The best healthcare in the world: our healthcare, though impeded by government intervention, is still the world's best. Adopting a single-payer socialized system would lead to shortages, frustration, and failure.

According to some experts, the American healthcare system is on the brink of failure. "We certainly are in a health care crisis," Marcia Angell, former editor-in-chief of the New England Journal of Medicine, told PBS. "If we had set out to design the worst system that we could imagine, we couldn't have imagined one as bad as we have."

To support her assertion, Angell points out the traditional signs of failure in the healthcare system. Americans, she says, spend more than twice as much as Canadians on healthcare. And, she argues, there is a similar disparity between American and British spending. "We certainly don't get our money's worth," she told PBS. "We have roughly 43 million people with no insurance whatsoever, and among the rest of us, many of us are underinsured. That is, we have shrinking packages. This might be covered, but that won't be covered." What's more, she argues, Americans are unhealthy. "Our life expectancy is shorter. Our infant mortality is higher. Our childhood immunization rate is lower."

This is predominantly the view of those who recommend that the United States develop a system of socialized medicine similar to that employed in Canada or that the current Medicare system be extended to everyone regardless of age. According to Angell, "doctors and patients both know that after enduring the tender mercies of the managed care industry, they might like a little bit of government regulation. In fact, the most successful part of the American health care system is Medicare." According to her, Medicare should be extended to all, in order to fix the healthcare system. We could begin, says Angell, by "extending Medicare decade by decade. Instead of over 65, going over 55. And maybe working up from children toward the middle. Ah, and then we would have a single payer system."

This is a seductive argument, but it proceeds from a faulty premise. While the U.S. healthcare system is costly and does face challenges, the costs were largely brought on by government actions and agencies, not helped by them (see article on page 12), and many problems attributed to our healthcare system--such as high infant mortality and short longevity--aren't a reflection of bad healthcare. Those things have other causes. In fact, the United States has the best healthcare system in the world, despite its being hamstrung by government rules and regulations.

Perceived Problems

In January, the Centers for Disease Control (CDC) reported that the rate of infant mortality actually increased in the United States in 2002 from the previous year for the first time since 1958. Infant mortality refers to the deaths of children younger than the age of one. Critics of the U.S. healthcare system point to this increase as a key statistic proving that the system is failing. Unfortunately for this thesis, infant mortality is influenced by many criteria other than healthcare.

For instance, there is a direct link between infant mortality and premature birth. Clearly the more premature an infant is when he is born, the greater likelihood of complications. In fact, according to the U.S. Dept. of Health and Human Services National Center for Health Statistics, complications stemming from short gestation and low birth weight are the second leading causes of infant mortality in the United States. Ironically, the advanced medical technologies used in the United States tend to increase our infant mortality rate, not decrease it. In the United States, advanced technologies and procedures have made it more practical in recent years for medical professionals to attempt to save severely premature infants. Such attempts do not always succeed, adding to the rate of infant mortality. "Resuscitation is more likely to be attempted on extremely premature babies born in the United States than in many other countries," writes Dr. John Abramson in his book, Overdosed America. "The extremely premature babies on whom resuscitation is unsuccessful are then counted as infant deaths, whereas they are counted as fetal deaths when resuscitation has not been attempted."

Additionally, abortion plays a role in the incidence of premature birth, and the high rate of abortions in the United States likely adds to the nation's infant mortality rate. Data compiled by medical researcher Brent Rooney and Doctor Byron C. Calhoun, M.D., and published in the Journal of American Physicians and Surgeons suggests that this phenomenon is well-known. According to the authors of the study, "A literature review retrieved 49 studies that demonstrated at least 95 percent confidence in an increased risk of preterm birth (PB), or surrogates such as low birth weight or second-trimester spontaneous abortion, in association with previous induced abortions."

