Bottom line: Other Countries Cut Out Services to Reach their Low Cost Status

By: Richard G. Fessler, MD, PhD

Will a single payer health care system hold down the increasing cost of health care in the United States? President Obama and other proponents of this socialized form of health care argue that it will. Of course there are many ways to debate this question, but much objective evidence suggests that it will not. Let’s look at this from two perspectives. First, what does the comparative cost data between the United States and government controlled health care systems (such as Canada) tell us? Second, what are the financial implications of this “less expensive”, government controlled health care system for the American taxpayer?

Most international comparisons of health statistics are based on data collected by the OECD (Organization for Economic Cooperation and Development). According to the OECD, the United States spends more for its health care than any other country on earth, whether analyzed as dollars per person or percentage of GDP. One problem with these statistics, however, is that not all countries report their cost data using the same guidelines.1 Thus, often the statistics are comparing apples to oranges; or put another way, garbage in = garbage out! For example, Germany includes the cost of nursing care in their cost statistics, Great Britain does not.2 Other countries count hospital “beds” whether it is occupied and staffed or not, others only count it if both are true.3 Obviously, cost data for these countries will vary depending upon what they include and do not include.

A study by Gerald Anderson et al, published in Health Affairs attempted to more accurately assess health care costs across international borders.4 To do this, these authors calculated the average annual increase in the percentage of per capita spending on health care by OECD countries. As seen in the figure below, health care spending in nearly all of the studied OECD countries grew at about the same rate as the US, or greater! In fact, according to these researchers, the real expenditures for hospital and physician services actually decreased in the US during the 1990’s, putting the US well below the mean for other OECD countries. When you consider that the US has greater access to health care and technology, less rationing, and a host of health care stressors not seen in other countries (e.g. a higher rate of homicide, obesity, and AIDS), these results argue strongly for the “strength” of our current health care system.

Average Annual Real Growth in Per Capita Health Spending 1960-1998:
United States 2.6
United Kingdom 2.5
Canada 0.8
Australia 2.7
New Zealand 2.6
Germany 2.3
Netherlands 2.6
Japan 3.5

The figure above does show that the increase in per capita health spending was much less in Canada than any other country. What is not seen in the figure, however, is that it did this by cutting services to the extent that patient access to care was compromised. For example, block grants to Canadian provinces for health care were cut in 1986, 1989, and (cut IN HALF) in the second half of the 90’s.5 Provinces, in turn, cut funding to hospitals, cut physician fees, limited purchases of new technology, and removed coverage of some services from provincial insurance plans.5 As a result available hospital beds were reduced by 1/3 (6.6/1000 to 4.1/1000) between 1987 and 1995. 6 In Saskatchewan alone, over 50 hospitals were closed. In 2002 it was reported that the Canadian health care system was underfunded by over 5 billion dollars annually!7 Throughout this period, satisfaction with the Canadian health care system fell precipitously.

A strong argument can be made, therefore, that cost increases will not be held down by a government run health care monopoly. Moreover, it also seems likely that access to health care and health care technology will become more restricted. If the Canadian experience is repeated in the US, Americans will not be happy! The second question we wanted to address, was how much will this “less” expensive, (and inferior) health care system really cost the American taxpayer?

Estimates of the cost of the socialized health care system proposed by President Obama are not being disseminated yet, as all deliberations of his health care task force are being kept quite secret. (Wait, didn’t he campaign on a policy of transparency?) However, we can get an idea by examining the impact of policies enacted during the first 100 days of his administration. According to a study conducted by USA TODAY, it will cost EVERY American household $55,000 just to cover the commitments already made by the Federal government, and this doesn’t include the “big ticket” items such as “universal medicare”!8 The US government took on $6.8 trillion in new debt in 2008, and no end is in sight. That means that, right now, the US would already need to set aside $63.8 trillion in a lump sum to pay obligated benefits that won’t be covered by future taxes. (That’s a half million dollars debt for every household in America.) Where do you suppose that money is going to come from? When all the sleight of hand ends, it comes down to this, you either raise taxes, cut benefits (as seen in Canada above), or both. The more I study the “model” systems which President Obama’s health care policies are based upon, two things become very clear: 1) the quality of health care in the US will become significantly inferior to its current state, and 2) it will cost the American taxpayer MORE, not less! As a surgeon, my recommendation for or against surgery for every patient is based upon a realistic analysis of risk vs benefit. (In neurosurgery, you can’t afford to live in a fairy tale.) If the American public were my patient, I most certainly could not recommend proceeding down the reckless pathway proposed by our current President and his administration.

