Wednesday, July 1, 2009

Single-Payer Fallacy

By Michael P. Tremoglie

The liberal intelligentsia loves to compare American politics and culture to Europeans for the purpose of illustrating what a backward people Americans are. Yet, the comparisons rarely are valid. More than likely they are fallacious.

Not too long ago, famed law professor Alan Dershowitz defended former New York Governor Eliot Spitzer’s scandalous affair with a prostitute by claiming that the incident would not even make the last pages of a European newspaper. Ergo, it was no big deal.

Similarly, advocates of socialized medicine like to say all other industrialized nations have a government run, single-payer health insurance plan and that eighty-seven nations cannot be wrong.

This ruse, commonly employed by advertisers, is known as ipse dixit. It is a fallacy by which the arguer uses the opinion of some supposed authority to validate their argument. Neither Dershowitz nor the socialized medicine advocates ever state why Europeans are experts on morals and healthcare.

What is even worse is that when such claims are made your average journalist or editor rarely bothers to examine the validity of the claim.

For example, if a journalist examined Dershowitz’s assertion about European politician’s sexual peccadilloes, he would learn it was not true. A British politician who used the same prostitution ring as Spitzer made front page news.

The same is true for socialized medicine.

Not every other industrialized nation has a single-payer health plan (The Netherlands, Germany, France, and Switzerland are some examples) and many are moving away from single payer plans (United Kingdom, Israel, and others).

I first began studying single-payer plans when I was the Director of Managed Care of Temple University Health Sciences Center. It was 1993 and Hillary Clinton had assembled her health care task force. One option being considered was a single-payer plan.

I listened to ardent proponents of single-payer and I also listened to Sen. David Durenberger of Minnesota, Dr. Paul Elwood, and Alain Enthoven, PhD, Professor of Economics, Stanford University. They were the members of the “Jackson Hole group.” This group conceived the idea of managed competition.

Initially, I considered a single-payer system a viable option. It seemed perfectly logical. However, after listening to those who advocated such a system, I realized that such a proposal was a specious one. Those who proposed this alternative seemed more intent using the issue as a vehicle to reshape society in their image rather than as a concern for the welfare of others.

The proponents of a single-payer system were dogmatic. They wrapped themselves in the cloak of morality. They pilloried insurance companies and hospitals. They condemned pharmaceutical firms. They talked about “patients not profits” as if insurance companies routinely and willingly send people to their demise to save a few dollars.

They will say the United States has de facto rationing for the poor - much as President Obama has said recently. They will imply that many Americans have beneficial medical procedures denied because of money.

I recall one particularly ethno-centric socialized medicine proponent comparing the USA to Germany. He said that the German physicians understand that healthcare is not a commercial enterprise. He claimed it is for the benefit of the people.

German physicians sound as if they are extremely altruistic. However, they are no more or less than American physicians. There are waiting lists for those who are enrolled in the several public “sickness funds” because German doctors get paid more for those who have private insurance.

Besides the German system has other problems. Inflationary costs are also impacting Germany.

Those who crusade for a single-payer system like to point to the Canada as the paradigm for the United States – it is far from it.

As part of my research of socialized medicine in 1993, I spoke with an administrator of the Province of Ontario's Health Insurance Directorate. He sent me articles that were supposed to illustrate the virtues of the Canadian system. Instead, much of the information concerned Canadians coming to America for healthcare.

One of the disadvantages of the Canadian system is that is based on prospective budgeting. This means that each year the government allocates a certain amount of money for hospital and physician services. If the funds are depleted before the fiscal year then the providers will either render free care or close.

It is not unusual for Canadian hospitals to temporarily cease operations or for Canadian doctors to go on strike. Yet, people like to portray the Canadian system as a panacea.

One feature about the Canadian system that is denied by the reformers is the waiting list for care by Canadians. The waiting list problem is so egregious that in June 2005 the Supreme Court of Canada issued a ruling in response to a lawsuit about waiting lists that the healthcare system has failed.

“Access to a waiting list is not access to health care," wrote Chief Justice Beverly McLachlin. Three of the seven justices wanted to declare the entire system unconstitutional.

Yet, waiting lists have been denied by those who want a single-payer system in America. During a 1993 Macneil-Lehrer Report, an advocate for single-payer said that waiting lists at Canadian hospitals were not true. Eleven years later, in 2004, this claim was repeated.

Yet, this was and is patently false. So much of a concern is there for the viability of the Canadian system that there was a major conference in September 13, 2004 to address the problem.

According to the August 18, 2004 editorial page of the Toronto Globe and Mail, Prime Minister Paul Martin wanted to reduce waiting time in five key areas.

