Why I am Opposed to a "Single Payor" Medical System

A simple remedy

Require the federal congress to participate in any health care system that it legislates for us. Currently, Congress provides itself with far better coverage than is available to you.

An overview of solutions

• Personal choice, personal savings through Medical Savings Accounts
• Public and private cooperation for better health care
• Tax Credits and Health Care
• Resources for more information

Analysis of the problem

Health Insurance

Frankly, I think health insurance companies have a tough job. An infinite number of things can go wrong with a human being, and for many of them, diagnosis and treatment are not clear cut. An automobile insurance company knows that even if you totally destroy your car, there is a certain amount of money, easily determined and planned for, that will replace it. With a health insurance company, there is no such upper limit. Creative physicians frequently come up with new treatments that are very expensive, and not guaranteed to help the insurance beneficiary. But if you are a health insurance company which has insured a sick ten-year old, you are going to look pretty heartless on the evening news explaining why the experimental treatment the parents and doctors wish to try is not covered under the policy. In my experience, health insurance companies are fairly lenient about giving the family and the doctor the benefit of the doubt in the above situation. And they have to raise their premiums to pay everyone concerned and stay in business. Read more to learn how government regulations and anti-competitive measures have increased your health care costs.

The Current System Discourages Innovation

Innovation that reduces costs is not free. Those who benefit from the current system will lose. (Reprinted from the National Center for Policy Analysis.)

"In many industries, disruptive innovations have enabled less-skilled people to perform tasks in a more convenient, less expensive setting that could previously only be performed by expensive specialists in centralized, inconvenient locations. This has been one of the fundamental engines of economic progress -- and one that established health care institutions have fought tooth and nail, say some Harvard University researchers.

For example, a portable X-ray machine was developed that uses night-vision technology borrowed from the military. It could revolutionize radiology. The operating costs are 10 percent of conventional x-ray technology, allowing physicians to use it in their office and transport it from room to room. This innovation faces many hurdles, however.

• Radiology suppliers were not interested since it threatened their existing business.
• Radiologists would be reluctant to embrace it since widespread use might reduce their referrals.
• Regulators would likely refuse to approve it because of opposition from the radiologists who help set safety standards.
• Hospitals would fight it because it would reduce their radiology business.

Yet, this is would not diminish quality of care. When care is complex, expensive and inconvenient, many afflictions simply go untreated. Portable x-ray technology would likely allow more people to obtain care sooner.

Source: Clayton M. Christensen, Richard Bohmer, and John Kenagy, "Will Disruptive Innovation Cure Health Care?," Harvard Business Review, Sept.-Oct. 2000. "

Monopolies and Medicine

Today there is not one hospital in the United States, not one medical school, that is free to provide you with the best of western and natural medicine. Many medical schools now have departments of "Alternative Medicine" but except for Andrew Weil, MD at the University of Arizona, none are directed by the leading lights of the integrative health care revolution. Researchers frequently publish studies on the use of magnesium to reduce death from heart attacks, but I know of no hospitals that actually use it. There is a tremendous amount of research on testosterone deficiency in men, and how that increases their risk of hearth disease, but again, mainstream hospitals ignore it.

The pharmaceutical industry makes grants to medical schools for professorships, for research, for educational conferences. All honestly done, all above-board, and all of it perpetuating a pharmaceutical approach to every health problem.

The US government writes hundreds of pages of regulations each year. Again, the desire is to protect you, the citizen. The result, too often, is that the large organization can comply, and the smaller organization cannot afford to.

We have a medical monopoly in the United States. If it were providing great service at a fair price, I would not object. It is not, and I do object.

"Experts" and You

Here is a review of the book Trust Us, We're Experts: How Industry Manipulates Science and Gambles With Your Future. And that includes many "medical experts."

Government tax policy has led to higher health costs

The Public Interest quarterly published an article entitled "How to Cure Health Care" By Milton Friedman. He reviews how federal policies since the 1950's have led to increasing costs and decreasing customer satisfaction in the health care industry. He notes as well, that HMO's are a creation of congress and your tax dollars.

Intervention vs Lifespan

Medical interventions can lengthen life. Knowing the cost of the intervention, and observing the result in numbers of patients, we can calculate how much money it costs to extend someone's life by a year. This can range from as low as $10 per quality-adjusted year of life gained by treating some age groups for high blood pressure to millions of dollars of cost per year of life gained from other interventions. References are provided. The figures are interesting; I do not believe they are all accurate. When we give medications to prevent stroke in patients with cardiac irregularities, we know that for every one hundred patients treated, we are going to save perhaps three or four lives. The other ninety-five patients take the medicine, run the risk of side-effects, and experience no benefit.

