Friday, May 21, 2004

Health Care Watch: Not so fast Kevin Drum on French Healthcare!

Kevin Drum writes that France has a socialized medical system that costs half per capita what ours does:

And despite the Economist's scary headline, which proclaims that "crisis looms," the French system provides this service to everyone in the country and does it for less than half the cost per person of the U.S. Even if they decide to raise taxes to cover a growing deficit in their healthcare fund (the subject of the Economist's article) their costs will still be less than half ours per person.

Now, there are undoubtedly drawbacks to the French system. They probably have fewer high-tech machines than we do, and the comparative cost figures may be skewed by the American love of elective procedures. Still, there would have to be a lot of drawbacks to make their system less attractive than ours.

So why not adopt it? Well, that would be socialized medicine. Can't have that, can we? After all, everyone knows that when you socialize something it automatically declines slowly into anarchy and uselessness. Right?

Well I admit that I have an ideological basis against centralized state programs. It's just one of those knee-jerk reflexive reactions as a conservative. I also note that there is a trade off. On a factual level, it's probably more instinctive for most people to compare our system to the Canadian Healthcare System.

Ironically, one of the few things it has in favor of it outright from my point of view is their ability to keep down costs.

"National health expenditures increased by 1.2% in 1996. Health expenditures were $75.2 B. or 9.5% of Gross Domestic Product (GDP) in 1996. In real per capita terms, a decrease of 0.6% was recorded in 1996 which is the fourth consecutive year that real per capita health spending has declined." [emphasis added]

Beware though liberals calling for socialized medicine! One of the ways that the Canadian healthcare system keeps a lid on costs is by busting nursing or doctor unions and labor organizations. This past year I listened on the radio to the back and forth on yet another government vs. worker strike occur with shrill voices on each side. This is bound to create some bad blood in the professional ranks and as a conservative I was never truly thrilled with the Federal Government under Reagan busting the air traffic controller's union strike.

There wasnt much support for the PATCO strikers. The public sided with the government and exhibited little sympathy for individuals whose earnings were already well above the national average. AFL-CIO president Lane Kirkland accused Reagan of "brutal overkill" in firing the strikers, and another union leader complained that the president was engaged in "union-busting," but pilots and machinists continued to do their jobs in spite of the PATCO picket lines, while labor strategists criticized Poli for calling an ill-advised strike that damaged Labor's image. The International Federation of Air Traffic Controllers considered a boycott of U.S. air traffic to show support for PATCO, but it never developed. (Canadian and Portuguese controllers did engage in a two-day boycott.)

The federal dreadnought turned all its big guns on the hapless strikers. PATCO leaders were hauled off to jail for ignoring court injunctions against a strike. The Justice Department proceeded with indictments against 75 controllers. Federal judges levied fines amounting to $1 million a day against the union while the strike lasted. Over 11,000 strikers received their pink slips, while 1,200 went back to work within a week's time. Morale among the strikers was shaky. "I thought Reagan was bluffing," lamented one controller. In October the Federal Labor Relations Authority decertified PATCO. [emphasis added]

So beware liberals that call for socialized medicine! The result is creating a situation where the Federal government is busting unions! Is this where the Democrats want to go? And the professional classes in the States like the doctors and nurses aren't going to be too happy either. According to this article by Glassman in Tech Station Central the Canadian docs are headed south.

Exodus! Movement of the Doctors

But the dissatisfaction in Canada goes beyond venting in surveys. Since the 1990's, Canada has experienced an exodus of physicians. Their number one destination? The United States and its much maligned healthcare system. At last estimate, there were over 8,000 Canadian physicians practicing in the United States. The vast majority have let their Canadian licenses lapse, indicating no desire to return.

The plight and flight of Canadian doctors reached its peak in the mid-1990's when the government tightened its healthcare budget and physician reimbursement declined dramatically. And yet, although the Canadian government has tried to reverse the trend by committing more tax dollars to its healthcare system, physician emigration still jumped by 68% in 2001. According to Dr. Hugh Scully, co-chair of a Canadian task force on physician supply, the equivalent of two or three medical school classes are leaving the country each year. It's a not a situation that a country with too few medical students can afford to maintain.

This medical brain drain is not inconsequential. Although 100% of Canadians have healthcare insurance, it does no good for the 18% of them who have trouble finding a doctor. Contrast that with the United States where 15% may be without insurance, but only 6% go without needed care as a result. Our system may have its problems, but access to care isn't one of them. At least not when compared to Canada's.

And why are Canadian physicians leaving their patients in the lurch? Not for the money. They leave for better research opportunities, for greater professional and clinical autonomy, better job choices, and better medical facilities. They leave, in other words, for all the advantages conferred by a free-market healthcare system -- the same advantages that we American physicians take for granted when we yearn for a Canadian-style system.

We should look to Canada, all right, but not as a role model. We should look to them instead as a warning. There but for the grace of God -- and a strong independent streak -- go we.

The author is a family physician who has been in private practice since 1991. She is board certified by the American Board of Family Practice, and is a Fellow of the American Academy of Family Practice. She is the publisher of MedPundit.

As you can see the author of the piece is an American doctor who is also a blogger. So while I agree the present system of health insurance coverage needs to be fixed it's also true that rushing off into socialized medicine isn't the best possible idea. Medicine for profit is an American idea and it should probably be rejiggered, but we can't solve our problems just by emulating the socialists of the world either.

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