As evidenced by countries implementing the national health insurance model, resources that are not allocated through a pricing mechanism, are inadequately distributed through waiting lists and/or through limiting access to medical technology. Indeed, waiting lists and the rationing of technology are the inescapable signs of price controls in any market. For example, the Canadian government, which manages a single-payer health care system, was compelled to reduce spending on health care to combat rising health care costs and a recession plaguing in the late1980s.(7) Such government expenditure limits are the inevitable consequence of an unlimited demand for medical services. No government can be expected to fund all of the medical care that is demanded at zero price. Consequently, tradeoffs must be made among preventative care, acute care, decreasing patient waiting times to receive treatment, and access to new technology. With limited funding, providing more of one means that less is available to satisfy others. Unsurprisingly, then, costly benefit-increasing technology, such as transplants and experimental treatments, are less available to Canadians than they are to Americans.(8) Moreover, the rate of technological innovation is much more rapid in America than in Canada, as technological development carries with it financial incentives that are absent under a more regulated economy.(9) As demand for services offered at no costs exceeds available supply, waiting time is used to ration medical care. As a result, medical services are inevitably diverted to those who are willing and able to wait the longest or those with the most political leverage. Indeed, cases such as those involving Quebec Premier Robert Bourassa, who upon learning that he needed an operation for melanoma in 1990 traveled to the United States for his operation rather than waiting his turn in Canada, are becoming more and more frequent.(10) Undoubtedly, relying on political rather than private decision making will negatively influence access to care, technology adoption, efficiency, and even health care outcomes.
While it is clear that the production and consumption of medical care is inefficient under a socialized system of health care, there remain those who fail to realize that once financial barriers to medical access are eliminated there is still no guarantee that the social disparities associated with the provision of healthcare will be eliminated. While proponents of the social insurance model argue that universal access will improve health outcomes, especially for the low-income population, evidence shows that nationalized systems do not eliminate or even significantly reduce health differences among population subgroups. In countries that have adopted the national health insurance model, per capita consumption of health care varies by as much as 50 percent across income levels and 100 percent between occupational categories.(11) For example, England's lowest socioeconomic group has infant mortality rates that are double those of the highest socioeconomic group, a discrepancy that has endured since the inception of the country's National Health Service.(12) Conceivably, this is no different than the United States where infant mortality rates for African Americans are roughly three times those of the white population.(13) Thus, while other developed countries do have universal coverage, their plans do not eliminate the inequalities of the previous health care system. If quality and availability of health care were primary concerns, then an honest and responsible look at similar systems in other industrialized countries would end the support of a system that has unequivocally proven to have the opposite effect.
Be Sure to Continue to Page 3 of "Universal Coverage: A Bridge Too Far?".
