Over the past 7 years and since the time of the passage of the ACA, I have listened without interjecting myself into the debate about the efficacy of moving forward with—Medicaid Expansion, SHIP, and Access to Health Care to those on the margin. This year the debate surrounding Health Care will begin to discuss once again the merits of “single payer systems.”
An article in the Wall Street Journal earlier this month by Dr. Scott Atlas reminded me of what we may be in store for as our legislature again debates these issues. I have included many of Dr. Atlas’s observations and statistics in my article below. The same arguments made 5 years ago about access to care, quality of care, cost of care, and allocation of scarce medical resources will be made again.
Obfuscations and dissimulations of facts have been presented in the press and at legislative hearings. I even heard that because a person did not have Medicaid he had to have his leg amputated—this argument was put forth by the head of the IHA who had never himself been directly involved in any type of clinical decision-making process that would necessitate such a procedure. Is the word “Calumnae” appropriate?
If any physician bore witness to such a situation—seeing another physician or hospital deny services to an indigent patient with the outcome described, and did not report such negligent behavior to the State Board of Medicine, they themselves would be held accountable by the institutions where to practice and by the SBOM. Presenting such fraudulent and deceptive arguments in the course of political debate only leads to hysterical decision making which almost seems to be the norm today.
I would like to dispel some other arguments you will hear this legislative session regarding “single payer” health care delivery systems. I heard last year a prominent Idaho Physician state during testimony before a legislative committee that the US ranks 32/35 nations in the developed world in infant mortality and that we were the only country in the group that did not practice single-payer medicine—both statements are false.
In the U. S. our infant mortality was 5.9/1000 live births—high in comparison to European countries and Australia and New Zealand. But in the report, the World Health Organization pointed out “that it is common practice in several western European countries to include only those infants who survived a certain period of time, infants that don’t survive that time are completely ignored when compiling statistics.” The British Journal of Gynecology determined a 40% variation and 17% false reductions in mortality rates of infants!
Premature births—the primary cause of infant mortality are more common in the US. The chance of surviving a premature immature birth is also higher in the US. The cause for prematurity is multifactorial but is 68% higher in the US than Briton and 200% higher than Ireland and Finland. The issue regarding the last two countries may in part be due to the definition of prematurity. In many counties utilizing single-payer systems, the decision to decide to take care of a premature baby may be an economic one and the baby may be allowed to die instead of deploying scarce medical resources that have alternative uses. When all these factors are considered the US has the third best neonatal fatality rates trailing only Sweden and Finland.
Life expectancy was also a figure quoted before the legislative committee. The U. S. has life expectancies for men and women of 76 and 81 years 5 years lower than France and Germany—-when immigrant populations are not figured into the calculus. But here again, the figures need to be inspected more carefully. In countries with homogeneous genetics and healthy lifestyles, life expectancy is much better.
Other significant factors include overweight and smoking. The Lancet reports that using body mass index (BMI) the US has a higher obesity rate than any other developed country. Smoking carries with it a 10-year loss in longevity. The U. S. has the highest rate of smokers on a per capita bases than any other developed country. Non-illness causes of death (accidents and violence) which are immediately fatal have nothing to do with health care quality. 66% of deaths among Americans less than 24 years of age are NOT caused from illnesses. For men between 20-24 years of age 84% of deaths in the US are caused by homicide and accidents.
Looking at disease process that cause the most morbidity and mortality and disability the USA has far superior results—cancer, heart disease, diabetes, high bold pressure, early access to life-saving surgery, earliest access to new drugs and diagnostic technology all lead to better outcomes. Wait times for patients with chronic debilitating diseases are far shorter in private systems—think weeks and months in single-payer systems like Western Europe and our own VA and Indian Health services.
Every country with a centralized health care system there is some form of privatization moving forward that is addressing the limitations of the government-controlled systems—so much for the idea that these countries only provide health care via the government. By the way, over 50% of people in British Columbia carry some form of private Health Care Insurance.
When pricing mechanisms and unfettered markets are allowed to function—conditions we have not had in this country for 30 years, prices will come down without impacting outcomes. Again this is exactly what is happening worldwide even in the single payer dominated countries.
Instead of presenting such false and surreptitious arguments in the press and before legislative committees, we should be exploring how to decrease costs—open markets and transparency and improve access to everyone—not just those “in the gap” but also to those who pay high premiums already, but forego going to a health care provider because they can’t afford the co-pays and deductibles. I wonder if any of them have had a leg amputated because of a lack of access—an economic incentive not to be seen by a doctor.
