When health care is made to seem "free" at the point of
consumption, demand for health services will rise uncontrolled
unless it is restrained by something other than cost. If market
forces do not allocate health-care resources, then long waiting
lists, limited access to specialized care, and
government-rationed supply will characterize the health-care
system. These consequences, described by John C. Goodman, Gerald
L. Musgrave, and Devon M. Herrick in
Lives at Risk: Single-Payer National Health Insurance Around
the World, are endemic in nations that have adopted a system
of single-payer national health insurance.
Lives at Risk takes on many beliefs about nationalized
health care, dubbing them "myths." Consider the myth that
citizens in nations with national health insurance have a "right"
to health care. Goodman et al. note, "There is no such right in
any sense that people ordinarily understand the meaning of the
term. What the right to care means almost everywhere is nothing
more than the opportunity to get services for free." Patients
only have a right to the services that the government says they
can have. In Canada, for example, if you can't convince the
authorities that you need an MRI scan, you are out of luck unless
you can pay for it in another country. "In fact, in the 1980s
some Canadian hospitals advertised in America in search of paying
customers to help out with their cash-strapped budgets,"
according to Goodman et al. "Yet, it was illegal for Canadian
citizens to pay for the same services." Until the practice was
discontinued, "one could maintain that Americans had more rights
in the Canadian health care system than Canadians did."
Or consider another myth, that all people in countries with
national health insurance have equal access to care. The evidence
simply doesn't support it. In 1980 the "Black Report" examined
Britain's system of care and found that access to care had not
become more equal since the National Health Service was
established in the 1940s. A similar report about two decades
later found that access to care had become more unequal
since the Black Report. Canada has fared no better; numerous
studies from the University of British Columbia show that access
to care varies widely across region. Not surprisingly, the
proximity of one's residence to an affluent city is one of the
best indicators of access to doctors of any sort, but especially
to specialists. Hospitals are more likely to have more staff per
hospital bed and patients are more likely to survive treatment if
they are located in an affluent region. Worse, those few who are
seriously ill do not receive adequate funding, as the majority of
funds go to the relatively healthy many who seek cheaper
procedures. To quote Goodman et al., "Foreign governments do not
merely deny lifesaving medical technology to patients under
national insurance schemes. They also take money that could be
spent saving lives and curing disease and spend it serving people
who are not seriously ill. Often the spending has little if
anything to do with health care."
Goodman et al.'s analysis falls flat, however, when the authors
try to design an ideal health system. While some of their ideas
would lead to greater individual liberty, others continue
government's meddlesome role. For example, they note that the
current tax code's treatment of health insurance means that
people who do not have insurance pay a "tax penalty." They argue
that taxes the uninsured pay should go to government agencies to
reimburse health care costs for the uninsured. When an uninsured
person decides to purchase insurance, what the government spends
should be reduced by the amount the government spends per-capita.
This may seem sensible in theory, but this nation's experience
with Medicaid shows that government is unwilling to reduce
spending, regardless of actual need. If anything, it demonstrates
that state governments love to keep the Medicaid money rolling in
because they find surreptitious ways to
spend it on other priorities. Indeed, Goodman et al.'s desire to
see a seamless transfer of tax money to government health
insurance will always be weighed down by meddling of politicians,
bureaucrats, and interest groups.
Despite that shortcoming, Lives at Risk is a book that
should be on every conservative's bookshelf. It provides abundant
intellectual ammunition to use against those agitating for
national health insurance, and does so in a lively, engaging
style. As the cost of health insurance continues to rise, and the
likes of the New York Times op-ed page uses it to
advanced socialized medicine,
Lives at Risk couldn't be timelier.
topics:
Taxes, Health Care, Medicaid, Books
