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February 14, 2006
You've Had Your Turn
Russell Roberts
I was speaking to someone yesterday who had lived in England. She said that the nationalized health system there is great for children, but as you get older and older, the attitude is "you've had your turn" so you have access to fewer medical resources. A pretty horrifying way to treat human beings. She said that the wait for an MRI is 4-6 months and that there was virtually no preventive care. If that is correct, it would help explain these data:
Is it true that there is virtually no preventive care in the UK? Anyone out there have experience with England or know something about it?
As I was telling my wife about the delays in England, my 13 year-old daughter immediately said, "sounds like Canada." That's because I had shown her this 24 minute documentary. It's pretty intense in parts, so you may not want to show it to your younger children. But for the older ones, I recommend watching it with them and helping them understand why there's no free lunch with "free" health care.
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» Health Scare from illinoisreview
At Cafe Hayek Russel Roberts has posted some comparisons on health care spending; age-standarized cancer deaths per 100K people; and cancer survival rates. As a percentage of Gross Domestic Produce the US spends 12.7% of Gross Domestic Product and your [Read More]
Tracked on Feb 14, 2006 7:14:22 PM
» [Cafe Hayek] You Had You Turn from Marketplace.MD Blog
Russell Roberts:
I was speaking to someone yesterday who had lived in England. She said that... [Read More]
Tracked on Feb 15, 2006 10:03:20 AM
» Mainstream Misleading. from The Bullwinkle Blog
Why do so many proponents of socialized health care need to make it mandatory? If its so great, why doesnt it work by allowing people to volunteer for it?
Because it doesnt. More than forty percent of the federal budget goes to Med... [Read More]
Tracked on Feb 15, 2006 6:17:22 PM
» Too old to live... from franck's blog
Russell Roberts ponders on some 1998 statistics from the WHO: if you get sick, you better make sure live in the US. [Read More]
Tracked on Feb 19, 2006 10:25:55 AM
Comments
Similarly: I recall an article in a UK paper 2 or 3 years ago about care for terminal kidney-failure patients.
That article was making some point about Euro govt's rationing of renal care, and mentioned the rate for various countries of people-per-100,000 population who were terminal patients receving care (presumption being there's a similar rate of terminal renal cases across countries, but the resources countries are willing to devote to a dying man before he gets shut off and sent home varies.)
The article was interested in European comparisons, but as an aside mentioned the rate in the US -- and that rate of patients RECEIVING CARE in the U.S. was VASTLY higher than in any European nation, by a factor of about 3 to 6 vs. various countries listed, as I recall. Rates ranged from about 200 per 100K elsewhere to 1300 per 100K in the U.S., something like that if memory serves.
Posted by: Kevin | Feb 14, 2006 3:13:06 PM
I know it sounds horrible, but when it comes to nationalized healthcare, rationing based on age makes sense. Unless someone can explain to me how we can afford to spend several hundred thousand dollars on every dying person.
Posted by: Randy | Feb 14, 2006 3:32:31 PM
Your data is extremely out-of-date (I can't tell if they're 8 years old or 10 years old or 12 years old...)
Suffice it to say, things have degenerated quite a bit in the US in the past ten years. For one, we're spending 16% of the GDP on health care, not 12%.
I don't know about cancer survival rates, but we top the ranks of mistakes, wait times, non-coverage, and avoidance of preventative care because of cost.
Much to the dismay of the guy Cheney shot (sorry; obligatory).
Posted by: Aaron Krowne | Feb 14, 2006 3:43:31 PM
Precisely Randy, which is why goverment issued healthcare is BAD! Wouldnt you rather determine yourself, when you are in your dying bed, if you want to live longer? Why should the goverment take on this role between life or death?
From what you (Roberts) said, the old saying is true: Capitalism meets increased demand with higher prices, socialism meets increased demand with longer lines. And who gets to choose how comes first in the line? Thats right, the goverment...
Posted by: Peter R | Feb 14, 2006 5:15:06 PM
What? Nothing about demographics? Heck, Switzerland with the second highest breast cancer survival rates has almost the genetics and racial and poverty figures as the Us so the two numbers must be comparable. Besides, "dying" of colon cancer? Are these those who have had colon cancer and then died are these those diagnosed with colon cancer and then died or are these died of colon cancer that was known 5 years previous? Mix and match those variables as you may. I suspect that US spending does not achieve societal optimums but probably gets a lot closer to "payer gets the most benefit."
