American Health Care: The Best in the World
By Richard E. Ralston
September 19, 2006
In the run up to the November elections, as in most recent elections, we are hearing a lot about how America is supposedly suffering from bad health care. The debate is normally divided between those who want to wipe out the entire system and replace it with government micro-management of every detail of your health care, and those who want only to vastly increase government spending on what is left of "private" health care. Both usually ignore what is, or should be, unique about American health care—a foundation in individual rights and limited constitutional government. Usually, the argument carefully avoids this moral and political context entirely.
Rarely is the issue stated explicitly. One economist who writes regularly for the New York Times has stated that the only obstacles to universal health care are outmoded concepts of "ideology and personal choice." He is quite correct. Get rid of the ideas of individual rights and freedom of choice, and you remove all restraints on government power to rule individual lives. (That, itself, is an ideology.) Without this context, the debate is reduced to dueling pragmatists whose primary concern is who holds the reigns of political power. The result is a choice between Socialism and State Capitalism, neither of which offer much hope for health care.
One side of the debate is condescending toward the unique American system and most things American. They avoid American principles in their admiration for socialism and collectivism elsewhere. The argument runs that America is the only industrialized country without "national" (i.e., government) health care. They do not mention that we are also the only country founded on an ideology based on inalienable rights and the U.S. Constitution. The other side of the argument is too often represented by those who claim admiration for all things American, but are often more interested in getting political credit for paternalistic handouts than principles.
In the last forty years, the government share of health care spending in the United States has increased from under 10% to over 50%, while the remaining elements of the free market have fallen under increasing regulations. What is left is still the best in the world. Canadians, we are told, have a better system because they live longer than Americans. Are there other demographic factors involved—didn't they also live longer before they nationalized their heath care system? Is it a better system because, although some prescription drugs are sold at a lower price, many more are not available in Canada at all? Is it better because Canadians wait an average of 17 weeks for referral to a specialist? Is the fact that Canadians come to the United States to spend more than $1 billion a year on health care an indication that Canada has better health care? One wonders why this superior system resulted in the Canadian Supreme Court striking down the law forbidding private insurance "because access to a waiting list does not constitute access to health care." Why did the Canadian Medical Association recently elect as their new President a physician who owns an illegal private clinic in British Columbia if they think Canada has a better system? Significant new spending by the federal government in Canada does not seem to be having much impact on improving the situation.
Neither has huge additional spending on the National Health Service in Great Britain over the last seven years improved their health care. Two years ago, many British hospitals stopped providing heart bypass surgery to smokers. The waiting lists were so long that they wanted to give priority to non-smokers who responded better to surgery. Last year several regions stopped providing knee and hip replacements to overweight patients because their response to surgery was not as favorable as thin patients on the waiting lists. This year the British Medical Journal reports that physicians in the National Health Service are often no longer treating patients age 80 or over for strokes. These are examples of how government makes rationing decisions. Many patients in Great Britain who survive the waiting lists undoubtedly receive excellent care. Just don't smoke, gain weight or get old. British waiting lists have provided the world with one important service: they have given great impetus to the medical tourism industry, in countries like India, for British patients who would rather pay for surgery in India than endure a long wait for free surgery in Britain. This industry is now also providing Americans with cost-saving surgical options.
The German government is presently struggling to increase taxes to pay for their health care system. Many other governments are looking for reforms and taking a step back from their government health care monopolies.
Americans want to afford health care costs that have risen as the result of increasing longevity and new drugs and technology. But health care costs have also increased in tandem with federal government involvement and with state regulations such as insurance mandates. But the remaining free elements provide better care than foreign governments provide their citizens for a reason: freedom. Individual freedom and personal choice, rooted in American values, provide principled health care, moral health care, and the best health care. That is why it is the best in the world.
Richard E. Ralston is Executive Director of Americans for Free Choice in Medicine.
Copyright © 2006 Americans for Free Choice in Medicine. All rights reserved.
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