existence of drugs which could extend their lives by months and in some cases years, the patients were often angry to learn that the NHS was unlikely to fund their treatment.” So it’s no surprise that as doctors learn what drugs NICE won’t permit be given to certain patients, they sadly won’t even mention their availability.
Virtually every area of British medical care is controlled by the NHS. It has restricted the construction of needed facilities resulting in considerable overcrowding. The NHS knows that if Britain adopted a Sanders-like “Medicare for All”-type system, which outlawed all private insurance and treatment, the government-run health care system in England would collapse.
Physicians are not inferior in England compared to those in the United States. The technology and pharmaceuticals are about equal in both nations so neither has any significant advantage in these core medical areas. So what makes Britain have such significantly higher mortality rates for ailments like breast cancer or prostate cancer? Answer: the NHS bureaucracy. It’s the British single-payer system that adds to dangerous wait times, cuts access to surgeries and life-saving drugs.
Even with private medical treatment available in Britain wait times have grown to life-threatening levels; starting cancer treatment has been delayed to more than two months. Last year, the NHS began limiting procedures that are greatly needed by the elderly: hip and knee replacements, cataract surgery and even angioplasty. Some actually wait as long as 13 weeks for a needed colonoscopy.
It should be no surprise then that even with quality physicians, of the seven major industrial nations, Great Britain has the poorest survival rates for prostate, colon, lung and breast cancers, according to the Centers for Disease Control and Prevention.
Life with the NHS is well known in England. They know their system is broken. Britain’s chief hospital inspector recently conceded that it is not “fit for the 21st century.”
Canada adopted a single-payer or socialized national health insurance for all of its citizens after the passage of the Canada Health Act in 1984.
First some facts about Canada: Of course it’s an independent nation and enormous in size but compared to the population of the United States, it’s more like a really big state. Canada has a population (35.2 million) less than the population of California (37.3 million).
Canada charges zero for medical treatment provided to all citizens (or permanent residents) at the point of service. There are no constraints to contain the unlimited demand for even the most minor of health issues. Restricting supply then is the only way to control national medical costs and that results in longer wait times for treatment.
It means that long wait times in Canada are intentional. The bureaucracy’s goal is to balance the financial cost of unlimited care but with limited access, against the political risks of an incensed voting public furious over these long waiting periods. This is basic economics not a Ph.D. version.
The Vancouver-based Fraser Institute has kept track of waiting periods for patients in Canada for decades. 2017 proved to have the longest times in the nation’s history under this socialist system. Fraser keeps score from two different aspects:  the time from the date of referral by the patient’s family physician to a consultation visit with a specialist and  the time from the consultation with the specialist to the actual treatment.
Twenty-five years ago, the wait time from the primary care physician’s referral to the appointment with the specialist was 4 weeks. In 2017 it hit an all-time high of 9 weeks – over two months for just the initial visit with the specialist! And the wait time from that consultation to actual treatment by the specialist? That increased from 6 weeks in 1993 to 11 weeks last year.
This all equates to an average total wait time for a patient in Canada from general practitioner referral to treatment by the specialist of five months. For those in need of a specialty like neurosurgery? The wait is nearly a full year for treatment.
It is no surprise many Canadians travel to the United States’ border hospitals for radiological services. The wait in Canada for an ultrasound is 3.9 weeks, 4.1 weeks for a CT scan and an amazing 11 weeks for an MRI. OECD (Organization for Economic Co-operation and Development) says the U.S. has 39 MRIs per million people, Canada has less than 10.
Fraser Institute’s report a few months ago entitled, “Waiting Your Turn: Wait Times for Health Care in Canada” estimates that over 60,000 Canadians seek treatment outside their country (mostly to the U.S.). This is 25% higher than just a few years ago so the trend is accelerating.
One might think that the Canadian government would be trying to increase supply based on this unmet demand. But in some provinces supply has contracted. For example in Ontario, there were about 33,000 hospital beds in 1990. By 2016, the number was down to 19,000.
This all has caused acute agony for some patients and severe frustration for many physicians. Some doctors have complained, some have lobbied, but a few have even gone to court on behalf of their patients.
In British Columbia, a group of surgeons and their patients are suing for the right to buy private insurance that covers doctor’s visits and hospital services that is currently banned by the Canadian public system. This suit has reached the British Columbia Supreme Court and could have nationwide implications.
As we know, the Bernie Sanders’ Medicare for All bandwagon cites the Canadian system as its primary model for nationalized health care here in America. But what its supporters won’t tell you or don’t know themselves is this: The Canadian model would collapse without the U.S. acting as its safety-valve alleviating its insufficient supply. Their citizens who have the means, now come to the U.S. in droves so they can get treatment without waiting many months as most of their fellow Canadians do.
Medicare for All would not only be cancerous to America’s medical system, it would also do great harm to health care in Canada.
1 thought on “Countries with socialized medical care and the misconception of “rights””
This is an excellent series, Mr. McGinley. I think you should share this material with the world.