Historically, the U.S. abortion rate has been substantially higher than the abortion rate in many other developed nations. According to the pro-abortion Alan Guttmacher Institute, the U.S. abortion rate in 2002 was 20.9 per 1000 women aged from 15 to 44. And this is a reduction on previous rates. The current U.S. rate remains substantially higher than the average abortion rates recorded in recent years in many similar industrialized nations. For instance, for the years 1990 through 1996, the average abortion rate in England and Wales was 15 per 1000. In Norway the rate was 16.2 and in Scotland the rate was 10.3 over the same period. In Canada, the average rate for the years 1990 through 1995 was 15.1 and in New Zealand the rate was 14.9 during that time. The low average rate of 5.8 per 1000 was achieved by The Netherlands during the period from 1990 through 1996. If dangerously low birth weight and premature births contribute to a higher level of infant mortality and abortion contributes to low birth weight and premature births, then nations with higher rates of abortion should experience higher rates of infant mortality. In such cases, infant mortality rates, etc., are irrelevant when evaluating the relative quality of the healthcare system.

Another frequently cited indicator of the failure of the American healthcare system is life expectancy. Despite the fact that U.S. life expectancy figures reached a record high of 77.6 years, based on mortality records examined by the Centers for Disease Control through 2003, the United States still falls short of benchmarks set by other developed countries. A similar disparity exists in figures for so-called "healthy life expectancy" which measures the number of years that a person can expect to live in what is termed "full health." According to this relatively new system of evaluation, created by the World Health Organization and known as Disability Adjusted Life Expectancy (DALE), America ranks 24th in the world with "an average of 70.0 years of healthy life for babies born in 1999."

Life expectancy rankings, though, have very little bearing on honest discussions of healthcare. Healthcare systems, generally, are designed to cope with and, hopefully reverse, the symptoms of disease or injury after the initial onset of symptoms. Such attempts may or may not succeed. A better approach to increasing life expectancy is to avoid altogether those conditions and circumstances that lead to the onset of disease. In fact, such "public health" efforts have had far more to do with the rapid advances made in life expectancy over the past century than do advances in medical care.

In Overdosed America, Dr. Abramson cites CDC data indicating that over the course of the past 100 years, life expectancy has increased by a remarkable 30 years. Yet according to the CDC report quoted by Abramson, "25 years of this gain are attributable to advances in public health." According to Abramson, "These include improvements such as sanitation, clean food and water, decent housing, good nutrition, higher standards of living, and widespread vaccinations."

Another major factor influencing life expectancy is behavior. Medical professionals can do little more than urge patients to live healthy lives. In the end, however, personal behavior remains an individual prerogative beyond the reach of medicine. Activities such as smoking, over-indulging in alcohol, use of illegal narcotics, and other dangerous behaviors contribute to diminished life expectancy. Critics of the healthcare system, therefore, can only use life expectancy figures in a disingenuous fashion.

The "Uninsured Problem"

In her critique of the American healthcare system, Marcia Angell also spoke of the disparities between the U.S. system and the universal healthcare systems in Canada and Great Britain in the area of healthcare coverage, saying that they are better. But here, too, her facts are used to hide the truth, not reveal it. She claimed that 43 million Americans are uninsured and many more are underinsured, in an attempt to convey the idea that many in the United States are being turned away from doctors' offices and hospitals when they seek medical attention. This portrayal of the state of the "uninsured problem" is inaccurate at best.

The number of uninsured Americans, which many believe is highly overstated because it doesn't correlate with other government data sources, is not indicative of the number of people who cannot get medical care. It shows the number of people who at sometime throughout the year let their health insurance lapse. Another component of the "uninsured problem" is immigration. According to a study published in 2000 by the Center for Immigration Studies, in 1998 32.4 percent of those in immigrant households lacked health insurance. This points to a problem with immigration policy more so than to a problem with insurance.

Also, those who are uninsured do have access to medical care. U.S. law requires that emergency rooms screen and treat any patient requesting emergency care, regardless of their ability to pay. Also, most people who go without health insurance some time during the year are young and healthy and unlikely to need medical care. In fact, many young people choose to forego medical insurance so that they can buy luxury items.

In tax-supported, single-payer socialized systems, such as that in Canada, all people are forced to pay for coverage via taxation. According to the March 2003 Current Population Survey, over 55 percent of the uninsured were between the ages of 18 and 34 years old. Add to this number the fact that between 6 and 7 percent of the uninsured live in families that make over $75,000 a year, and one gets a more realistic look at the problem. And anyone in the United States can see a doctor at any time and pay for the visit out-of-pocket.

