Hillary’s quest for the presidency is over, for now, and so Hillary-care will not be foisted upon Americans in the near future.
The Democrats’ approach to healthcare in general, though, rests upon a greatly expanded role for the state in the provision, funding and regulation of healthcare.
While many Americans are eager for healthcare reform, and an end to snags in accessing and paying for medical care, they should be extremely wary of any proposal to ameliorate these problems by moving towards socialized medicine. Single-payer systems are at the extreme end of government-provided care and yield some of the most disturbing examples of government monopolies harming patients, but any degree of government administration reduces the choice available to individuals.
This tendency can most readily be seen in the education sector. When the state assumes responsibility both for providing education and for regulating other providers, a structural conflict of interest results. Inevitable, meaningful school choice does not exist in most districts. Private schools often provide excellent and accountable educations for all levels of schooling, but with a price tag that puts it beyond the reach of many families. Increasing numbers are opting to homeschool, often with great outcomes, but this choice requires that a family be able to devote the bulk of at least one parent’s time to teaching — also not an option for all. Indirectly, many families manage within the limitations of public schooling by buying a house in a district with good schools, or by using private tutoring services as a supplement. Households with the most limited resources, unable to use any of these remedies, often make do with second-rate services.
So it is with government-provided healthcare. Public healthcare becomes the default option, but it never outperforms private or semi-private care, as exhaustive comparisons of European healthcare regimes show. State-of-the-art care becomes harder to access, as incentives for healthcare providers, administrators, and consumers are all skewed by artificial constraints. Those without the money to obtain the best treatment, or the connections to pull strings, find it increasingly hard to get appropriate medical care. The most pernicious aspect of government provided health care, though, is in the rationing of medical care and services. When the commodity being mismanaged is healthcare, the results include injury, disability, and death. Chilling examples from Canada show why single-payer, universal healthcare is not the way forward.
Canadians pay significantly higher taxes than Americans do. Many attempt to justify this by pointing to the services with which Canadians are provided. Comparing the quality of healthcare north of the border with that in the U.S. makes it clear that Canadians aren’t getting their money’s worth. While all insurers require that the treatments they fund be appropriate for the patients in question, in Canada government healthcare administrators have taken this a dystopian step further and now decide which people are deserving of treatment.
The most recent and outrageous example is the case of Samuel Golubchuk, an elderly Winnipeg man who died of natural causes in June, despite the best efforts of some of his caregivers to bring his life to an earlier close. Admitted to the hospital in fall of 2007 after contracting pneumonia, Golubchuk required a feeding tube and a ventilator. In November, his doctors decided to withdraw this care, despite the wishes of Golubchuk’s children and the patient’s own religious beliefs, which forbade the hastening of death. So strongly did the doctors in Golubchuk’s intensive care unit feel that their decision should override the wishes of the patient, expressed by his clergy and next of kin, that three of them resigned rather than comply with a court injunction obtained by the Golubchuk family against the withdrawal of life support. A local philosophy professor even characterized Golubchuk’s care as a waste of resources, endorsing the idea that doctors should decide who deserves treatment.
Seldom does the Canadian medical system act in such a heavy-handed manner. But this impulse to manage costs and ration treatment, whatever the cost in human suffering, reveals itself in slightly less obvious ways everywhere. Bill Murray is a resident of Alberta, Canada’s wealthiest province which has an affluent government. When he was advised to have surgery on his hip due to severe joint pain, the health ministry declined to provide it, saying that Murray was too old to benefit from the surgery. Murray was 57 at the time. Murray was able to pay privately for the surgery, an option that is legally foreclosed to most Canadians and that was later also denied to him. When he needed the same surgery on his other hip, he was unable to obtain treatment publicly or privately in Alberta and had to travel to Montreal for medical care. Murray is at the tip of the Baby Boom generation, a group that will no doubt be surprised to learn that it is too old to benefit from medical treatment for such commonplace problems as arthritis and joint pain.
Despite the commitment to equality professed by proponents of socialized medicine in Canada, Canadians receive very different levels of care depending upon their province of residence. Avastin — a cancer-fighting drug that shrinks tumors, extends life expectancy and improves quality of life for colon, breast, and lung cancer victims — is considered the standard of care in every G8 country except Canada. British Columbia, a reasonably well-off province, as well as Quebec and Newfoundland (much less prosperous), provide the drug to their residents. Elsewhere, patients must lobby on an individual basis for Avastin, and few are successful. Even those who persuade their health ministries to provide them with this therapy face a delay while they make their appeal, despite the time-sensitive nature of malignant cancers.
Even when necessary treatment is theoretically provided, waiting lists can expose patients to unnecessarily high risks of disability and death, as Shona Holmes found out. After a variety of distressing symptoms including vision loss were traced to a brain tumor, Holmes faced waiting lists of several months before meeting with a specialist. She then had another wait before receiving treatment. Unwilling to lose her sight, she traveled to the Mayo Clinic in the U.S., where she was told that if the tumor were not removed immediately, she risked permanent blindness and possibly death. Even with these test results and diagnosis, Ontario’s public health insurer was incapable of shortening wait times for Holmes. She ended up paying for her own neurosurgery in the U.S., which led to a complete recovery and a hefty bill that the Ontario government refuses to pay, despite their inability to provide Holmes with necessary care — and their duty of care toward her.
All of these examples reflect a command economy gone awry. One of the clearest lessons of the 20th century was the futility of letting bureaucrats control and predict supply and demand. Despite this, the Canadian government — at the federal, provincial and regional levels — dictates the number of places at medical schools, the price of medical treatments, the number of procedures that may be carried out per facility, and which drugs may be prescribed (beyond simply monitoring their safety and effectiveness). Other countries with publicly provided healthcare show similar ignorance of markets, most famously Britain’s NHS. Unique to Canada among developed countries is the paternalistic abolition of private healthcare. Having decided that state-provided care is the best way to meet the healthcare needs of Canadians, the government of Canada has prohibited the private provision of medically necessary services.
The cases discussed above are not exceptional. Many Canadians find themselves refused the care they need, whether because waiting lists are too long, their therapy is not considered necessary by a public administrator, or they themselves are not a high enough priority. Some can afford to travel to the U.S. or elsewhere to obtain the care they need, but the rest are without recourse. Ironically, elective medical care, paid for by consumers directly or by private insurers, is easy to arrange. Cosmetic surgery, corrective eye surgery, dental, and chiropractic care are available everywhere and become more affordable with each passing year. It is only those services considered necessary to health and life that are controlled and rationed by the government. There are loopholes. Some cancer treatments can be purchased privately (for tens of thousands of dollars) for patients denied it by their government, and residents of one province can sometimes travel to another region in Canada and pay for their own treatment there. However, since there is no private health insurance in Canada, such options are available only to the wealthy. Meanwhile, the fundamental unfairness of forcing everyone to pay for an unwieldy, inefficient universal system that does not provide necessary care to all Canadians goes unaddressed.
It is understandable that many Americans want healthcare reform. The “Great American Side Effect,” as one European researcher describes the coupling of health insurance with employment, has created distortions in the market for healthcare and health insurance that take a heavy toll on the self-employed, unemployed, and those with existing conditions. But single-payer universal healthcare will solve nothing — and will only lead to cases like those of Golubchuk, Murray, and Holmes.
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