Re-examining Some Myths of Health-Care Problems : Reform: While socialized health systems in other countries now look toward privatization, U.S. looks to more government involvement.

In virtually every country with national health insurance, politicians, health ministers and other government officials are searching for ways to reform health-care systems. Increasingly, the reforms being adopted seek to replace socialism in medicine with privatization, competition and market incentives.

As other countries struggle to reform their health-care systems, they often look to the United States for guidance. Ironically, many in the United States are urging more government involvement. Though still in the formative process, President Bill Clinton’s health-care reform proposal will surely rely on increased government control of the health-care marketplace.

Pointing first to Britain, then Canada, then Japan and now Germany, the ideal health-care system for those advocating more government control has proved elusive as information about other systems gets disseminated to the public. Yet their inability to find an ideal national system has not diminished their quest.

Which works better in health care: government or markets? An adequate answer must examine the international evidence concerning five important myths that tend to dominate discussions of health-care reform.

Myth 1: Average life expe c tancy is a test of the success of health-care systems.

It is just not so. Doctors, nurses and hospital personnel do not control life expectancy, total mortality, in part because they do not control lifestyles. The test of a health - care system is not life expectancy in general; it is life expectancy once an individual is in a hospital or under a doctor’s care. Britain has pretty good life expectancy in general. But according to the Brookings Institution, 9,000 kidney patients each year are denied both renal dialysis and kidney transplants, with fatal results.

The United States may have one of the worst infant mortality rates among industrial countries. But when it comes to treating specific diseases, the United States ranks high, because it has invested the resources to save lives of newborns.

Myth 2: Countries with national health insurance have been more successful than the United States in controlling costs.

International comparisons of health-care spending are difficult, in part because costs for administration, hospital construction and research and development are not measured the same in all countries. But certain comparisons can be made. Before Canada implemented its national system in 1967, for example, the country was spending 75% of what the United States spent on health care per person. By 1987, Canada continued to spend at 75% of the U.S. level. In fact, over that 20-year period, real increases in health-care spending were virtually the same in both countries.

Myth 3: Countries that spend less on health care have more efficient systems.

It’s relatively easy not to spend money on health care, provided you can withstand the political pressure. Politicians supporting Oregon’s recently approved Medicaid reforms believe they can.

Most developed countries impose global budgets on hospitals or area health authorities, and force them to ration care. But the fact that some countries have been able to ration heath care successfully does not mean they are running efficient health-care systems. Japan spends far less per capita on health care than the United States, but the average length of a hospital stay in Japan is 50 days, compared to nine days in the United States. That is one reason why you don’t see U.S. hospital administrators going to Japan to learn how to run a hospital.

Myth 4: Other developed countries have established health care as a right.

Actually, citizens in other countries do not have a right to a CT scan, heart surgery or any other specific medical service. They don’t even have a right to a specific place in a waiting line. If you are the 100th person waiting for heart surgery, you don’t have a right to the 100th operation. Other people can and do get ahead of you. In fact, Americans can jump the Canadian queue because they are allowed to pay for health care in Canada whereas Canadians are not. As a result, more and more Canadians are coming south for care they cannot get in Canada. In 1989, for example, about 100 Canadian heart patients went to the Cleveland Clinic to get timely treatment.

Myth 5: Countries with national health care provide equal access for all.

Certain patterns tend to be followed in countries where health care is rationed. There is substantial evidence that when care is rationed, the elderly and poor are pushed to the rear of the waiting line. When use of medical services is weighted by the incidence of illness, low-income people in almost every country see physicians less often and spend less time there than those who are better off.

The Black Report, the latest and most comprehensive study ever done on the British national health service, concluded that access to health care in Britain today is at least as unequal as it was back in 1948, when the system of national health insurance was instituted.

And things are no better in Canada. Among the 30 health regions in British Columbia, access to all physicians varies by a factor of 6 to 1 and access to specialists varies by 12 to 1. In Quebec, infant mortality rates are three times greater for Cree Indians than for the white population. In every country some people slip through the social safety net. Seeking to to provide for these individuals is one reason Clinton wants to restructure the U.S. health-care system. About 85% of Americans now have health insurance, primarily through employer-provided private health insurance, Medicare or Medicaid. The Administration can provide for the uninsured individuals by expanding Medicaid to cover many of the poor, both unemployed and working poor, who currently do not qualify. That would require additional funding--but the Administration is apparently already resolved to spending more. Better yet, the government could directly subsidize the poor with tax credits (vouchers), so they can purchase their own health insurance.

A change in the federal tax law would also be beneficial. Currently, only those who receive health insurance through their employer get a tax break. Everyone else--the unemployed, the self-employed and the employed but uninsured--must pay taxes first and purchase health insurance with what’s left, making the effective price of health insurance far higher.

With increased support from the federal government for those who can least afford health insurance, the United States can increase access to health care and maintain the world’s most technologically advanced health-care system.