Posted by: Robert Cote | Feb 14, 2006 5:32:23 PM
UK: wait to see specialist after referral from General Practioner: in my area they send you a letter telling you thatthey'll contact you in about 17 weeks for you to phone them to make an appointment. the appoitnment will probably then be about 4 weeks after that. When you go for an appointment you will be kept waiting, possibly for several hours (it used to be that the entire mornings patients were told to turn up at 9.00, talk about being run for producer interest). only after you have seen the consultant and if he decides that you need surgery will you then join a waiting list for an operation, and you may wait for years. even cancer patients wait for months for diagnosis and die rather than live because of the wait for treatment. even when operations are scheduled they are frequently cancelled at the last moment, especially in the winter. The care on the wards is very variable. There are good managers and staff, and then a ward can work well, but the very next day it can be atrocious and sloppy. The Nationa Health Service NHS does mad things like import nurses from africa who have aids, so then they get treated on the NHS at costs of up to £10,000 per year. The economists could have told us, indeed have told us, precisely that this would be the result but the politicians are willing to lie about economic reality and most people believe in a fantasy about what the government can do and how everyone should have health care free at the point of delivery without any understanding that this is not achievable. all that is had is peculiar varieties of rationing, no control over costs, and relentless propaganda from unions about how our nurses are angels.
Posted by: wex zqed | Feb 14, 2006 5:33:33 PM
*** For one, we're spending 16% of the GDP on health care, not 12%.****
Whatever the number, what I like to point out that no one else ever does: of course we spend a greater proportion of GDP on healh care than other countries. We can afford to. We're richer than them. If they were wealthier, they also would be spending a greater proportion. Turns out that as you go up the Economic version of Maslow's hirarchy, people are willing to spend ever more to cheat death and alleviate pain, not to mention all the vanity-related healthcare.
Hell, we spend even more than that, if you also count all the useless supplements and infomercial crap morons who yap about about "toxins" buy.
I predict in 30 years (when we'll be richer than today), we'll be spending an even greater portion of GDP on healthcare.
Posted by: Kevin | Feb 14, 2006 5:39:18 PM
Health care is an emotional subject that brings out some of the worst economic thinking. As commentators on this wesbite and elsewhere have pointed out, there is no fundamental difference between health care and any other "necessity" like food and housing -- yet only the most hardened marxists propose that we "ration" food and housing. There is absolutely no reason to believe that a government-run health care system would be "better" (in terms of access, quality, efficiency, etc.) than a market-driven system. Of course, for humanitarian reasons, we should maintain some kind of "safety net" for basic health services, but beyond that, I say let individual consumers and providers decide what is best for them.
Posted by: Steven M. Warshawsky | Feb 14, 2006 5:41:07 PM
Question for Aaron Krowne: what's your source for your claim that wait times for health care in the U.S. are longer than anywhere else in the world?
Posted by: Don Boudreaux | Feb 14, 2006 6:05:26 PM
Two comments on the UK system. First, there are regional differences in the standard of care offered by the NHS. Broadly, the inner cities fare worse than rural areas. That said, even in the better areas the speed with which patients are treated is abysmal. This remains the case in spite of the rapid increase in the governments subventions for the NHS. Most of the extra money has been used to increase NHS staff salaries!
Secondly, there is a thriving private medical sector in the UK. Many companies now offer private insurance to management above a certain level as a 'perk'. This system works quite well at the level of the specialist and surgeon. Unfortunately, the coverage rarely encompasses the GP, internist in the US, who provides the mandatory reference for patients to consult with specialists and surgeons. Moreover, doctors are allowed to provide private services only as a adjunct to NHS work. Nevertheless, it provides for those who can afford it or who have it paid for by their employer a standard of care which approaches that available in the US.
I have lived in six countries throughout my working career. In not one of them did the health system provide adequate coverage at what I would regard as a satisfactory level of expense. The US provides generally superb service but the cost, which is indeed 16% of GDP, is extortionate; the UK is at the other end of the spectrum, severely rationed but cheap care. The continuing advances in medical technology allied with greater life expectancies can only exacerbate the problem.
Posted by: Reg Hall | Feb 14, 2006 6:18:00 PM
I'll make a deal with all you pro-socialized medicine folks. You can have your program if you exclude everyone who has ever gambled, smoked, drank, gone to a professional sports game, purchased a television, or gone to a movie. If people can afford these things they can certainly afford some form of catastrophic health care.
