April 15, 2002 | Commentary on Health Care
So it's not surprising to hear some members of Congress agreeing
with syndicated columnist Molly Ivins on how to reduce the number
of Americans without health insurance. "The answer is universal
health insurance, a single-payer system," she writes. "Every other
industrialized nation manages to do this better than we do."
Tell that to Ralph Smith. The 57-year-old Canadian suffers from
prostate cancer, a condition that can prove fatal if it's not
treated promptly. He's doing better now, but no thanks to "the
answer." After waiting nine months for treatment in Canada's
single-payer system, he went out and found his own care, at his own
Smith's case isn't an exception, either. Lengthy lines for
healthcare are common in Canada. A September 2001 report from the
Fraser Institute, a Vancouver-based think tank, found that the
average waiting time for surgery in Canada (between a doctor's
referral and treatment) rose from over three months in 1999 to four
months in 2000-2001.
Things are worse for the people stuck waiting for care in Britain's National Health Service. A recent report published by the London-based Adam Smith Institute notes that some 1 million are on NHS waiting lists. "One in four cardiac patients die while waiting, and one in five lung cancer patients wait so long they go from being treatable to untreatable," notes London's Guardian newspaper.
At least British patients can opt to pay for private care (if
they can afford it). Most Canadian provinces have made it illegal
for patients to pay out of their own pockets for medical services
that are covered by the government-run system. As Mark Steyn, a
columnist for Canada's National Post, wryly notes, Canada's got
"all the coerciveness of the Cuban system, with none of the
Fortunately for Ralph Smith, he had the means to help himself.
But many in Canada -- and other countries with single-payer systems
-- don't. And neither do the millions of Americans who would, under
various proposals being considered by Congress, be forced into
Medicaid, the federal government's own "single-payer" health-care
program for poor people.
The fact is, Medicaid's ailing -- and adding the estimated 40
million Americans who lack health insurance at any given time would
make matters worse.
State-run Medicaid programs are in big trouble. Last year, 37
states spent more on Medicaid than they had budgeted -- $410
million in Indiana alone -- and 20 states anticipate shortfalls in
this year's spending.
If Medicaid rolls expand, the federal contribution grows, but so
does the state contribution. To many, spending more on Medicaid
means less for education, law enforcement or a variety of state
States have begun responding to these financial shortcomings by making cuts to Medicaid. They limit services, cut back on medication, curb treatment options and reduce payments to doctors.
The result, of course, is substandard care. Take breast cancer.
The National Cancer Institute reports that women on Medicaid are
three times more likely to die from it than women who aren't on
Medicaid. The Institute also found that women on Medicaid were 41
percent more likely to be diagnosed with breast cancer "at a late
stage" and 44 percent less likely to receive radiation
Rather than force uninsured Americans into a flawed program that
puts bureaucrats in charge of health-care decisions, President Bush
has suggested a way to help these families get affordable insurance
that meets their needs. His solution: refundable health-care tax
He proposes that low-income uninsured families and individuals
who don't have employer-based coverage receive a subsidy worth up
to $3,000 a year for families and $1,000 for individuals to help
cover premiums. Providing these subsidies through refundable tax
credits will give these families and individuals the credit "up
front" when payments are due, not make them wait for reimbursement
at year's end. Under such a system, even those who owe no taxes
would get the help they need.
Perhaps most importantly, it would put uninsured Americans in
charge of their own healthcare -- a claim neither Medicaid nor the
Canadian system can make. Is it worth it? Ask Ralph Smith. The fact
that he's alive today may have everything to do with the fact that
he gave up on "single-payer" in time and did what all Americans
could do under President Bush's plan -- take control of their own
Nina Owcharenko is a health-care policy analyst at The Heritage Foundation, a Washington-based public policy institute.
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