Moreover, in a critique done by the Urban Institute of a book entitled Health Policy and the Uninsured (2001), it was noted that "no causative links between lack of insurance and poor health have been supported." In other words, any claims made that a lack of health insurance is causing poor health or deaths are completely unsupported by known facts.

Socialized Medicine

In truth, when the real disparities between the U.S. system of healthcare and universal systems are analyzed, U.S. citizens actually enjoy much greater access to healthcare than people in the universal systems. According to Maclean's, a prominent Canadian publication, in 2003 Statistics Canada, the Canadian government office responsible for tracking statistics, "estimated that 4.3 million Canadians had difficulty accessing so-called 'first contact' services such as family doctors, and 1.4 million Canadians had difficulty getting specialized care over a 12-month period." In other words, some 13 percent of the entire Canadian population found it difficult just to visit the family doctor. Of the 1.4 million Canadians who were unable to see the specialists they needed, "30 percent said their health deteriorated" as a result.

One of those whose health deteriorated was Alberta resident Beverly Ray. According to the Canadian publication The Report, Mrs. Ray's unfortunate encounter with the Canadian healthcare system began in 2001. Suffering from "rectal incontinence," she was sent for a sigmoidoscopy. After the test, she was ordered home and told to drink Metamucil, a fiber supplement. This made her condition much worse. Months later, "the same doctor ordered the same test again," said The Report. Again, the prescription and the result were the same. After an excruciatingly long 14 months, Mrs. Ray was finally scheduled for a colonoscopy. A preliminary investigation revealed a serious hernia.

"Oh my God, this is huge!" Ray told The Report she recalls the specialist saying. "It took them 14 months to find a huge hernia. My first question was, 'How could they have missed it with two obviously unnecessary tests?' I'm irritated that I was placed under anesthetic three times, and dismissed as having irritable bowel syndrome, when a simple physical examination would have sufficed." This, unfortunately, was far from the end of her saga. In July of 2002 she was admitted for corrective surgery and prepped with an IV and morphine. But just an hour before the surgery was scheduled to begin, the hospital called off the procedure because it could not pay overtime to an assisting surgeon. "You know how the system is," Ray recalled the lead surgeon telling her.

Ray was then rescheduled for surgery two months later, in September, but again, the hospital canceled the procedure. This second disappointment was devastating. The disabled victim told The Report: "I considered downing all of the four different bottles of pills I was on." Fortunately, she did not take such extreme action. Persevering despite her condition and the frustrating labyrinthine bureaucracy of the Canadian system, she contacted the Alberta College of Physicians and Surgeons. Through them, she was able, finally, to get on another waiting list that promised slightly more rapid access to the surgery she desperately needed. As a result of her experience, Ray is on a crusade to reform the system. "I want to make people more aware that the 'health-don't-care' system is failing us, and I'm not alone. People more serious than I am are waiting and waiting and not getting fixed."

Ray's tragic experience is a classic example of a socialized economic system failing to provide adequate supply to meet demand. Socialized medicine (universal healthcare) leads to dangerous disruptions in the supply of medical services. The current healthcare system in the U.S., despite regulation and the existence of government introduced perturbations in the form of Medicare and Medicaid, still allows the function of some semblance of a market, keeping healthcare accessible.

Like all markets, that which functions in the healthcare arena allows supply of services to meet demand. More demand for certain services may push the price for that service upward, but higher prices tend to attract suppliers, lowering the prices. The market, therefore, has a self-correcting ability that allows needs to be met as they arise.

