Tim Parke, the Clinical Director of Auckland Hospital Emergency Department, has written an opinion piece in today’s Herald, extolling the virtues of state health care. “Universal” health care, as he calls it. That word immediately alerts me to the socialist thinking that will be behind the article. The most obvious aspect of state health is that it is not universal at all, except in the sense that it offers the same baseline service to all comers. This baseline service is often very inadequate, meaning that those who cannot afford private health insurance, are forced to endure a far lesser standard of service than their wealthier counterparts. This is why health outcomes for lower income groups are worse across the board. Of course this problem occurs in private health systems as well, but at least it is more clearly spelt out there. It is also much easier to rectify (although looking at Obama’s appalling health care bill, one would be forgiven for thinking addressing health access imbalances was something difficult).
Being forewarned about the social lens that Dr. Parke is about to employ in his article, it is easy to spot exactly where it is being used. Dr. Parke poses three questions and then proceeds to answer them with socialist filters that invalidate each argument he makes. Take his opening question:
“How does the New Zealand system of large public hospitals, subsidised GP networks, ACC insurance and small private hospital contribution perform relative to highly privatised US healthcare?”
He immediately proceeds to quote OECD data. I have often blogged on the dangers of using international comparison data to draw conclusions about the effectiveness of health systems and interventions. It is rare for the data methodology between countries to match. Dr. Parke mentions US infant mortality without once considering that the US count all still births and late-term abortions in their mortality statistics. Some countries do not even include babies that have died less than 24 hours after birth. Typically, the US fares badly in life expectancy for the simple reason that their weighted infant mortality drags it down.
The most obvious aspect of state health is that it is not universal at all
”Besides the obvious problems with direct comparison of data, one must also point out that in the list of comparison data that Dr. Parke uses (Life expectancy, heart attack, stroke, cancer, trauma, breast cancer, infant mortality and premature death) only breast cancer has a direct correlation with quality and access to health care. It is also the only statistic where the US do better than NZ. All other stats rely almost entirely on social factors such as diet, exercise and living conditions. It is any wonder that the US – a nation of obese, junk food consumers who think that “exercise” is a word that describes a school homework book – fare badly in most of these stats?
If you are really looking for a statistic that measures the true effectiveness of a health system, then you need to concentrate, not on the total population, but on the portion of the population whose health is significantly affected by the healthcare system, namely, the elderly. A standardised quality of life assessment for 75 – 80 year olds would almost certainly reveal that the US elderly have far better QoL than a similar group in any other country. Most are covered by either medicare or private insurance. Access to health care is relatively unrestricted in comparison with NZ.
In New Zealand, access to public health care is heavily restricted to the “most needy”. The upshot of this is that an elderly person with hip arthritis must wait until they are in constant pain and virtually immobilised, before they will get their hip replacement. That person’s musculature will have severely atrophied and their ability to recuperate and re-mobilise will have been severely curtailed. All too often the scenario is that, instead of a decade of good life following a hip replacement at 75, the elderly person suffers pain and decreasing mobility for 3-4 years, gets a hip replacement, mobilises poorly and ends up a year later in a nursing home, dying a year or two after that. That is the real face of public medicine.
Not content with meaningless comparison data, Dr. Parke goes on to ask two Straw-man questions. The first:
“Are public hospitals inherently unsafe compared with private facilities?”
He is, of course, quite correct to suggest that the flurry of press anecdote about bad outcomes gives the false impression that private facilities (that are rarely mentioned) are safer than the public facilities. He is also completely correct to suggest that part of this is due to the higher levels of complexity of patients that gravitate to the public hospitals. Of course, part of this increased complexity is entirely self-inflicted by the difficulty in obtaining timely elective surgery, allowing patients to deteriorate and become more complex in their pathology.
But this is not the real problem with this question. The real difficulty with this point is that it is not a question that any serious debater of these issues would formulate. No-one who knows anything about medicine thinks for a moment that public medicine is inherently less safe than private medicine. What they think is that public medicine is inherently less human.
No-one who has spent a night in a public health facility and, then, in a private one would have any doubt in their mind that the private facility is infinitely nicer. I am not here talking about better food or nicer decor. I am talking about the attitude of the staff, particularly the doctors. Public health tends to drive doctors to become task orientated (seeing the patient as a set of disconnected problems). State doctors derive no income from patients directly. While this can be a good thing, it typically eventually leads to busy doctors who see patients as a nuisance. There are some terrific doctors in the public health system who are superb with patients, but there is no doubt that the system lends itself to disinterested, arrogant doctors.
You may think I exaggerate here, but I have seen a good number of senior registrars go out into private practice and suddenly metamorphose from complete assholes to pleasant, caring practitioners who can’t do enough for their patients. Financial incentives are a wonderful thing.