1 OE CD Health Ststems: Facts and Trends 1960-1991, “Organization for Economic Cooperation and Development, 1993.”
2 Goodman, John C., Musgrave, Gerald L., Herrick, Devon M., Lives at Risk, Rowman and Littlefield Publishers, Inc, New York, 2004, pp 78.
3 Hensher, M., Edwards, N., Stokes, R., “The Hospital of the Future: International Trends in the Provision and Utilization of Hospital Care”, British Medical Journal 319:845-848, 1999.
4 Anderson, Gerald F., “Health Spending and Outcomes: Trends in OECD Countries 1960-1998.”Health Affairs (May-June) 2000. pp 150-157.
5 Gray, Gwen, “Access to Health Care Under Strain: New Pressures in Canada Amend Australia”, Journal of Health Politics, Policy, and Law, 23:905-947, 1998.
6 Possehl, Suzanne R., “Northern Plights”, Hospitals and Health Networks 71:56-60, 1997.
7 Spurgeon, David, “Canadians Need to Spend C$5bn More a Year on Health Care”, British Medical Journal 325: 1058, 2002.
8 Cauchon, Dennis, “Leap in US Dept Saddles Taxpayers”, USA Today, Friday, January 30, 2009.


Richard G. Fessler, M.D., PhD is a professor of Neurosurgery at Northwestern University in Chicago, Illinois. He is very active in the research and development of new surgical techniques that are designed to provide patients with less blood loss, faster recoveries and improved outcomes over traditional spinal surgery. You can learn more about Dr. Fessler’s work at Northwestern University’s Feinberg School of Medicine by visiting

http://www.feinberg.northwestern.edu/news/past-years/2008/2008L-January/fessler.html

Debunking the Myths about Health Care in America

Image by prudencebrown121 via Flickr

By John H. Peloza M.D.

Special Book Review

In “The Top Ten Myths of American Health Care. A Citizen's Guide,” Ms. Sally C. Pipes surgically exposes the misleading arguments of those who support government run national health care. In a time when Americans seem to believe in the competence of government to solve the health care “crisis,” she gives the reader ample reason to think again. There are many examples of how poor government solutions perform in reality as compared to theory and at what cost in both financial and human terms. Ms. Pipes acknowledges the main problems with the U.S. health care system being access and affordability. She clearly demonstrates why this exists and how to address it in a responsible, effective, and workable manner relying on free markets rather than the heavy hand of unresponsive and bureaucratic government central planning.

Each chapter exposes and debunks a commonly held myth about U.S. health care. Myth 1 starts by reviewing whether or not Government Health Care is More Efficient. The author clearly proves that the notion of the government being able to deliver efficient and high quality healthcare to the American public is nonsense. Ms. Pipes demonstrates that government’s administrative costs are passed on to the private sector, price controls lead to doctor shortages, waiting lists, and rationing of care as well as stifling innovation. U.S. government medicine (Medicare, Medicaid, the VA system) with its incomprehensible regulations and bureaucracy is rife with fraud and waste. In Myth 10, Government-Run Health Care Systems in Other Countries are Better and Cheaper than America’s, the author further illustrates the life-threatening limitations of health care systems in Britain, Canada and France compared to care in the United States. The author also explains how crude measures of health care quality like infant mortality and life expectancy are obtained by researchers and manipulated. She clearly points out that when reviewing how well a health care system serves sick people, which is the true quality metric, the United States excels. For example, Cancer patients have much higher survival rates in the United States than any other country and the U.S. also leads the world in research and innovation in pharmaceuticals and medical technology. In Britain, a government agency (National Institute for Health and Clinical Effectiveness – NICE), explicitly limits patients access to the latest and most effective drugs and technology by manipulating data with pseudoscientific cost effectiveness analysis. In the case of life threatening illnesses, “cutting costs, cuts lives.” In France, the government-run health care system is so stretched beyond their limit that a simple heat wave in August 2003 took the lives of 15,000 elderly patients because of a shortage of doctors and hospitals. In Canada, a dog can get a hip replacement “in under a week and in which a human can wait two to three years.” In a landmark decision overturning the ban of private health insurance in the Canadian province of Quebec, Chief Justice McLachlin stated, “access to a waiting list is not access to health care.” Calculating only health care costs without considering value provides meaningless data.