It should be remembered as well that socialized systems like Canada's don't just stifle innovation and cause supply disruptions, but that they are dehumanizing as well. In a socialized system, the system itself and the government that controls it determine who has access to healthcare. Moreover, as noted earlier, such systems depend upon coercive taxation. Consequently, single-payer socialized systems fundamentally restrict the basic, God-given right of individuals to keep the product of their labor and also restrict the fundamental right of association by which a person can freely decide with whom to engage in contracts and exchanges, including those involved in the purchase of healthcare goods and services. In a concrete sense, in a socialized system, government has control of the money and determines what treatments are allowed and who gets them. Government may even determine who lives and who dies. This is not a choice that government has any right to make--even if the bureaucrats administering healthcare are trying sincerely to act in the best interest of patients. In reality of course, government-controlled medicine would be used to benefit the State not patients, as the tragic consequences of government-controlled medicine in Nazi Germany and Soviet Russia have amply demonstrated.

The Best Care Anywhere

As the situation stands now, when it comes to sophisticated diagnostic capabilities and treatments, Americans have access to the best--though it could be even better if government meddling were limited or restricted altogether. Even critics of some aspects of the U.S. healthcare system admit as much. Uwe E. Reinhardt is professor of health economics at Princeton University. In an interview with PBS on the subject of healthcare, Reinhardt pointed out: "When you go to international conferences, there's always two themes. They admire our medical clinical care, because we're advanced. They admire some of the stuff we try to do with quality control." Though internationally the U.S. insurance industry is despised, Reinhardt notes that people nevertheless flock from abroad to study U.S. medical practices.

Among the strengths of the U.S. healthcare system are constant attempts to innovate directly or otherwise quickly employ innovations devised elsewhere--brought on, of course, by market incentives. In just the last few years, much promising research has been done in a number of areas, leading to new hope for those facing a variety of hitherto vexing disorders. The late economist Julian Simon and coauthor Stephen Moore pointed out in their book It's Getting Better All the Time, published in 2000, that scientists "are nearing major breakthroughs in solving the baffling biological puzzles behind AIDS, cancer, diabetes, Lou Gehrig's Disease, arthritis, multiple sclerosis, and even Alzheimer's disease." In addition, Simon and Moore pointed to the development of the biotechnology industry. "There are now an estimated 1,300 companies, 100,000 people, and $13 billion a year devoted to biotechnology," they noted. "This industry, which did not even exist 20 years ago, is dedicated to one end: finding the biological explanation for disease."

Indeed, medical innovation in every seemingly arcane area continues at a breakneck pace. In the month of July alone, U.S.-based researchers made a number of stunning finds. In one notable example, researchers at the University of Michigan (UM) found a compound that may save the lives of people afflicted with a deadly type of muscular dystrophy. Many people afflicted with this incurable disease die of heart failure while still in their twenties. UM researchers found, however, a compound known as poloxamer 188 (P188) that can prevent this outcome in mice. According to professor Joseph M. Metzger, the scientist who directed the research, P188 might offer hope to those suffering the effects of the disease. "If issues of dosing and long-term safety can be resolved, our research suggests that poloxamer 188 could be a new therapeutic agent for preventing or limiting progressive damage to the hearts of patients with muscular dystrophy," Metzger said.

In addition to advancing medical innovation directly, U.S. healthcare providers are eager to embrace the latest technology invented elsewhere. Computed Tomography (CT) scanners were invented in the United Kingdom. They were, however, much more heavily adopted, and are consequently more readily available, in the U.S. than in Great Britain. In a policy analysis paper for the CATO Institute, John C. Goodman, president of the National Center for Policy Analysis in Dallas, pointed out: "For years Britain manufactured and exported about half the CT scanners used in the world. Yet through the years the British government purchased very few scanners for the NHS [National Health Service], and even discouraged private gifts of the devices to the NHS." As a result, patients in Britain, serviced by that nation's socialized medicine bureaucracy, have limited access to this important diagnostic tool, while patients in the U.S. suffer no such shortage. "Today Britain has only half the number of CT scanners per million population (6.5) as the United States (13.6)," Goodman writes.

Final Analysis

Proponents of socialized medicine for the U.S. speak blithely of ethics and the necessity to treat medicine, in the words of Marcia Angell, as a need. "It's not a commodity, and it should be distributed according to need," Angell told PBS. In a market-based system, that's just what happens, and people like Beverly Ray get the care they need. If the socialists win and the United States adopts a single-payer system like that used by Canada, Americans, like their neighbors to the north, will face a future marked by acute healthcare shortages.