The Accidental Experiments
In science, anecdotal evidence is anathema to controlled experiments. Anything that you learn from “something your aunt went through” should be bolstered by double-blind clinical trials before institutionalizing it. Though this doesn’t always happen in medicine—people are dying and there is often not enough time to work through FDA approval or peer review avenues—you sometimes find that the exact experiment you need has been done already.
In terms of healthcare, Great Britain and Canada are two such metrics.
Highlighted by the London 2012 Summer Olympic Games1 (in a typically British spectacle which celebrated sports through a segment on children not going to bed), Britain’s National Healthcare Service is a point of pride amongst many Brits. A Welsh friend of mine bragged about how “everything is paid for, so I don’t have to worry about being ill” to my inevitable disbelief (then I started investigating because I didn’t believe her). The NHS is a single payer service that provides necessary primary care to any British citizen who walks in. “Elective” health procedures, such as optical care and dental work2, have a premium charged for them.
Canada’s health care system functions in much the same way. A single payer system funded through income tax, the Canadian system thrives on low administrative costs (most insurance claims are handled entirely on the doctor’s end—the patient is barely involved), charging premiums for “upgrades”, and additional insurance or out-of-pocket payment for elective procedures. You could think of Canada’s system as a buffet—it takes the best of many plans (and, admittedly, parts that need to be improved) and slaps them together on a plate. In this way, the elderly’s prescription drugs are paid for in full but employee-based private coverage still exists.
So to pop the question3: do these systems work?
And the Walls Came Tumbling Down
The answer is everything you never want to hear when you pop someone (especially if it’s a competitive swimmer) the real question: Sort of.
There is no denying that universal coverage—and these two systems in particular—is providing some quality care. The UK’s life-expectancy is higher and the infant mortality rate lower than the US. Canada’s survival rate for colorectal cancer and breast cancer is the best in the OECD4. Excluding the fact that perhaps Canadians are genetically pre-disposed to have better chances at surviving cancer (nerd joke alert), this does provide hard evidence that health care doesn’t “fall by the wayside” when it’s opened up to everyone.
The general purpose of both health care delivery systems works. People who need to see a doctor can see a doctor, at no cost5. However, where both of these systems fail is through wait times. Usually, researchers use knee-replacement surgery as a parameter for comparing wait times—it is a non-emergency surgery that lots of people tend to need as they get older. In Britain, the mean weight time is five months to a year—enough time for you to put your affairs in order, quit your job, and then be wheelchair bound and obese for six months as your mobility decreases with each passing day. In Canada, wait time has been measured on referral to a specialist—another non-emergency but pressing metric. This wait can be up to four weeks for most patients.
A Commonwealth Fund report in 2010 released a provocative figure detailing the health care systems of seven first-world countries. The US, ironically, came in fifth in “timeliness of care”—behind the UK (at #4), but ahead of Canada (who came in dead last). This marks one of the major points where Obamacare can really fall flat on its face—but it becomes less of a clear cut policy issue and more of a moral issue. If the PPACA opens up healthcare to everyone who needs it, there will no doubt be an influx of patients into the system. More patients with the same amount of facilities and doctors clearly means an increase in waiting time. How much of an increase? I’m not that clever of an economist or health policy expert, so I can’t tell you. But is it really morally tenable to shut people out of adequate care simply because you have more means to pay for it than they do? It’s a very sticky issue and one that really, at its heart, rests on the reform of the healthcare delivery service and improvements in treatment efficacy and speed.6
Monsters in the Dark
We’re not out of the woods yet. Regardless of any failings Obamacare has idealogically, there are a few more pitfalls. The first of which comes to us, in the Olympic spirit, from Canada. The provincial governments have recently been feeling the squeeze of increased healthcare costs—drug costs, in particular—and have since gone Sarah Palin maverick and banded together to force Big Pharma’s drug prices down. Is this a preview of things to come?
Wisconsin presents a challenge as well. (Where’s Massachusetts, you ask? Currently implementing even more healthcare reforms, actually.) Regardless, Wisconsin has already extended coverage to 91% of the state. In addition, a program known as BadgerCare has supplemented those families without employer-provided insurance who also make too much to be included in Medicaid. As you may be able to surmise, the taxes imposed by the PPACA will actually stifle the current dissemination of healthcare by revoking it and putting in the federal provisions. In addition, Medicare funding—which the state will pay for—only provides redundant coverage. In very blunt terms, Wisconsin highlights how Obamacare only works on a broken system—and wastes costs on those health care systems which are currently working7.
Most poignantly, Sarah Kliff of Wonkblog (of course), mentions that universal coverage does not mean universal access. Taking a cue from our friend Massachusetts, the publicly funded healthcare schemas, like Medicare, that provide subsidies for things such as drugs, can still present cost-preventative co-pays and premiums (we’ve gone through this a bit last time, so I won’t bore you when you probably would be doing something like rather watching the Olympics)8.
To stick the landing, as it were, Obamacare is far, far from perfect. Although there are great ideas, there are also great stumbling blocks. Take it from Kathleen Sebelius herself: “[We have a chance] to move forward with implementing and improving a law that is already lowering health-care costs.” [Emphasis is mine. Now get out of here.]
Currently listening to: Skrillex – Bangarang.
(I hear the dubstep groans. Don’t worry, I’m not normally a fan—this one is just catchy).
1Don’t click this link unless you want to know every result hours before you could watch it because, perhaps, you have a job or are in class during the live event. Thanks for NOTHING, NBC.
2Way too easy to make this joke. It’s not even clever.
3Raise your hand if you had a free-association moment after this sentence of the million screaming girls and/or gay men (in Washington, DC or other hospitable states only, of course) asking Ryan Lochte or whatever swimmer the spotlight is on that night, to marry them. #watchingtoomucholympics
4Organisation for Co-operation and Economic Development. AKA: the club of rich countries.
5It’s important to note that the proposed healthcare system in the USA would not be as generous as Canada’s or the UK’s because it would still cost everyone money. Looking into my crystal ball (and rearview mirror, respectively), I see Republicans (but first liberals—the rearview mirror thing, see?) shouting that the Democrats botched the entire affair by not going all the way and making health care free.
6It also rests on the supply of more doctors.
7The PPACA actually encourages this sort of thing—so it’s a bit of a misnomer to call it a problem. There is a waiver included in the provisions that propels states to “do better” than Obamacare if they can—like Wisconsin—and if they can, the federal requirements for implementation are revoked and the state snags the monetary difference between costs. However, if Wisconsin isn’t proactive (for political reasons, you could imagine), then this op-ed actually will come true. If not…file it under partisanship.
8If you haven’t been watching the Olympics…I don’t even know what I would say to you. I’m fresh out of (supposedly) witty comebacks.