Fortunately, Americans don’t have to speculate about what a government-run health care system looks like. All we have to do is observe our neighbor to the north, Canada, which some argue has a model we ought to adopt.
Increasingly Canadians themselves are turning to alternatives to their national system. For years, Canadians have crossed the border seeking treatment in the U.S. Private clinics are opening, despite uncertain legality, at a rate of about one a week.
Other single-payer countries are also seeing demand for private care. In Britain last year, private organizations provided 5% of non-emergency procedures. The Labour government has pledged to raise that to 15% in 2008.
Driving these trends are the rationing and lack of innovation that are inevitable features of a government monopoly. In exchange for claims of universal health care, governments must ration in order to keep costs manageable. Governments simply cannot repeal the law of supply and demand. Brian Day is president of the doctor’s association in Canada. His take on Canada’s system? He told the NY Times, “This is a country in which dogs can get a hip replacement in under a week and in which humans can wait two to three years.”
Dr. David Gratzer was so appalled by what he saw after becoming a Canadian doctor that he wrote a book, Code Blue, about his experiences. He described an ER full of patients on gurneys waiting interminably for care, some as long as several days. He described surgery patients he referred to pain clinics with three-year waiting lists. And cancer patients with four-month waits for radiation therapy.
A recent study found that only half of Canadian ER patients receive what is considered timely treatment. Referrals to specialists take four to eight weeks on average, even for cancer patients.
And once you get to the top of the waiting list in single-payer systems, you’re often out of luck if you need state-of-the-art technology or procedures. New radiation technologies have extended the five-year survival rate for U.S. prostate cancer patients to 81%, compared to 44% in Britain. As a senior British health official, William Wells, recently said, “The big trouble with a state monopoly is that it builds in massive inefficiencies and inward-looking culture.” That culture and associated incentives are not promote an environment of innovation.
None of this suggests that the U.S. patchwork system is without need for improvement. Some of our problems, such as portability of insurance when one changes jobs, are ripe for legislative solutions. Costs are obviously high. We are drowning in paperwork. Some of our problems are the legacy of government policies to promote employer-provided insurance.
But these problems should be addressed with more freedom and innovation, not less. In a word, the solution is markets. Only by moving more toward market solutions, as Canada and Britain are currently doing, will we see more cost-effective, timely, life-extending treatment for more people.