The oxymoron of ‘universal health care’

There is a pervasive assumption about public health care, that it is “one-speed”, “universal” and equitable. This is used as a justification that overrides all practical consideration. After all, as long as everyone “gets the same chance”, any amount of disadvantage is irrelevant, at least in democracy-based thought. So they refuse to permit private hospitals, which would relieve some pressure off the public system and ensure a better service. Given the importance of public health, such negligence is criminal.

This is perverse thinking, but the premise itself is utterly wrong. Public health care is not “universal”. The masses are stuck with a sub-standard health care system, and the rich pay to go to the United States, or other countries, for better treatment. Doctors also leave in droves because of the lower salaries and bad working conditions. The system is only universal insofar that the state has universal control either way (through immigration control, if you leave). If the United States sabotages its own health care system by socializing it, the same thing will happen.

I’ve made some bold claims, which people who do not live in Canada, the UK, Sweden, or a country where socialized medicine is prominent, might doubt. But Canada is a good example of its failure, since it is the country that monopolizes health care the most. Also, Canada spends the most on health care of all OECD nations (on an age-adjusted basis). But it has inferior technology available.

“Although Canada is the fifth highest among OECD countries in terms of total spending on health (as a percentage of GDP), it is generally among the bottom third of OECD countries in availability of technology. (…) The local comparison is equally unfavourable. CT scanners, nuclear medicine facilities, MRIs, lithotriptors, positron emission tomography (PET), specialized intensive-care facilities, and cardiac catheter labs are all less likely to be found at a community hospital in British Columbia than at a similar hospital in Washington or Oregon. Angioplasty and transplant facilities are mainly restricted to the University teaching hospitals in British Columbia, while they are more widely dispersed in the two American states.

Furthermore, the trend is worsening in some categories. For example, the data reveal that Canada’s deficit in the availability of MRIs became worse between 1986 and 1995 relative to other leading OECD countries including Australia, France, and the Netherlands, not to mention the United States.”

The Availability of Medical Technology in Canada: An International Comparative Study” (Fraser Institute, August 1999)

It is not simply a question of injecting more money in the system. While we should expect that the price of medical services would get lower with time because of technology, it seems that with public health care the exact contrary is observed.

In Canada, there is no correlation between health budgets of various provinces and waiting times, and waiting times in the country have ballooned while spending has risen. Between 1993 and 1998, while the health care spending per capita has risen by 77$, the average waiting time have risen from 9.95 weeks to 14.21 weeks (for a statistical study of the relation between spending and effect in Canada, see “Spend More, Wait Less”, Martin Zelder, 2000).

The issue of medical resources being used as political tools is not documented to my knowledge, although it is part of socialized medicine here in Canada. Thus we observe phenomena such as shortages of beds, which would make no sense in a private system.

All these phenomena are also observed when comparing with other countries. Only 5% of Americans wait more than four months to receive surgery, compared to 23% in Australia, 27% in Canada, 26% in New Zealand, and 38% in the UK (“Comparison of Health Care System Views and Experiences in Five Nations, 2001”, Commonwealth Fund 2001 International Health Policy Survey).

In the UK, more than a million people wait on the lists and one-quarter of cardiac patients actually die before it is their turn to be called in (“The million-year wait”, Adam Smith Institute, 2002). In Sweden, the only private hospital there, St. Gorans, operates at 15% less cost than the Swedish public hospitals.

There are many other issues turning around health care, such as insurance and drug prices, two issues heavily affected by free trade and state intervention. For instance, the American government’s privileges granted to work insurance over personal insurance has hurt the poor, and so will their new policy of drug protectionism. The state is the enemy of the less fortunate, and nowhere is this more true. The poor are less healthy, and pariahs regardless of the system, because it is always politically-motivated.

However, free market systems are still much more efficient, even with that in mind. As long as the government maintains the inefficiency of resource redistribution by its social programs, we cannot compare the financial burdens imposed on the individual by different systems. There is no reason why private redistribution-based health insurance cannot be more efficient in a private system than it is in a socialized system.

In essence, the issue is about economic freedom. The more economic freedom that exists in a given system, the more efficient and consumer-oriented it is. The less freedom there is, the more politically-motivated and inefficient it is. Some people invoke the importance of health care as a motivation to keep it socialized, but it is precisely because health care is vital that we should take it away from political interests. By taking the market in our own hands, we will be able to find solutions that could never exist otherwise.