Myth #15

Under National Health Insurance, Health Care Dollars Are Allocated So That They Have The Greatest Impact On Health.

Of all the characteristics of foreign health care systems, the one that strikes American observers as the most bizarre is the way in which limited resources are allocated among competing needs. Foreign governments do not merely deny lifesaving medical technology to patients under national insurance schemes.

They also take millions of dollars that could be spent to save lives and cure diseases, and spend them to provide services to people who are not seriously ill. Often, these services have little if anything to do with health care.

Britain, once again, exemplifies this behavior. Throughout the National HealthService, there is a pervasive tendency to divert funds from expensive care for the small number who are seriously ill toward the large number who seek relatively inexpensive services for minor ills. Take the British ambulance service, for example: [138]

  • English "patients" take more than 2l million ambulance rides each year – about one ride for every two people in England.

  • About 91 percent of these rides are for nonemergency purposes (such as taking an elderly person to a local pharmacy) and amount to what an official task force report described as little more than "free taxi service."

  • Yet for genuine emergencies, the typical British ambulance lacks the modern, lifesaving equipment considered standard in American cities.

While as many as 9,000 people die each year from lack of treatment for kidney failure, the NHS provides an array of comforts for the many chronically ill people whose kidneys are in good working order:

  • Each year about 4.1 million people in England are treated in their homes by "health visitors " – more than 1.1 million are treated in their homes by chiropodists and "meals on wheels" serves almost 33 million meals in people's homes.

  • Social workers attending to the needs of the elderly and the handicapped help with the installation of more than 17,000 telephones and telephone attachments, help arrange more than 93,000 telephone rentals, help more than 49,000 people with home alterations, assist in arrangements for 63,000 vacations and help an additional 346,000 people with other personal appliances and aids.

While tens of thousands of people classified by their physicians as being in "urgent need" of surgery wait for hospital beds, the NHS spends millions on items that have only marginal effects on health:

  • On the average, the NHS spends more than $90 million each year on tranquilizers, sedatives and sleeping pills, almost $32 million on antacids and about $11 million on cough medicine.

  • About 9.7 million people receive "free" eyesight tests every year, and of these about 2.3 million receive free or subsidized eyeglasses. [139]

If the NHS did nothing more than charge patients the full costs of their sleeping pills and tranquilizers, enough money would be freed to treat 10,000 to 15,000 additional cancer patients each year and save the lives of an additional 3,000 kidney patients. Yet such options are not seriously considered.

A full description of the ways in which "caring" takes priority over "curing" within the British National Health Service would fill a volume the size of a phone book, and readers may wish to consult other references. [140] Suffice it here to say that the tendency pervades every aspect of British medicine.

Spending Priorities in Canada.

Although not as pronounced, similar trends can be observed in Canada, where the government has expanded the services of general practitioners while tightly controlling access to modern medical technology. For example: [141]

  • In the United States, only 13 percent of all physicians are engaged in general practice or family practice.

  • In Canada, over half of all physicians are general practitioners and the percentage of GPs has been rising over the past two decades.

  • Ontario even has a policy requiring that 55 percent of its physicians be in general practice.

In general, Canadians have little trouble seeing a GP. But specialist services and sophisticated equipment are increasingly rationed. As noted above, although the United States has seen a major expansion of outpatient surgery, Canada has actively discouraged this trend – presumably to control spending. All over Canada, CAT scanners and other equipment are restricted to hospitals, and Ontario has legislated this restriction.[142] The Canadian system encourages the provision of routine services for the many at the expense of specialized care for the few. As one Canadian economist observed, "A growing number of operations are triaged because resources are used to continue first-dollar coverage for sniffles and splinters." [143]