Saturday, August 18, 2007

Free, universal health care is neither free nor universal.

The United Kingdom was a pioneer of socialist health care. There is supposed to be universal coverage and “it’s all free”. Of course it’s not free. It isn’t even universal.

Around 11% of British purchase private health insurance. They can’t opt out of the National Health Service and still pay for it. They then pay extra to purchase health insurance mainly because of the long waiting periods for state care. So 11% of British pay for health care twice -- once for “free” national health care and then a second time to receive the care in a timely way. In New Zealand about one third of residents purchase private insurance just to avoid the waiting lines of the “free” state care.

But, when it comes to people who know the National Health Care system the best, the percentage with private insurance increases dramatically. The Sunday Times reported recently that “55% of senior doctors pay medical insurance” and turn to “private medical treatment instead of using the National Health Service.”

A pro-NHS pressure group, Patients Association, is outraged saying, “Those who work in the NHS at the highest level should have enough confidence in the system to use it themselves.” Should and does are two different things.

The chairman of the British Medical Association, Jonathan Fielden, said “What consultant do with their own health care is very much a personal matter. Consultants will try to minimise the time they are away from work in order to maximise their ability to care for patients.”

That brings to light one aspect of nationalized health care that is often ignored. Fielden is saying that doctors who become ill seek private care to reduce the time they are away from work. Fair enough. That benefits patients who otherwise wouldn’t be treated. The lesson here is that had these physicians been treated within the NHS they would spend less time working and more time waiting. The waiting lines for care in nationalized systems are infamous and well documented.

What I find interesting is the aspect of the time they spend away from work. This is a cost of nationalized health care that is literally off the books. When socialist health care is deemed more cost efficient, waiting costs are not included in the total.

Consider two patients with the same malady. One has private insurance in the U.S. The other is an NHS patient. Each needs the same surgery, without which neither can work. And let us assume the income per week is $600 for each.

The American is booked off of work due to illness and a week later has surgery. He takes about one week to recuperate. The health insurer pays out $10,000 for the surgery. After two weeks the man is back at work. The cost is $10,000 plus two weeks of lost wages. Even if the company had sick leave they have to pay to have someone else do the work. Either way someone is paying for those two weeks of lost work. But the statistics show the $10,000 surgery as the “health care” cost even though the total actual cost was $11,200.

In the U.K. the patient also books off from work due to illness. He is put on a waiting list. He’s not as critical as others so he keeps finding his surgery delayed. Waiting four to six months is not uncommon but assume his wait is just four months.

When he eventually receives the surgery the official cost is $6,000 or $4,000 cheaper than the U.S. The socialists crow about the “cheaper” alternative. They completely ignore the lost wages. A four month wait would be around 17 weeks of lost wages. There is the one week recuperation period as well. The lost wages would amount to $10,800. The surgery was $6,000. The total, cost would be $16,800. That’s $5,600 more than in the U.S.

But the $10,800 in lost income is not counted as a cost when the two countries are compared. Only direct medical costs are counted. This makes the socialist system look cheaper than it really is.

Advocates of state run health care might try to divert the issue by saying that under the socialist system the worker still receives benefits replacing his lost income, at least in part. True, just as the U.S. worker may have sick leave that covers the cost. But in both cases someone has to cover the missing work. The cost doesn’t disappear by transferring it to another party.

Socialists remind me of small children who think that if they close their eyes then daddy disappears. If they can’t see him then he isn’t there. Health care, in nationalized systems, isn’t free. You just don’t pay for it directly. It is there even if you don’t see it. The Wikipedia entry on health care describes the NHS and says there is “complete political consensus on the importance of free public health care.” Whoever wrote that is the child I was refering to. They don’t directly see the cost, so it’s free. In one forum a woman asks: “Canada has free health care, why can’t the United States do the same thing?” One university newspaper proclaimed: “Free health care is the perfect prescription for the U.S.” If they don’t see it directly, it isn’t there.

Even if they look at the costs of the care itself they ignore indirect costs, such as the cost of waiting. The majority of physicians in the U.K. have private care because the cost of waiting is so high, not just for them, but for their patients as well.

The sympathizer for socialized care might argue that many of the people who receive “free” health care are not employed and have no lost wages. It is true that unemployment is much higher in the socialists countries than in the U.S. But that assumes that suffering is not a cost. The elderly couple who won the lottery in the U.K are one example. Both needed knee replacements and were in a great deal of pain. But pain doesn’t “cost” anything, so it doesn’t count. After months of waiting they won the lottery and used the winnings to go private. They could have kept waiting for the NHS to eventually get round to them. The cost of pain was higher to them than the cost of the surgery.

Many of the costs of socialized care are not calculated when we see the two systems compared. The U.S. has higher direct costs and lower indirect costs. The socialists systems have lower direct costs and higher indirect costs. To compare only one set of costs biases the results.

There is another aspect to the waiting that proponents of socialized care ignore. When you are waiting you are not receiving health care. You are not covered! You might get lucky and become covered later, but you are, at that moment, uninsured and uncovered.

The NHS has plenty of people who are not covered by health care.

For instance, this report from Aberdeen recently noted that 25,000 people are waiting in one area alone to get on the list to be seen by a dentist. Another U.K. press report states that only 46.2% of all Scots have dental care, in spite of it being “free”.

To be seen by a doctor or a dentist, under NHS, one must be registered on the books of that doctor. The problem is that most doctors have all the slots in the books filled. If you move to the area, and wish medical care, you must fill out an application to be put on the books. If the books are full you are rejected. You can try other physicians but the answer is pretty much the same everywhere -- the demand for care exceeds the supply and the books are full.

You can then appeal to a quasi-government body and ask them to put you on the books anyway. If they determine you are urgent they will order a local physician to add you even if he’s already booked solid. However, if they determine you are not urgent, you are in limbo. You can’t see a physician for a check up or routine care until an opening is found.

You can ask to be put on the waiting list to be added to the books. But that doesn’t mean you are able to see a physician -- unless, of course, you pay for it directly.

Denial of care is routine under socialized system -- they are never universal as they are touted. For instance, the NHS now has a rule that anyone who has smoked in the previous four weeks is no longer eligible for surgery for anything. This rule will be enforced with mandatory blood tests for nicotine traces.

The BBC reports that many elderly are denied needed dialysis because of chronic shortages in the NHS system:
A doctor at the Royal London Hospital in Whitechapel said: "If you have only got room for three, you obviously have to turn away the fourth and the fifth.

"We can either do it on the basis of first come, first served, or we do it by turning down the person least likely to benefit from the treatment.

"If you have a patient in their 70s with a lot of problems, who is unlikely to survive anyway, and a patient in their 20s or 30s with just kidney failure, then you have to make a decision to turn down the elderly patient and treat the younger one.

"But we are having to say no to more and more people."
Heart bypass surgery is far more common in the U.S. than in the U.K. That means more bypasses per 100,000 people are performed though the need for surgery is similar The difference is that the socialized system provides fewer surgeries. In the U.S. Pacemakers save lots of lives. In the U.S., by 1981 the rate of implantations was 513 per million population. In 1997, under the socialized system of care in New Zealand the implantation rate was just 23 per million population. People are denied care under socialism yet it is called “universal” coverage.

The truth about free, universal health care is that isn’t free. It’s not even that cheap if you look at all the costs. And it’s not universal.

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