Wednesday, March 25, 2009

If you get Universal health care with a single payer you better have a "safety value"

In Great Britain, at least for some, the safety value for the NHS is private health care. In Canada, if you can afford it, the safety value is to leave and get the care in the United States or overseas, perhaps in India.

Here is a reference to comments made by the Director of Trauma at McGill Hospital Centre in regard to the events surrounding the death of Natasha Richardson. He said in part:

"It's impossible for me to comment specifically about her case, but what I could say is ... driving to Mont Tremblant from the city (Montreal) is a 2 1/2-hour trip, and the closest trauma center is in the city. Our system isn't set up for traumas and doesn't match what's available in other Canadian cities, let alone in the States,...

The system is not "set up" for trauma in part because there were no air evac helicopters in that area. As pointed out by others capital investments in the health care system in Canada are costs to the system that cannot be recouped. In the US, the purchase of,for example, an MRI, is also a cost to the hospital or clinic but it can be recouped and typically is a profit center. So hospitals under which system are likely to have MRIs readily available?

It is important to recognize that "universal health care coverage" and "single payer" are not the same thing.

David Henderson of the econlog blog has this to say about the single payer system in Canada:

The essence of "single payer" medicine is that no one other than the government is allowed to pay for medical care. Thus the term "single payer." There are a few exceptions in Canada but, by and large, the more serious the ailment, the more stringent the ban. So, for example, if you want to be treated for cancer in Canada, you can not do so legally and any doctor or hospital that tries to charge you faces serious penalties, up to and including a prison sentence. In that sense, Canadian health care is one of the most totalitarian systems in the industrialized world and is far more extreme than the National Health Service of Britain.

When rationing by waiting turns into health care denied by health care delayed ( as numerous anecdotes or case reports indicate) as occurs in Canada the single payer may in effect work directly counter to the promise of universal care that the single payer system promises. There are many problems of single payer system as a cursory study of the health care in Canada and Great Britain will show, but a single payer system that outlaws private care is, as David Henderson says, about as totalitarian as you can get since your life is in the hands of the state.

1 comment:

Michel Accad, M.D. said...

That is exactly correct. The dilemma facing the socialists in the US is this: they clearly cannot afford to eliminate the private sector as they did for the Medicare-age population. A universal system of "basic" coverage will provide things that people can afford out of pocket anyways (eg. vaccines and lovastatin), and will promise things that it will not deliver (eg. tertiary care). The presence of the private sector internally or abroad will automatically outcompete the governmental system by promoting an internal or external medical tourism industry that will find the cheapest means of delivery of services really needed by people who will be forced to pay for them out of pocket. The recognition of the emptiness of the promise will be the end of system. The only resort they have in the short to medium term is to continue to make the private delivery of care as expensive as possible through regulation, but this will be difficult to do in a way that doesn't also increase costs for the public sector. What will happen in Britain will be instructive; The NHS will be the canary in the coal mine for socialist systems.