Myth #10

National Health Insurance Would Benefit America's Elderly.

Table 11

If the experience of other countries is any guide, the elderly have the most to lose. In general, when lifesaving care is rationed, the young get preferential treatment. Take chronic kidney failure, for example. [103]

  • Across Europe, 22 percent of the dialysis centers reported that they refused to treat patients over 55 years of age in the late 1970s.

  • In Britain, 35 percent of the dialysis centers refused to treat patients over the age of 55, 45 percent refused to treat those over 65 and those over 75 only rarely received treatment.

Table XI, which shows treatment rates by age for four European countries, illustrates two pertinent features of nonprice rationing of medical care. First, when resources are limited, middle-aged patients get priority over older patients. In Germany, France and Italy, the treatment rates were highest among those aged 55 to 64. In Britain, the treatment rates were highest among those aged 45 to 54. Since our kidneys do not get better with age, these treatment rates undoubtedly reflect rationing decisions rather than medical need.

Second, the more limited the resources, the worse the degree of discrimination against the elderly. For example, for the population as a whole the treatment rates in Germany, France and Italy were 50 percent higher than in Britain. As a result, elderly patients in the first three countries had a much better chance of getting treatment.

These observations are also consistent with more recent evidence on access to heart surgery: [104]

  • Per capita, the United States performs twice as many coronary bypass operations on elderly patients as Canada does.

  • Among 75-year-olds, however, the difference between the two countries is four to one.

How serious is the problem of the denial of lifesaving medical technology to elderly patients? Lacking hard data, one can only speculate. In general, health economists arereluctant to take population mortality rates as an indicator of health care quality. This is because whether a person lives or dies in any given year is far more likely to be determined by that person's lifestyle and environment than by anything hospitals or doctors do. In the United States, for example, some people believe that as many as 75 percent of all deaths are directly related to lifestyle. [105]

Despite these caveats, if the life expectancy of any population group is significantly affected by the health care system, it is likely to be the elderly. And international statistics on population mortality are consistent with the proposition that the elderly have the most to lose by nonprice rationing of medical care.

If nonprice rationing results in discrimination against the elderly, then they ought to do better in those countries which spend more on health care – and thus have less of a rationing problem. In order to test this proposition, one recent study compared life expectancy at age 80 among OECD countries. The study found that: [106]

  • For life expectancy for 80-year-old males, the United States ranked second (behind Iceland) along with Canada, Japan and Switzerland.

  • For life expectancy for 80-year-old females, the United States was second, after Iceland and Canada.

  • Compared with all OECD countries, an 80-year-old male can expect to live a half-year longer in the United States, and an 80-year-old female can expect to live almost a year longer.

  • There is very little relationship between health care spending and life expectancy at birth, which tends to correlate with per capita GDP.

  • However, among 80-year-olds, there is a statistically significant correlation between life expectancy and health care spending – on a par with the influence of GDP.