Hint: It’s not about health care.
Ask yourself this question: What is the one health system characteristic every developed country has, except the United States?
If you answered: Every other country has made health care a right, you’re wrong. Citizens of Canada have no right to any particular health care service. They have no right to a CT scan or open heart surgery. They don’t even have a right to a place in line. The 100th Canadian waiting for heart surgery isn’t entitled to the 100th surgery.
If you answered: Every other country guarantees essential care to all its citizens, you’re wrong. Citizens of Canada and Britain are routinely denied prompt access to basic health care.
If you answered: Every other country guarantees access to care, regardless of ability to pay, you’re wrong again. In Britain people routinely go to the private sector and pay out-of-pocket for care they cannot get from the state. Canadians come to this country. In both cases, lack of ability to pay is a barrier to care.
If you answered: Other countries make primary care more accessible because there is no barrier of money, you’re wrong once more. Americans get more primary care than Europeans. Even uninsured Americans get as much or more primary care as Canadians get.
So what really is the difference?
What’s It All About Alfie
Answer: Other countries have nationalized, or collectivized, their health care systems. So far we have not.
In the United States, whether you have insurance at all, what kind of insurance you have, where you get it, what price you pay — these decisions are primarily made by individuals and employers in the private sector. In other countries, they are made by government.
In terms of democratic theory, in other countries people get to vote on what kind of insurance you have and you get to vote on theirs. In the United States the health insurance of most working-age families is based on individual choice, not public choice.
As for day-to-day operations, the U.S. health care system is actually far more similar to the systems of other countries than most people realize. Critics tend to exaggerate the role of out-of-pocket payment in the United States and minimize its role in other countries. In fact, U.S. citizens pay about 13¢ out of pocket every time they spend $1 on health care and this is well below the OECD average (20¢) and even and below that of Canada (15¢)!
Despite all the claims about how different the U.S. system is from the Canadian system, the two systems are far more similar than they are different. Both countries pay doctors the same way; both rely heavily on third-party payment; and both ration by waiting. In Canada, when people see a doctor, the visit is free. In the U.S., it’s almost free. In fact, it’s probably fair to say that there are fewer differences between U.S. and Canadian health care on average than there are among the various types of health plans within the U.S.
The real issue, then, is not about health care at all. It’s about collectivism. It’s about whether we are going to make decisions in one-sixth of our economy privately or publicly. It’s about private sector institutions versus government and ultimately the ballot box.
If I’m right about this, two follow-up questions spring to mind:
- Why would any rational person want other people to vote on his health insurance and why would he want to vote on theirs?
- If the real issue is individualism versus collectivism, why don’t those who want to collectivize the system admit that?
The answer to the second question is: It’s bad salesmanship. In Europe the collectivists often do admit what they’re all about. Granted, they use code words like “solidarity,” but they frankly admit they are fundamentally opposed to having individuals make their own decisions about their own care. In the United States, the very word “collectivism” sounds unAmerican. So the proponents often resort to intellectual dishonesty — making intentionally inaccurate comparisons between our system and the systems of other countries, finding fault with private health insurance while ignoring the even great faults in Medicare and Medicaid, and making ridiculous claims about how problems are going to be solved once the government takes over.
I don’t recall a recent example of an American being intellectually honest enough to admit that the real reason for national health insurance is that in matters of health, private decision-making is socially intolerable. If you know of an exception, post it in the comment section
The answer to the first question I’ll reserve for a future Health Alert.