The difficulty, of course, is that we do not know where you are one of the few that will benefit, or the many who will not.

These decisions are difficult to make. They would be easier to make if we had better information. We would have better information were there less pharmaceutical company influence on medical research and practice.

Solutions that don't work

The Future

Projections of the future cost of the Medicare program are uncertain. We have better projections for Social Security. If you are curious what your social security benefit will be when you retire, and what your children will have to pay in payroll taxes to make that happen, click here. This site also shows what your retirement income would be were your payroll taxes invested in the private sector at 4 to 5% interest (a rate no one can guarantee, either). Let me caution you to take this with a grain of salt, as your payroll taxes pay not just for your retirement, but are insurance for you and others against early disability. (Of course, we don't all agree on what constitutes "disability.") And if you are curious about your Medicare program, then and now, click here.

National Health Care - The experience from abroad

"As other countries struggle to reform their health care systems, they often look to the United States for guidance. Yet, many in this country are encouraging us to copy the health care system of some other country. Unfortunately, the advocates of national health insurance have painted a rosy picture of how it works elsewhere - often ignoring the many problems and failures.

National health insurance promises to make medical care a right and to grant all citizens equal access to it. Yet in those countries which have adopted national health insurance people are often denied access to modern medical technology, and the distribution of health care resources is far from equal. The special victims of national health insurance are the poor, the elderly, members of minority groups and residents of rural areas."

This quote is from the National Center for Policy Analysis, which has information from numerous countries about the success (or lack of it) with their national health insurance plans.

Time spent with the physician

A survey of patients showed that Americans spend a longer time with their doctor than people in other countries.

Great Britain

Whereas 72% of British citizens expressed satisfaction with the British National Health Service in 1998, only 58% report that they were satisfied in 2000. This is according to a study reported in the British Medical Journal.

Canada Moves To Tighten Limits On Access To Care

From the Vancouver Sun by Jeff Lee

B.C. to probe medical loophole after woman pays for surgery.
Avoided three-year wait

The government of British Columbia is attempting to close a loophole that allowed a woman to pay for her own elective knee surgery after she was told there was a three-year waiting list at a public hospital.

Leone Kowalewich opted to pay the $1,400 operating room and supplies fee at a private Vancouver clinic and have the procedure performed immediately.

Under the Canada Health Act, only "third parties" such as insurance companies and the Workers' Compensation Board can contract for such services. Ms. Kowalewich got a third party, in the form of a friend, to put the bill on a credit card, then she paid the friend back.

"If you had a sore tooth, you'd get it fixed, wouldn't you? I couldn't wait. It hurt every day," she said. "I don't consider it elective surgery. Now I don't have to live on Tylenol."

Michelle Stewart, a spokeswoman for the B.C. health ministry, said the province is now seeking a legal opinion on the loophole, which she said was designed to allow insurance companies a cost-effective alternative to having an injured worker waiting for surgery while collecting benefits. "The ministry's approach is that we believe our legislation and the Canada Health Act is clear. No citizen should have to be extra-billed for services they are entitled to," Ms. Stewart said. "We're looking at ways to close this down."

Mark Godley, the clinic's executive director of the False Creek Surgical Centre, where Ms. Kowalewich's surgery was performed, said the clinic is responding to a demand from patients whose only alternative is a long waiting list.

"What is the difference if it is the WCB, the RCMP or a first nations that is the third-party payer or a small employer, and not someone who wants the service but can't wait?" he said. "I look at this from a moral standpoint. I have a mandate to provide people with adequate care, and it upsets me when I see they can't get it."

More Canadians On Hospital Waiting Lists In 1998

The Fraser Institute's annual survey, "Waiting Your Turn: Hospital Waiting Lists in Canada," has found that about 880,000 Canadians were waiting to receive medical treatment in in the 2000-2001 time period, higher than ever before. In British Columbia, patients wait about 19 weeks between referral by their general practitioner and initiation of testing and treatment. Patients in Saskatchewan wait about 29 weeks (over 6 months!).

For Canada as a whole, and across all specialties, actual waiting time exceeded what specialists consider to be reasonable for all specialties except medical oncology.

Subsidizing Sickness: Medicine and the State

Here is a thoughtful essay about governments and health care.

World Health Organization Report

From an article in Health Affairs...

Does the U.S. rank 37th among nations in the world in the quality of health care? Actually, it received that ranking in "overall system performance," in a World Health Organization (WHO) report, "World Health Report 2000: Health Systems -- Improving Performance," which ranked health systems in 191 countries.

