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Archive for the 'Socialized Medicine' Category

Tyler Cowan alerted me to this NBER Working Paper by Sherry Glied. (Unfortunately, the full report is gated.) Based on an analysis of data from 20 developed countries, she concludes:

  1. There is no general relationship between the way in which countries pay for health care and their ability to control costs. Public v. private financing, general revenue v. payroll taxes, third-party v. out-of-pocket spending - nothing seems to matter very much.

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I am probably one of the few people you interact with who has a real interest in understanding nonprice rationing of health care.  In fact, I may be the only such person.

By "real interest" I mean a desire to understand nonmarket processes the same way economists understand markets - which means, to be able to explain the past and predict the future.

Most of what has been written about nonprice rationing of health care is descriptive, not analytical.  In fact, I don't believe anyone has developed a real theory about it.

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David Himmelstein and his wife Steffie Woolhandler are associate professors at Harvard Medical School. Together they are a one-couple team, promoting Canadian national health insurance in the Unites States. They provide the intellectual leadership for the Physicians for a National Health Program. They are about the only academics around whose scholarship routinely gives aid and comfort to the advocates of socialized medicine, unless you count the Commonwealth Fund. They are pleasant (at least to me); they are dedicated; and they are wrong.

I first debated David on a college campus about 15 years ago. My most recent debate with them is reprinted in Annals of Thoracic Surgery. In between the two debates I had an epiphany. I discovered that the worst features of the Canadian system are not the differences with our own system, but the similarities.

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Is there rationing by waiting under government-provided health care? Of course there is.

  • In Britain, where the government has been measuring these things for years, up to one million people are waiting to enter British hospitals; and the waiting lists are an issue in every election.
  • In Canada, where the Fraser Institute keeps the best records, people are waiting for 771,000 procedures; and the Canadian Supreme Court, after declaring such waits a violation of basic human rights, ruled that residents of Quebec can buy private care when they are denied prompt service from the government.

However, in the documentary "SiCKO," Michael (if-you-disagree-with-me-you-must-be-on-the-drug-industry-payroll) Moore claimed there was no serious waiting problem in Canada. On CNN and his Web site, he claims there is more waiting in the United States. Source of that claim? The Commonwealth Fund. Paul (if-you-disagree-with-me-you-must-be-evil) Krugman has now joined the fray, making the same claim in the New York Times. He too cites the Commonwealth Fund.

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We have a new Michael Moore site: http://sicko.ncpa.org/. At his own site, Michael invites visitors to send him health horror stories — but only about the U.S. system! To add balance, our site has health horror stories about Canada, France and Britain (easily obtained from a Google search).

Michael Moore didn't want me to see "SiCKO," his pro-socialist, anti-private health care documentary.  If you know anything about health care systems, he didn't want you to see it either.  At least, not at first.

In the beginning, the only people allowed to view the film were reviewers who knew nothing about the subject.  The apparent theory was: get it reviewed by people unlikely to spot all the errors and omissions before you open it to more discerning viewers.

The movie is full of errors and omissions, but that is almost beside the point.  Since the whole purpose of the film is to compare the worst features of American health care with the best features of health care in Britain, Canada, France and even Cuba (!), who can complain about a few errors here and there?

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