Other chapters are just as devastating to the proponents of socialized medicine. Myth 3: Forty-Six Million Americans Can’t Get Health Care points out popular “sound-bites” that have been especially misleading and misrepresented in the media. Of course, the misrepresentation of the actual data has also been politically useful. The truth is that only eight million (not 46 million) Americans are without health insurance for over one year, and all people residing in the U.S. have access to health care by law. It is against the law for an Emergency Room to refuse care to a person. The 46 million factoid includes non-U.S. citizens (more than 10 million), people with incomes greater than $50,000/yr (18 million, of those almost 10 million have incomes greater than $75,000/yr) who choose not to purchase health insurance, and 14 million low-income Americans who qualify for generous government assistance but do not enroll. The fastest-growing segment of the uninsured population is households making more than $75,000/yr. There are uninsured Americans, and we need to consider this fact, but the number is drastically less than cited by the media and politicians.

There are seven other myths that are explained in similar detail in the book: We’re Spending Too Much on Health Care, High Drug Prices Drive Up Health Care Costs, Importing Drugs Would Reduce Health Care Costs, Universal Coverage Can Be Achieved by Forcing Everyone to Buy Insurance, Government Prevention Programs Reduce Health Care Costs, We Need More Government to Insure Poor Americans, and Health Information Technology Is a Silver Bullet for Reducing Costs. The underlying problem in health care is government policies and regulations that interfere with the normal function of a free market. In fact, according to a report published in 2004, the medical industry spends over $340 Billion each year on government regulation. This is a huge amount that is not even being considered for cost reductions or efficiencies. A cost that simply shows up in the price of drugs and medical services passed on to the patient.

But this book is not only about the diagnosis of health care problems in the United States. It also offers solutions to these issues so that we can lower costs and achieve universal choice in health care and universal coverage. As you might expect, this requires much less government and a freer market. Ms. Pipes cites the example of a free market in health care, Lasik eye surgery. Costs have dropped about 40% over the years and quality has improved significantly. The free market reforms include changing the tax code to allow individuals to purchase health insurance with either refundable tax credits or allow income tax deductions for health care expenditures. Other reforms include reducing costly government mandates and regulations, allow the purchase of insurance across state lines, expand Health Savings Accounts, support retail health clinics, implement tort reform, and provide vouchers for the working poor and chronically uninsured.

This book is important in the health care debate. It exposes the factually incorrect and misleading arguments made by proponents of government-run health care and the devastation wrought by well-intentioned policies. Ms. Pipes gives the reader ammunition when confronting the seductive siren song of free, quality health care for all administered by the thoughtful, caring, and competent bureaucrats from the Department of Motor Vehicles. I highly recommend that you purchase this must-read book and read it’s eye opening conclusions.

Link: http://www.healthandsharing.com/

FREE TO CHOOSE ABORTION, NOT FREE TO CHOOSE YOUR HEALTH CARE: OBAMA'S OBSESSION WITH DEATH

Image by Ted Abbott via Flickr

by Kathy Barkulis


What will it take for ordinary Americans and politicians to wake up to the cold reality of nationalized health care as proposed by President Obama? Will it take a medical crisis in your own family? Will it take a medical crisis in your own personal life? Will it take an anonymous board of people appointed by the government deciding whether you can have life saving medicine or surgery? What has to happen to you before you say "ENOUGH"? It is easy to close your eyes when you and your family are healthy, but are you sure this will always be the case? And why is it that the choices Obama wants us all to have, are choices of death, and not choices of life?