Posted by: NathanB | Feb 14, 2006 6:28:23 PM
I must say the claims of the advocates of America's status quo healthcare system are getting weaker by the day. The cancer survival rates are impressive, for instance, but what exactly is the point of mentioning such statistics? Surely the point is not to make some kind of generalized claim about "socialized medicine" versus "free market healthcare" -- because the US has a system that is far from being the latter. Indeed, what such statistics tend to point out is the desirability of spending a lot of money on healthcare. Shockingly, people in countries that spend more on heroic medicine tend to survice chronic illnesses like cancer better than peoople in countries where this is not the case!
The argument that Americans survive cancer at higher rates than, say, Britons, sounds an awful lot to me like arguing that it is good for governments to spend mega dollars on healthcare (as Washington does) than it is for governments to be tightfisted with healthcare (as London apparently is). What it doesn't sound like is a capitalism versus socialism argument -- at least not when the capitalist society in question relies on the public sector for 50-60% of healthcare spending.
I should point out that I personally favor continued, significant particpation from private sector actors in the healthcare system -- similar to what goes on in, say, France or Australia or Japan or Germany. And I likewise deem British or Canadian-style single payer a bad fit for the USA. But I also think the current US healthcare system -- with its tight relationship to employment, out of control costs, rampant adverse selection problems, increasing spottiness of coverage, various perverse incentives, and its unimpressive overall macro outcomes -- is an increasingly disfunctional, expensive mess.
Posted by: P.B. Almeida | Feb 14, 2006 6:57:20 PM
If you're going to ration health care on the basis of age, the UK approach at least makes more sense than ours. It's certainly better to disproportionately fund health care for the young than the old. Medicare is insane.
Posted by: FXKLM | Feb 14, 2006 8:03:03 PM
Public health care spending per capita is higher in the USA than in the UK.
Wait times for surgery and the like vary wildly between countries with socialized medicine.
Whatever you want to advocate regarding health care, you can easily find the statistics supporting it.
Posted by: iasius | Feb 14, 2006 8:50:44 PM
*****I was speaking to someone yesterday who had lived in England. She said that the nationalized health system there is great for children, but as you get older and older, the attitude is "you've had your turn" so you have access to fewer medical resources. ...She said that the wait for an MRI is 4-6 months...*****
This isn't true in Britain if one has the resources to jump the queue and pay for private care. In this regard the British system isn't all that dissimilar from America's, in that greater economic resources translate into better care. One advantage to the British system, though, is its universality. It may suck to wait 4-6 months for an MRI in Britain, put for many millions of Americans, the effective wait for an MRI is eternity.
Posted by: 99 | Feb 15, 2006 12:03:49 AM
*** put for many millions of Americans, the effective wait for an MRI is eternity. ***
That's actually not true -- or at least not as true as people think. I can't speak for every situation, but for the most part, if you really need care, you get it, whether or not you have insurance or can pay for it. You just might get stuck with a nasty bill afterwards.
You could fill up a room with doctors I personally know who'll whine that they don't make as much money as people think, because they have to treat a lot of people who never pay (I come from a family of DRs and medical personnel).
I was even one of those notorious uninsured myself for several years, and the one time I needed to go to the doc there was certainly no hesitation in treating me at all (though I didn't get an MRI!)
Posted by: Usophanes | Feb 15, 2006 1:21:26 AM
The "Health Care" section of my blog carries a series of such horror storiesaboutthe NHS. I’d also strongly recommend NHS Blog Doctor.
http://nhsblogdoc.blogspot.com/
Don: Krowne’s comment "I don't know about cancer survival rates, but we top the ranks of mistakes, wait times, non-coverage, and avoidance of preventative care because of cost."
Specifically mentions "on the grounds of cost". What I think he means is on the grounds of cost to the patient. The NHS rations things on cost as well. For example, Herceptin is not a routinely approved treatment for cacner on the grounds of cost....cost to the taxpayer.
Posted by: Tim Worstall | Feb 15, 2006 6:04:21 AM
One morning in Australia my daughter woke up and could not walk due to a large lump in her leg. My wife took her straight to the local doctor; he referred her to a paediatrician for an emergency visit, who referred her for an emergency ultrasound and then an MRI. It took a couple of days all up for the problem to be diagnosed. We were pretty happy with the service.
