"Universal" healthcare's dirty little secrets

http://www.latimes.com/news/opinion/...nion-rightrail

Universal healthcare's dirty little secrets

Patients in countries that provide government insurance often
experience hurdles to care such as extremely long waitlists.

April 5, 2007

AS THEY TACK left and right state by state, the Democratic
presidential contenders can't agree on much. But one cause they all
support - along with Republicans such as former Massachusetts Gov.
Mitt Romney and California's own Gov. Arnold Schwarzenegger - is
universal health coverage. And all of them are wrong.

What these politicians and many other Americans fail to understand is
that there's a big difference between universal coverage and actual
access to medical care.

Simply saying that people have health insurance is meaningless. Many
countries provide universal insurance but deny critical procedures to
patients who need them. Britain's Department of Health reported in
2006 that at any given time, nearly 900,000 Britons are waiting for
admission to National Health Service hospitals, and shortages force
the cancellation of more than 50,000 operations each year. In Sweden,
the wait for heart surgery can be as long as 25 weeks, and the average
wait for hip replacement surgery is more than a year. Many of these
individuals suffer chronic pain, and judging by the numbers, some will
probably die awaiting treatment. In a 2005 ruling of the Canadian
Supreme Court, Chief Justice Beverly McLachlin wrote that "access to a
waiting list is not access to healthcare."

Supporters of universal coverage fear that people without health
insurance will be denied the healthcare they need. Of course, all
Americans already have access to at least emergency care. Hospitals
are legally obligated to provide care regardless of ability to pay,
and although physicians do not face the same legal requirements, we do
not hear of many who are willing to deny treatment because a patient
lacks insurance.

You may think it is self-evident that the uninsured may forgo
preventive care or receive a lower quality of care. And yet, in
reviewing all the academic literature on the subject, Helen Levy of
the University of Michigan's Economic Research Initiative on the
Uninsured, and David Meltzer of the University of Chicago, were unable
to establish a "causal relationship" between health insurance and
better health. Believe it or not, there is "no evidence," Levy and
Meltzer wrote, that expanding insurance coverage is a cost-effective
way to promote health. Similarly, a study published in the New England
Journal of Medicine last year found that, although far too many
Americans were not receiving the appropriate standard of care, "health
insurance status was largely unrelated to the quality of care."

Another common concern is that the young and healthy will go without
insurance, leaving a risk pool of older and sicker people. This
results in higher insurance premiums for those who are insured. But
that's only true if the law forbids insurers from charging their
customers according to the cost of covering them. If companies can
charge more to cover people who are likely to need more care -
smokers, the elderly, etc. - then it won't make any difference who
does or doesn't buy insurance.

Finally, some suggest that when people without health insurance
receive treatment, the cost of their care is passed along to the rest
of us. This is undeniably true. Yet, it is a manageable problem.
According to Jack Hadley and John Holahan of the left-leaning Urban
Institute, uncompensated care for the uninsured amounts to less than
3% of total healthcare spending - a real cost, no doubt, but hardly a
crisis.

Everyone agrees that far too many Americans lack health insurance. But
covering the uninsured comes about as a byproduct of getting other
things right. The real danger is that our national obsession with
universal coverage will lead us to neglect reforms - such as enacting
a standard health insurance deduction, expanding health savings
accounts and deregulating insurance markets - that could truly expand
coverage, improve quality and make care more affordable

As H. L. Mencken said: "For every problem, there is a solution that is
simple, elegant, and wrong." Universal healthcare is a textbook case.