But other researchers criticize the WHO report for its eccentric methodology. For instance, its composite index of overall performance includes patient satisfaction and the accessibility of health care to low income and elderly people. But no actual patients or citizens of these countries were surveyed; rather, the report relied on a survey of public health experts, many of whom did not reside in the countries whose responsiveness to patients and the poor they were rating.

And when researchers compared the WHO rankings for 17 industrialized countries with the perceptions of their citizens recorded in a number of surveys, they found there was little relationship between the two measures. For instance,

• The two countries rated most highly by the public --Denmark and Finland -- rank at the bottom of the WHO ratings.
• Italy is ranked second by WHO, but only 20 percent of its citizens say they are satisfied with their health care system.
• Denmark is ranked 16th in the WHO overall performance measure, yet 91 percent of Danish citizens say they are satisfied with their health system.
• WHO ranked Spain third among the industrialized countries, but it is 13th in rank measured by the satisfaction of its own citizens.

WHO ranked the U.S. 17th, and Canada 14th, in overall system performance among industrialized countries, while in citizens' satisfaction with health care, surveys show they rank 14th and 12th, respectively. But by another WHO measure, the health system's responsiveness to non-health needs, the U.S. ranks first and Canada 5th.

(Source: Robert J. Blendon, Minah Kim and John M. Benson, "The Public Versus The World Health Organization On Health System Performance," Health Affairs, May-June 2001. For Health Affairs text (free) click here.)

Patient's Bill of Rights

The so-called "Patient's Bill of Rights" is mostly concerned with who can sue whom. Critics charge that the chief beneficiaries are lawyers, who could receive at least $1.4 billion to $2.8 billion annually from the new lawsuits.

Solutions that work

Personal choice, personal savings through Medical Savings Accounts

Medical Savings Accounts (MSA) are the best way for us to have maximum control over our health care choices at minimum expense. For more on MSA's, click here or here.

In the article by Milton Friedman above, he points out:

For most of the last decade [the nineties]-under the leadership of Nelson Mandela-South Africa enjoyed what was probably the freest market for health insurance anywhere in the world.... South Africa's insurance regulations were and are sufficiently flexible to allow the type of innovation and experimentation that American law stifles.... The result has been remarkable.... In just five years, MSA plans captured half the market, proving that they are popular and meet consumer needs as well as or better than rival products. South Africa's experience with MSAs shows that MSA holders save money, spending less on discretionary items in a way that does not increase the cost of inpatient care. Contrary to allegations by some critics, the South African experience also shows that MSAs attract individuals of all different ages and different degrees of health.

(Go to Public Interest, click on Archives, then on Winter 2001 to see his article.)

In addition, the Council for Affordable Health Insurance provides information about Medical Savings Accounts (MSA's) and other government policies that affect the health insurance industry.

Public and private cooperation for better health care

The Atlantic Monthly notes

In an anti-political time the politics of remedy is still possible. Two congressmen, one liberal, one conservative, both versed in the relevant complexities, agree on the bones of a plan to insure the 44 million Americans without health insurance.

We will probably do best to allow a combination of public and private systems for health care.

Tax Credits and Health Care

Corporations can buy health services and health insurance without paying tax on the premiums. A true Patients Bill of Rights would give individuals the same freedom.

As the Commissioner of Insurance for the Districtof Columbia writes in the Washington Post, it's time to re-think health insurance, focusing on REAL insurance that protects against catastrophic loss and giving consumers more freedom to make their own choices about routine health expenses.

For more, check out the Galen Institute.

For more information

Health Affairs

Health Affairs provides free web access to their printed material on health policy issues. As far as I can tell they provide an unbiased viewpoint, with rational analysis and recommendations.

National Center for Policy Analysis

The National Center for Policy Analysis provides information on a wide variety of health care issues.

The Galen Institute

The Galen Institute examines health issues from a working person's point of view.

News about Governmental Decisions governing Health Care

The Citizens' Council On Health Care publishes a weekly email newsletter.

With all due respect

This page is designed to give you information beyond what the broadcast media provide. It should help you understand why our health system got where it is today. I hope by reading it you will understand how we can change our governmental policies to improve service and cost.

If, after all this, you still imagine that by government taking over, doctors and nurses will magically appear to serve your medical needs and the medical needs of the poor, with no extra expense, think again. If you imagine that by government taking over, that the system will become "simpler" and "more efficient", take a look at Medicare. If you imagine that by government taking over, that the "fat" can be skimmed off the better-insured and given to the uninsured with no extra tax bite and no loss of service quality, look at other government programs and then look at your bible. "To those that have, even more shall be given, and from those that have not, even that little shall be taken away."

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