And talking of money, we come to Dr. Parke’s second straw-man.
“Why should taxpayers be forced to cover people who don’t make health provision for themselves and their families?”
Why should this be a Straw Man? Firstly, it is because, apart from the odd libertarian, most of us don’t mind helping the poor to have access to health care. There may be a lot of resentment generated by welfare payments, but the vast majority of us are comfortable with health. More importantly, though, state funded healthcare is not the only workable model for helping the poor to access health care. There is absolutely no reason why the taxpayer could not fund a basic insurance policy that the person can choose himself. The matter of free choice is vital, and is the reason why Obamacare will fail. If people can choose their own policies, competition drives down price and pushes up benefits. If you have a state run insurance, like ACC, it is usually both expensive and inadequate.
There is much to dislike about US healthcare. Millions of uninsured without access to healthcare, absurd litigation and massive costs. None of these problems are an inevitable consequence of a private health system. The first represents a failure of US government, who continue to insist that a state-run insurance scheme is a viable answer. The second is also a failure of US government to curtail the ridiculous excesses of the lawyers. The third is the inevitable consequence of the first two failures – over-servicing of medicare patients and a deeply ingrained defensive medicine, that over-investigates everything for fear of legal action if a problem is missed. The US could make it’s health system the envy of the western world if it had the will to. In the meantime, New Zealand will undoubtably keep viewing its health system through the socialist lenses of organisations like the UN and the OECD and pat itself on the back for its wonderful system.
And individuals, particularly the elderly, will continued to be disserviced by it.
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Nov 16 10 8:46 am
It’s long been my contention that most people here are so caught up in the problems of the US system that they miss the fact that that system actually has some significant advantages – like actually getting treated.
I still grate at the fact that a test I needed required my condition to worsten, and only then received a “are you a NZer” (how the heck could they *not* know that?!?) letter months later as the first indication that the referral had even gone through.
scrubone´s last [type] ..Brrrrrr
Nov 16 10 9:14 am
“The most obvious aspect of state health is that it is not universal at all, except in the sense that it offers the same baseline service to all comers.”
In a country where not everyone needs the same care, can there be any other meaning? We can argue about what that baseline should be but isn’t that the very definition of universal health care?
“A standardised quality of life assessment for 75 – 80 year olds would almost certainly reveal that the US elderly have far better QoL than a similar group in any other country.”
Your command of imaginary statistics is inspiring.
My imaginary statistics say I’d rather be poor in New Zealand than poor in the US when it comes to being looked after when I’m sick.
Thomas Beagle´s last [type] ..Strange Data Collection Method
Nov 16 10 6:44 pm
We can argue about what that baseline should be but isn’t that the very definition of universal health care?
The definition of universal healthcare always implies the term adequate. Universal also implies that everyone has the same access, yet people are clearly denied access to healthcare they need in New Zealand. Therefore the argument around the baseline is not only not academic, it is essential to the determination of whether healthcare is truly universal.
Yes, my command of imaginary statistics IS inspiring. As inspiring as your command of imaginary refutation of said imaginary statistics…
Nov 16 10 2:43 pm
MacDoctor…here is a wealth of info on healthcare in the US vs the socialized nations from an American blogger/journalist friend of mine who has experienced various systems and ….suffice to say….he says don’t get sick anywhere else but the States…it beats them all .
Thomas Beagel….maybe you should do some reading too…
http://freestudents.blogspot.com/search/label/socialized%20medicine
http://freestudents.blogspot.com/search/label/health%20care
Nov 16 10 9:25 pm
I’d like to add that huge chunks of the money spent on health-care in the US has nothing to do with increasing life-spans. For example: it costs about twice to get a newer type of lens implant for cataract patients, compared to the older type. With the older type, they often have to wear glasses, but the newer one often means they can see better than their kids! There are treatments that are more expensive than older treatments, but simply quicken the speed of recovery without even a better medium-term advantage. There are treatments that are more expensive than older treatments, and do not even quicken the pace of recovery, but merely reduce some side effects. There are tests that can be done half as frequently, and the resulting delay in spotting the disease makes no difference in longevity but only in some hard-to-quantify “quality-of-life” factors.
Nov 16 10 10:25 pm
Indeed so. The socialist will rapidly point out that these advances benefit the individual, rather than the group and, thus, immediately discount them as a “waste of money”.
Nov 17 10 11:42 am
I’ve had the privilege of working directly with Dr. Parke in the British Health Care system. He is a talented physician, who cares for his patients and has an international reputation for clinical excellence.
Whilst I appreciate the points you make; whether a patient lives, dies or suffers should not be dependent on their credit limit, insurance company or bank balance.