An article by Murray Campbell, in the August 19, 2004 Globe and Mail, said the Saskatchewan Surgical Care Network, “a leader in wait-time assessments” has needed nearly two years to develop a framework that allows patients and doctors to know the length of queues…a common language had to be created so that …everybody understood what constituted an urgent operation.”

According to Peter Singer, Director of the University of Toronto’s Joint Centre for Bioethics (quote by the Globe and Mail), “The Western Canada Waiting List Project…is developing tools to manage waiting lists.”

The September 8, 2004 edition of the Toronto Star featured an article about how one Canadian citizen had to wait six months for initial consultation with a cardiologist.[1]

In 1989 the government of British Columbia contracted with hospitals in the state of Washington because of the waiting times for bypass surgery.[2]

According to Dr. Richard Davies, a cardiologist at the University of Ottawa Heart Institute, writing in a 1999 Canadian Medical Association Journal about Canadian waiting lists said, “ In …Ontario …71 patients died while waiting for CABG (by-pass surgery), 121 were removed from the list permanently because they had become medically unfit for surgery, 211 were taken off the list temporarily (the usual reason for this is medical instability, in which case patients are often reinstated in a higher urgency category), 259 were removed from the list for unspecified reasons and 44 left the province and underwent CABG elsewhere.” [3]

As is usually the case with those Americans who advocate some sort of socialized system in this country, they are not providing the American public with the facts. If that is the case why is it that Dr. David Wonham, a Canadian cardiologist, implemented a program that refers Canadians to United States hospitals for cardiac care? Why is it that in October 1996 Canada’s largest province began to make arrangements to send pregnant women to the U.S. to get medical treatment?

If Canadian access to care is superior to the United States system then why is it that in 1990-91 the Canadian healthcare system paid over $250,000,000 for out of country healthcare? When I was in Quebec in 1999, a news report complained of the state of pediatric care in Quebec.

Writing for the National Center for Policy Analysis in February 2001, Toronto physician David Gratzner cited several examples of lack of access by Canadians.

In a March 1996 letter to the Canadian Medical Association, Dr. Keith Martin, a Member of Parliament wrote, “To make matters worse, the federal government, the enforcer of the Canada Heath Act, has decreased transfer payments to the provinces (seven billion dollars for healthcare, welfare, and education in the last budget), while forbidding them from raising additional funds other than through increasing taxes. Indeed, a politically and economically unpalatable solution. Thus, in its zeal to uphold the Act the federal government has forced the provinces to ration healthcare, thereby withholding medically necessary treatments from sick Canadians. Furthermore, governments use the Act to prevent people from purchasing healthcare from private practitioners. This drives some patients down to the United States where over one billion dollars is spent annually for treatment withheld by our "best healthcare system in the world".

Dr. Martin’s figure of one billion dollars annually paid by Canada for healthcare in the United States is significant. If a nation like Canada with one tenth the population of the US spends a billion dollars a year outside of the country for its healthcare - where would United States citizens have to go-Mexico?

Single-payer advocates point out that life expectancy in Canada is greater than the United States. This is because there healthcare system is superior they claim.

Surely, it is a plausible thesis. One would think that mortality would be a good barometer. However, like most data that liberals use, one has to consider what the actual causal relationship of the data is.

Mortality just tells you life expectancy it does not state why. A CDC report indicated that the healthcare system only accounted for ten percent of the mortality rate in the United States. Lifestyle was a more significant factor in determining mortality in the U.S. according to the CDC.

However, the raison d’ etre of single-payer proponents is the uninsured in the United States. The figure of 45 million uninsured in the United Sates is proffered and liberals everywhere secure in their own ignorance repeat this factoid. There are two difficulties with this. First, uninsured numbers change periodically. Second, as is always the case with such data - it does not say why people are uninsured.

Young people for example generally do not concern themselves with things like life insurance, health insurance pensions and the like. They usually defer health insurance overage. How many uninsured chose simply to buy a more expensive care or home rather than insurance? I know people who think nothing of spending thousands of dollars at the casinos however, they will complain about their insurance premium.

It is time Americans realize they were being duped by single-payer proponents who act out of political ideology not medical necessity. Remember you read it here first because the mainstream media will not tell you this.

As Benjamin Franklin noted nearly two centuries ago, “A mutual change of necessities, the more free.. the more it flourishes. Most of the restraints put upon it.. seem to have been the project of particulars for their private interest under the pretense of public good. "

[1] ret fm w/s 9-8-04
[2] ret fm w/s 9-8-04
[3] ret fm w/s 9-8-04

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