Why is national health care so popular in other countries?

President Obama’s supporters often complain that opponents of national health care are opposed to any reform. Baloney. We who oppose the currently proposed health care bills are not opposed to reforming our health care system. We know it has problems and we want to fix those problems, but we also know that, although our heath care system is not perfect, it also is not completely broken. For more than 75% of us, the system works well, so we are opposed to a complete transformation from a private to a public system. We want change, not revolution.

So, at this point, it seems the debate boils down to whether we prefer a public or private health care system. One of the major arguments in favor of a national system is that virtually all western countries have some form of national health care. The major benefits seem to be that everyone is covered and it is less expensive. These notions are very interesting. They suggest that government can provide more service at a lower cost than private enterprise and the free market. This seems counter-intuitive to most of us and flies in the face of our very successful capitalist economic system, not to mention that most Americans consider government programs to be bureaucratic, hide-bound, inefficient, and financially profligate. Nonetheless, all those other countries that seem to like their national health care cannot be ignored. Why do they like their national health care so much?

The answer is actually fairly straight-forward. It is a classical demonstration of the difficulty of applying statistics to human endeavor. We begin by noting that western societies generally provide living conditions that are quite safe and healthy. Consequently, prior to attaining the “end of life” years, most of us encounter relatively few serious medical problems. We rarely seek medical help, and then usually for fairly simple problems that any reasonably competent provider can adequately address – cuts and sprains, colds and flu, acid stomachs, high blood pressure, and such. For most of us, these routine types of medical issues will be all we ever encounter until we are old. Since any health care system can adequately deal with such routine issues, national health care is as good as any other. Simply stated, 90% or more of young and middle aged westerners only require routine medical care, so those 90% are perfectly satisfied with national health care. Additionally, routine heath care usually does not require expensive tests, procedures, or specialists, so the cost is relatively low. So, since any system can deal with routine medical issues, and such issues are relatively inexpensive to treat, national health care systems can treat them effectively and at a reasonable cost. In summary, national health care systems do fine 90% or more of the time. By any statistical measure, they work well.

But this is not a study in statistics. Medical issues are personal. Although national health care may be fine 90% of the time, the care received by the other 10% is an equally important measure of the quality of the health care system. Quality care means treating individual people, not the average person or even the 90% majority. When you become seriously injured or ill, when you have a serious medical condition that requires expensive tests, specialists, complex operations, intensive care, and long term recovery, you could care less what the polling data say or what most folks think of the system. You need comprehensive quality care, now!

In countries that have national health care, people who seek care for serious medical conditions often complain about the competency of their specialists and surgeons, and about the long waits necessary to get approval for expensive tests or specialists or surgery. Additionally, once approval is granted, they encounter more long waits to actually obtain the tests, see the specialists, or have the surgery. These are people with serious medical conditions – the kind that require timely care before they deteriorate too far. Yet these are the very people that are forced to wait. These are the other 10%. These are the people who need health care the most and receive it the least. That’s why those that can afford it come to the U.S. for treatment of serious conditions.

Try this analogy. Assume the tap water in 90% of the neighborhoods in a town is clean and healthy, but the water in the other 10% of the neighborhoods is dangerous and can cause serious bodily harm if consumed. If you poll the residents of the town, 90% will say their water is fine, but who would argue that this town has a water crisis that must be addressed? Even though 90% of the residents are perfectly happy with their water, the town’s water system is terribly flawed and unsatisfactory.

That’s exactly the situation with national health care. For 90% of the people, it is fine, but, because of the serious problems encountered by the other 10%, the overall system is flawed and unsatisfactory. Polls are statistics that measure quantity, not quality. That’s why polls show that residents are overwhelmingly satisfied with national health care systems.

Here at home, most of us agree that two of the major problems with the U.S. health care system are the escalating costs and the 5% or so of our citizens that cannot obtain or afford health insurance. While a national health care system might well address both of these problems, it would doubtlessly decrease the quality of health care in America.

The problem with national health care is that, like most large bureaucracies, it handles routine reasonably well, but it wilts in the face of the unusual or abnormal. National health care systems provide an adequate quantity of heath care, but poor quality to those in greatest need. Private health care in the U.S. provides excellent but expensive quality, but inadequate quantity. Our goal must be to provide excellent quality and quantity at a reasonable price. This is indeed an ambitious goal, and one that can never be achieved by a government run program.