A quarterly magazine of urban affairs, published by the Manhattan Institute, edited by Brian C. Anderson.
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Would the candidate support a government-run health-care system?
2 November 2008
Thanks to Andrew Dillon and his bureaucratic agency, tens of thousands of British patients have gone blind. Hes sorry about that. The question is: Does Barack Obama want to duplicate Dillons flawed efforts in America?
Dillon heads the Orwellian-named NICE, the National Institute for Health and Clinical Excellence in the UK. Its job is to review new medications and decide whether the British government should fund them for the public. On the surface, this seems reasonable enough, since new drugs can be pricey, even when theyre not necessarily better than current ones. NICE, however, often rules against drugs that are readily available in other countries, like the United States. Obama, among other leading Democrats, thinks that the institute is a fine idea; indeed, he promises to spend billions on a NICE-inspired institute to guide reviews and research on comparative effectiveness.
The British themselves, however, are in revolt. In August, responding to popular discontent, Dillon formally apologized for NICEs refusal to pay for Lucentis, a drug that treats macular degeneration, a leading cause of blindness. Two years ago, NICE had ruled that approving Lucentis didnt make economic sense. Government reviewers set stringent guidelines: for example, patients had to be unable to see at all in one eye before they could be eligible for the drug. This summer, however, NICE finally decided that Lucentis was worthwhile for practically anyone with macular degeneration. The new rules that it drafted look nearly identical to those proposed by the Royal College of Ophthalmologists (which are similar to those used by American doctors). Meanwhile, patient advocates suggest, roughly 50 Britons every day went blind waiting for NICE to come to its senseswhich adds up to 36,000 people over two years.
NICEs failure is typical of single-payer systems. Countries like Britain, Sweden, and Canada havent found a remarkable new way to deliver modern medicine; rather, their governments ration care, relegating patients to wait in pain and, in some cases, to die. Back in the 1990s, Canadian government planners pared back on physician supply in the name of cost control. Today, according to the national medical association, roughly one in six Canadians lacks a family doctor. Small towns hold lotteries, with the winners getting a trip to the GPs office. The frustration is palpable: this spring, after years of proclaiming the superiority of socialized medicine, one prominent Quebec politician quit government and went to work for a private health-care company. In Sweden earlier this decade, the government declared that no one should have to wait more than three months for a hip replacement. But by 2004, wait lists had grown so long that 60 percent of patients were waiting longer than that. Görann Persson, a patient with a bad hip, caused a national sensation when the media revealed that he had waited eight months for his procedure. Persson was the countrys prime minister.
What does single-payer health care have to do with the American election, you ask? If I were designing a system from scratch, I would probably go ahead with a single-payer system, Obama observed last month in New Mexico. The surprise isnt that the Democratic presidential candidate feels that wayhe made similar comments a year earlier to The New Yorker. He was even more open during the 1990s, describing himself outright as a proponent of single-payer health care.
Rather, the surprise is that Obama wasnt called to task. Americans understand the need for health-care reform. To some groupsacademics, union officials, and politicianssingle-payer health care looks like a panacea. Back in the heat of the ClintonCare debates of the 1990s, more than 70 congressional Democrats voted for a Canadian-style system. Today, they remain biased in favor of such a system, even if theyre more cautious about advocating it publicly. Former senator Tom Daschle, an Obama supporter, wrote in his recent book that a pure single-payer system is politically problematic in the United States, at least right now. Underlying message: if only.
The next president of the United States will need to tackle health care, and he will face a daunting task. Private health-insurance costs spiral upward, while Medicare costs are unsustainable. What to do? Perhaps first we can agree on what not to do: enacting an already failed socialist experiment.
David Gratzer, a physician, is a senior fellow at the Manhattan Institute. His most recent book, The Cure: How Capitalism Can Save American Health Care, is now out in paperback.