So far, President Obama has not told the American people how he will pay for his grand experiment. They hinted at a national VAT tax, adding 20% on to the cost of goods at the manufacturing level, which will be passed down to consumers. They also hinted at taxes on soft drinks, beer, wine, cigarettes, etc., none of which will cover the entire cost of this plan, but will surely increase the cost of living to middle class Americans. This is the group Obama promised would have no new taxes. While I don't believe you can put a price tag on your healthcare, and easy access to it, I do believe we need to be told how it will be paid for.

But the most egregious aspect of Obama's "Medicare For All" plan is the federally appointed "health board" that will make decisions for the health care of Americans. Obama has insisted that citizens can choose to take the government plan or keep their own private insurance. But did you know that Obama plans to force private insurers to adopt the decisions of the federal health board, or face steep tax consequences? The reality of that situation will be that private insurance companies will not be able to provide health care at any cost, and employers will gladly hand over the responsibility to the government. Only the very rich will be able to afford effective and all inclusive health care. There will be no ability for insurance companies to compete with a "free" government plan. Before you can say "Pap Smear," the whole country will be under the umbrella of a nationalized system that rations out health care like a short order cook rations out hash. The rich will always get the health care they want under Obama's plan, and the rest of us will just get the health care Obama thinks we "need."

It's ironic that the Democrats, and Obama, shout from the rooftops about a woman's right to choose abortion, but none of them want Americans to have the right to choose their health care. Oh they say you'll have the right to choose your health care, but when you read their plan, there will be no choice for you and your family. They are planning to game the system so that you will have no choice left but to take the government plan. In the eyes of President Obama and Nancy Pelosi, it is better for all Americans to have a generic and highly bureaucratized health plan, than for some to have no health plan. Yet, even that argument is a lie. Right now, hospitals cannot refuse medical care to an American brought into their hospital for emergency treatment. And often they don't refuse care to non-Americans either. Just walk into any hospital emergency room in the country on any given day and look at how many people are qued up for treatment. The taxpayers already pay for that privilege, but we will pay far more under Obama's plan.

So I ask you again. What will it take for you to stand up and protest a nationalized health care system where a federal health board will decide what kind of medical treatment you get? Will it be your down syndrome child who needs a new heart valve? Will it be your mother who needs a hip replacement? Will it be your husband who needs an experimental drug for a rare disease? And will it take a federal health board to refuse that treatment for your family members? If so, it will be too late by then to do anything about it.

YOU MUST SPEAK OUT NOW. You can start by calling the four Republicans who plan on voting yes for Obama's health care plan. They are:

Chuck Grassley 202-224-3744
Olympia Snowe 202-224-5344
Orrin Hatch 202-224-5251
Susan Collins 202-224-2523

CALL THEM NOW and voice your opposition. CALL THEM EVERY DAY. Send their names and phone numbers to everyone you know.

Then, send them letters voicing your opposition using email and snail mail.

Second, write letters to the editors of your local newspapers. Send those letters repeatedly until they get published. Tell everyone you know to do the same.

Third, call radio talk shows and make your opinion known.

Fourth, and most important, call and fax members of Congress voicing your opposition. Crash their switchboards. You can go on-line and get phone numbers of Senators and Congressmen on http://www.realclearpolitics.com/ and many other websites, such as C-span.

Talk to your friends and relatives about this issue, and urge them to take action. Start the conversation by asking them this question: IF I FOUND OUT I HAD A RARE FORM OF CANCER THAT A GOVERNMENT HEALTH CARE PLAN REFUSED TO TREAT, WOULD YOU BE WILLING TO SELL YOUR HOME TO RAISE MONEY FOR ME TO SAVE MY LIFE? During the silence that occurs after you ask that question, ask them instead to speak out in opposition of this plan by calling Congressmen and Senators. Ask them to write letters.

Apathy is not an option anymore. Our lives, and that of our families are on the line.

PRESIDENT OBAMA CAN'T HAVE CONTROL OF OUR HEALTHCARE UNLESS WE GIVE IT TO HIM WITHOUT A FIGHT.






Link: http://smartgirlpolitics.ning.com/profiles/blogs/free-to-choose-abortion-not