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No, Not The Nhs!
American pols should stop dreaming of "universal health care" and visit Britain.


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Iain Murray

Whenever I hear the words “universal health care”–as I did during Sunday night’s Democratic debate in Wisconsin–a shiver goes down my spine. You see, I grew up in Great Britain, where the National Health Service supposedly provides top-quality health care to all Britons, free at the point of delivery. That’s the theory, at any rate. Yet you pay for it in taxes, of course, and in practice, the NHS provides below-par service. Sometimes the treatment can be excellent, but more often, you have to wait months or years for operations; equipment is outdated, and doctors are overworked. Britons are beginning to wake up to the idea that the NHS is no longer “the envy of the world,” and even Tony Blair’s free-spending government has realized that universal, taxpayer-funded health care is an unsustainable ideal.

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So I shivered freely yesterday when I read that the Institute of Medicine has issued a report calling for universal health care for all Americans by 2010. The reasoning behind the report is sloppy, and the alternatives suggested for implementation are all problematic. This report deserves to be treated with as much contempt as the Clinton health plan comprehensively rejected by Congress ten years ago, and for much the same reasons.

Part of the reasoning behind the recommendations is that in 2002, 43.6 million people lacked health insurance at some point. That simple figure, however, conceals a much more complicated truth. “At some point,” for instance, means that not all of those millions were uninsured at the same time, and many were only uninsured for short periods. What really matters is those who are chronically underinsured, and that figure is much smaller–between 9 and 13 million, depending on whose figures you believe. But even that doesn’t tell the whole story.

Many of the uninsured are actually eligible for government insurance programs of one stripe or another, like Medicaid, but they either don’t know about them or fail to sign up for them. Others know all about all the options available to them, or can afford private insurance, but still don’t bother.

As it happened, I lacked health insurance for several months last year. I had a period of self-employment and, being still a permanent resident and not a citizen, was ineligible for Medicaid. Yet my lack of coverage was a choice: I was making just about enough money to have afforded basic coverage, and there are tax breaks that would have offset the direct cost, but I decided not to take up the option. I weighed the definite cost against the theoretical benefit and concluded that I could live with the risk. While my daughter was eligible for certain programs, my wife and I decided that the actual cost of the one or two pediatrician visits she needed was absorbable. We bore the risk ourselves rather than placing it on the government.

We were not alone in this. A recent study by the Dallas-based National Center for Policy Analysis found that from 1993 to 2002, the number of uninsured people in households with annual incomes above $75,000 increased by 114 percent, while the number of uninsured people in households with incomes under $25,000 fell by 17 percent. The poor are getting more coverage while the comfortably off are choosing to buy less. If rich, young, male software developers working on a contract basis are choosing not to be insured because they reckon the likelihood of them needing insurance is small, then that is an example of labor-market flexibility, not a medical crisis.

So what does the Institute of Medicine recommend to fix this non-crisis? There are three non-costed options, each with its own problems.

First is a requirement for employers to provide health insurance (the federal government would cover those not employed). This essentially amounts to a new tax on business and would have the predictable effect of putting many out of work, making them dependent on the state for more than just health care.

Second, the IoM suggests a requirement for all individuals to obtain coverage, with tax credits to help them afford it. In other words, government tells you how to spend your money. If your judgment is that you could spend your hard-earned cash on something else for more benefit, tough.

Finally–and this is the really frightening idea–they recommend a single-payer system administered by the federal government. This would get rid of the need for insurance premiums and enrollment qualifications. The authors of the report admit it would require a tax increase–and indeed it would. The health sector currently spends 13 percent of American GDP (well over a trillion dollars), with only 8 percent of that provided by the government. The solution would also be equivalent to the nationalization of a large segment of the insurance industry, with the almost certain imposition of health rationing in the form of waiting lists for service, as seen in the NHS.

Yes, there are some poor people who are chronically uninsured, but most of them can be covered by some already existing program, if they want to be. Admittedly, there may be an argument for some additional programs for those who have fallen through the system’s cracks. But the solutions proposed–which would destroy jobs, are offensive to individual liberty, or would merely emulate a failed bureaucracy–are not the answer. The tingling in my spine tells me that much.

Iain Murray is a senior fellow at the Competitive Enterprise Institute.



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