I suspect we will in the end agree to disagree.
Nov 17 10 1:58 pm
Actually, even though our system is half the cost of the US, ours is about as tidy as its going to get, whereas the US system has enormous scope for improvement, and thats both the public and private schemes.
I’d suggest they will easily outperform us when they set their mind to it, and of course, despite their current problems, they are much richer than we are, so they win going away once they:
Neuter the lawyers
Fix the border problems with Mexico
Allow interstate private sector competition.
JC
Nov 17 10 4:14 pm
In an ideal world Doug everyone would have access to quality medical care when they needed it. But healthcare is a service…not a right.There is no such thing as a right to something another human being has to act to provide you with.Its certainly “right” for a person to seek healthcare,their right to life contains the corollary “sub-right” of maintaining that life…thats logically consistent and unargueable…but they have no right TO it…big difference.To claim such a “right” is to claim a right to enslave others to yourself…whether done by the person themselves or via the state its simply morally wrong and therefore also inefficent.
In a free and moral society healthcare is paid for by the person using it…or those willing to fund them without coercion.If the state system were to disappear all people would be a lot richer and have far more choice and competing options for their care….and for those truely needy private charity would easily cover them because other people,freed from oppressive taxation and finally able to make their own choices to take care of themselves first would then act out of benevolance to help those they see have had a really rough deal from life through no fault of their own.
Kiwis already give voluntarily now,over and above the tax take to help their fellows now inspite of already being massively taxed for the welfare state…why would that change when they are free and financially able to assist by choice?
Nov 17 10 4:22 pm
As for the socialist horror story that is the British NHS….a system that kills people by leaving them to die of dehydration or stavation in their beds…or fails to realise that a patient has been dead in a bed for a week or more ……shudder.
http://freestudents.blogspot.com/search/label/socialized%20medicine
Nov 17 10 7:34 pm
I have never worked with Tim Parke but all reports of him I have heard say he is an excellent physician. I have no problem with his clinical opinions, only his political ones.
whether a patient lives, dies or suffers should not be dependent on their credit limit, insurance company or bank balance
And yet you seem happy that it is dependent on bureaucrats in New Zealand
Nov 17 10 5:40 pm
As a practicing Urologist who now resides in the USA let me say the following:
The NZ healthcare system, much like the Canadian or the British (to name a few), is an egalitarian and altruistic system that puts the needs of the community above the needs of the individual and treats every patient as their brother’s keeper. It operates on the grounds that people have a “right” to health care (its neither a right nor a privilege) or cheaper healthcare and so some people will be sacrificed to fulfill the needs of others e.g. elderly for the poor, cancer patients for non-cancer patients etc…..There is an enforced requirement that everyone be treated equal, and lower quality, equally bad medical care is acceptable. To not accept it would require questioning the premise. A person cannot argue that they should have good medical care, because that would be demanding something that cannot be offered to everyone within the egalitarian system.
Furthermore, it is based on a utilitarian kind of perspective where all that matters are numbers, just maximizing numbers of members of the group who have status X and little to no concern for any person in particular. Today they sacrifice somebody else to pay for Tammy’s life saving meds and don’t worry what that costs that sacrificed person, maybe costing them their life. Tomorrow, Tammy is the one up on the sacrificial alter to somebody else, now getting her meds cut off in the name of some other group, possibly dying now too.
The American model of healthcare is a mismatch between those ideas on one hand and individualistic free market elements on the other. The deficiencies arise from the interventionist elements in our system (subsidies, mandates, regulations etc…). What is typical is that the government determines how health care is going to be paid for and almost the entire private sector adjusts to it and copies that same method of payment and then health reformers turn around and claim that poor results are proof of private sector failure. I also noticed that Macdoctor confuses health insurance with health access, the two are not the same.
Such immoral systems violate the rights of healthcare providers (doctors, insurance companies, nurses etc…) when they force them to provide for the healthcare of others. Not to mention all the coercion involved with the wealth redistribution that is required to fund such bloated public health systems. More fundamentally, should other individuals be obliged to pay for your care purely because you need it, regardless of the cost to them? I say no to that. The needs of some are not moral claims on the rights of others
As for me, I moved to the US from NZ where my diabetic sister can now receive better quality care. I will continue advocating for a free market in healthcare because I believe it is the only moral system where voluntary transactions are possible and no one is sacrificed for the alleged benefit of another or has unchosen obligations towards others and because the US has the most potential in reform. Meanwhile I will continue to support those medical charities and people whom I consider close to my values and my heart.
As for Dr Tim he can enjoy the immoral system that he tries to inflate as somehow good or moral by setting up straw mans and using misleading statistics while failing to recognize the vast violation of rights that occurs everyday in order to sustain these death-worshiping medical systems