A roundup of some health care discussions

Herewith a collection of recent articles I have found enlightening about health care proposals.

The Weekly Standard provides insight into the Dutch effort since the 1980s to move away from nationalized health insurance, first to a kind of public option/non-profit cooperatives/private mix and when that didn’t alleviate the problems sufficiently, to a more openly private insurance system. This is noteworthy for several reasons. The Dutch economy is among the most heavily socialized. The Dutch system, like other European systems began from the position that health care was a right for everyone. The country experienced the predictable inefficiencies of the system with its lack of incentives through competition.

Contrary to the desires of American liberals, the watchword has become to overcome managed competition. People now have to buy private insurance that the top one-third of the population already bought to escape the public system.

The article also reviews the many ways that government systems fail and how they try to control the inevitable costs. Government health care may not deny you the care altogether. But, “[one] way for a government to ration care is to simply delay it. You probably will get the care eventually but a long wait time means that there are fewer resources, facilities, and equipment needed in a health care system.” Or, “[another] approach to rationing is to limit availability of technology.” Examples would be the few MRI machines available in Canada, so that people have to go to the U.S. or, once again, wait. Or, “[rationing] may also take the form of limits on payments for medications.” That results in underfunded budgets for medications, which cannot be exceeded on pain of fines. Thus, needed drugs are underprescribed.

The solution in countries that ration health care? “For those who want to avoid these waits, supplemental private insurance and access to a discrete private system is one solution. While some countries have expanded access in the public system because wait times became intolerable, this has led to costs rising at rates that have themselves become a major issue.” An example of that is the German system, with which my family has some familiarity. The French system is often lauded as being a particularly responsive public system. France is one of the countries that has consciously expanded access to health care to reduce wait times. But France, combining expansive care with bureaucratic inefficiency, now has a budgetary albatross whose costs have so spiralled out of control that they threaten the government’s fiscal stability. This has become a major political and economic problem.

Economist Robert Samuelson discusses the inevitable cost explosion that will come under any government health insurance coverage. Extending Medicare to all will suffer from the defects of the current version of the program, but on a grander scale. Samuelson does not believe that rationing will be the result. Instead, as all the liberal talk of health care as a “right” shows, and as has already occurred with mandates imposed on private insurance coverage, Congress will expand the program but only talk about constraining costs. The best that can be expected from Congress is to try to squeeze doctors, hospitals, and drug companies. The rest will be increased taxes and/or deficits. And the President? “He simply claims that his plan will do things it won’t. What he’s offering is an enlarged version of the status quo that, as he says, is already unsustainable.”

Public systems are clearly prone to odd examples of expansion of “necessary” health care.

Once more about those uninsured: General estimates place the number of uninsured Americans who make less than $50,000 (roughly the median earnings of a family of four) and who don’t qualify for government programs at 8 to 14 million. The lower figure are the chronically uninsured, the higher figure those who are temporarily uninsured at some point when the survey is taken. Not 46 to 50 million, a figure thrown around that has been debunked for a long time. Even in that category, a lot are young single people in excellent health who probably could afford to pay relatively cheap premiums if they were not subsidizing costly insurance mandates, but opt not to do so. The Census date used there are from 2007, but there has been little change in the percentages of uninsured over many years.

Then there is the usual collection of stories of Canadians being sent to, or escaping, the wonderful Canadian health care system that liberals seek to emulate. There is the agreement between Ontario and the city of Detroit and other municipalities to provide services to Canadians they cannot get there as readily. Detroit!?! Even defenders of the arrangement agree that such safety valves allow Canada to have a smaller health care budget. That should answer the argument why Canadians pay less for health care. As with so much of their national existence, they depend on the U.S. On whom will they be able to free-ride if the U.S. follows their lead?

Another, though older, example of that vaunted Canadian care. Via Mark Steyn at The Corner, some incidents from EuroCare, including the sad tale of Irish mothers who have to wait months before getting a first obstetrician appointment. Again, via Mark Steyn, the tale of 4000 mothers who had to give birth in unusual circumstances due to a lack of maternity beds in Britain. Also note the links in the middle of the Daily Mail article for further examples.

A zestier discussion, courtesy of Ann Coulter, who argues (correctly, in my mind) for more competition among insurance companies and fewer government mandates.