Then we went to England. The problem recurred. We took her to a doctor and told him what the problem was. He booked us in for an emergency MRI...in 3 months time!
We came back to Australia for the treatment instead.
Posted by: James | Feb 15, 2006 6:46:12 AM
My uncle in England had all the symptoms of a stroke
late one Friday night. They told him to come in Monday morning for treatment.
Posted by: Tom | Feb 15, 2006 9:15:38 AM
> I don't know about cancer survival rates, > but we top the ranks of mistakes, wait
> times, non-coverage, and avoidance of
> preventative care because of cost.
If we top the list of mistakes it's only because private sector health care providers are the only group serious about reducing them and therefore the only group serious about *tracking* them.
Topping the wait times? Nonsense. Americans invent or adopt almost half of new therapies and new medicines in the world, a strong indicator of dynamism and speed. Check up on the differences in wait times and availability of MRI and other high tech equipment and surgical facilities. Also, question how many foreigners with NHS-style systems are coming here (or going to India). I recently read about someone in Canada needing the same knee surgery as I (ACL reconstruction); I got into the MRI at my convenience, and scheduled the surgery at my convenience. Surgery took place in a private office; I was in at 0900 on Monday, home by lunch, walking on my own Wednesday, back at work the following Monday. The Canadian waited months for access to an MRI and then months more for an ancient technique that put him in the hospital for several days. Total social cost of each?
Non-coverage? Big deal. Many Americans who can afford it believe they can go without coverage, and who are we to second-guess them? About half of the non-covered are immigrants - why should we offer health care to immigrants in addition to all the other benefits of immigration? What would the effect of a coverage policy be? (Hint: More immigrants, therefore more money spent on coverage)
It's "preventive" not "preventative" (sorry, pet peeve). What exactly is preventive health care, why is it so valuable, and what is driving the cost? (Hint: licensing, FDA, and Medicare mandates)
The best preventive medicine is free: don't smoke, keep your BMI in the normal range, aerobic exercise 15 mins/day, reduce or eliminate meat from your diet, have a glass of red wine now and then, drink green tea or yerba mate instead of coffee, have a daily aspirin, go #2 regularly, eliminate starches, wear your seatbelt, brush and floss. With the money saved from dropping meat from your diet, you could afford a dentist visit and a physical every year.
Posted by: Eric H | Feb 15, 2006 10:15:39 AM
>eliminate meat from your diet ... With the money saved from dropping meat from your diet, you could afford a dentist visit and a physical every year.
Sorry, quick comment on this. I was vegetarian for 15 years and basically followed much of the rest of your prescription for health most of the time - I recently added some meat back in because I was not made healthier by vegetarianism. I was made much kess healthy, I think. I have greater energy and better physical health symptoms and fewer cravings for unhealthy foods now. Different people have different dietary needs. Most women feel the need to eat meat when pregnant and some women literally faint from the best vegan diet in terms of known nutritional value. My husband became weak, pale and looked like skin and bones when he tried a vegetarian diet for two weeks (at my request).
Meat is also not necessarily more expensive and is probably cheaper than a very "healthy" (in nutritional terms) vegetarian diet, especially in America.
Sorry, that was off-topic entirely, but I wanted to add my 2 cents on that.
Posted by: liberty | Feb 15, 2006 1:33:27 PM
"I must say the claims of the advocates of America's status quo healthcare system are getting weaker by the day."
P.B., you are not seriously asserting that anyone is arguing for the US status quo, are you? I have never once heard the argument that the system is not in need of dramatic, systemic change of one form or another. The commies will tell you the system needs to be nationalized, and the libertarians will tell you it needs to be purely privatized, with plenty of variation in between, but literally no one is saying it's Just Fine The Way It Is.
Posted by: Noah Yetter | Feb 15, 2006 2:43:12 PM
Typical political carping. Nary a philosophical argument among you. Never having had a bad experience with private health care in the US, which includes the treatments and services provided my 90 year old grandmother, I have to point to Capitalism as the root source of good health care, if expensive. But lots of things are expensive. This is not a fair argument.
The problem isnt who dies or gets sick or why or when or any other conrete but the plain fact that the things we need in life, including medical treatment, can and must be earned. The fact that I can think and plan for the future means that I must do this in order to live a happy life. My 90 year old grandmother has had nothing but trouble with Medicare. Thankfully she thought ahead, saved and planned, and can provide herself good private care.
This is the lesson to be learned here.
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