If we in California and the United States had wings and an infinite monies
we could fly the best available healthcare to everyone here, there and
everywhere.
The ideological concept of "universal care" looks right, sounds moral and
feels good. California Governor Arnold deserves some credit for trying
something bold. The problem is that history shows these programs do not
work. They have failed in Canada, Great Britain, and other European
countries (France, Germany, and Sweden). Coverage has become too costly in
Massachusetts in less than a year.
The etiology of healthcare fever is always insufficient funds. The
Governor's plan is estimated to cost 12 billion a year. But if you believe
that number we have a long wide concrete bridge over Newport Bay to sell you
for twenty- three bucks.
When the level of money injected into the blood sinks too low the medical
outcomes are rationing and restraint accompanied by chronically high moral
dilemmas. Medical care will be rationed, one way or another, so long as the
government has finite resources and so long as people keep confusing
insurance with fee-for-service.
JAPANESE UNIVERSAL CARE FAILING
Now, according to a recent release by the American Association of Physicians
and Surgeons, it is failing in Japan.
If universal care were the genuine cure-all, the one country where it should
work is Japan. They have a homogenous population, healthier lifestyle, eat
more fish and soy, more vegetables and far less obesity than here. If
universal care does not work there why should it work anywhere?
According to Japanese legislator Takashi Yamamoto, who was just diagnosed
with cancer, "abandoned cancer refugees are roaming the Japanese
archipelago." Patients are told theyıll never get better, even when
treatments exist, and many are not even informed of their diagnoses.
Cancer mortality rates in Japan have been steadily climbing and are now more
than 250 per 100,000, while U.S. rates are now around 180 per 100,000.
Japanese public television showed the stark contrast. In the U.S., multiple
specialists meet to discuss a cancer patientıs care. In Japan, a single
doctor usually makes the diagnosis and carries out treatment with minimal
consultation.
THREE HOUR WAIT FOR THREE MINUTE VISIT
While Japanese patients want American-style treatment, their policymakers
are alarmed. With a huge national debt and corporations worried about higher
taxes, they say Japan canıt afford to pour money into treatments that canıt
extend life span by very much.
"America did too much of this and thatıs why their medical costs have
grown," said Masaharu Nakajima, a surgeon and former director of the Health
Bureau at the Ministry of Health, Labor and Welfare.
Since Japan enacted universal health insurance in the early 1960s, the
emphasis has been on a minimum standard of care for all. People must pay a
monthly health-insurance fee, and large companies pay also. Coverage
decisions, doctorsı pay, and other rules are set by the central government.
Japanese doctors complain that they have no time to spend with patients. The
experience of seeing a doctor is summarized as "a three-hour wait for a
three-minute visit."
"Our rights as individuals are not being recognized," stated lung cancer
patient Hidesuke Hashimoto. Mr. Hashimoto, a former math teacher, undertook
to study his options on his own, moving along to a different hospital when
told there was nothing more that could be done, and sometimes paying out of
pocket (Landers, Wall Street Journal 1/11/07).
SHOULD THE STATE OWN YOUR BODY?
Commenting on the WSJ article, Craig Cantoni, a columnist in Scottsdale,
Ariz., writes: "Like nationalized health care in other countries, the
Japanese system is based on the premise that the state owns your body."
Therefore, "the state can dictate what medical care can be withheld from
you, either by policy or by making you wait so long for care that you die in
the mean time. Nor is [this] justified by the fact that Japan spends about
half as much per capita on health care as the United States, or by the fact
that the Japanese have a longer life expectancy."
TWO MINUTE WARNING
If rights are seized for reasons of cost or efficiency, no right is safe
from do-gooders and busybodies, from lawyers, politicians, and bureaucrats,
and from the tyranny of the majority.
If the universal healthcare system is failing in Japan it will fail in
California, just as in Massachusetts or any other state that experiments
with it.
Editor's Note: Michael Arnold Glueck,M.D. wrote this week's commentary
