Politics & Policy

Bypassing The Wait

Clinton's own health plan would have cost him dearly.

The speed with which President Clinton received quadruple-bypass surgery provides an important lesson in health-care reform that voters should keep in mind this election season.

Last Thursday, the former president went to Northern Westchester Hospital, near his home in Chappaqua, New York, complaining of chest pain and shortness of breath. According to the New York Times, “initial tests showed nothing extraordinary,” but doctors asked the former president to return the next morning.

Friday morning, cardiologists performed an angiogram. One reported seeing “multi-vessel coronary artery disease, normal heart function and no heart attack.” However, the extent of the blockage in his coronary arteries was severe enough that doctors sent him to Columbia-Presbyterian Hospital in Manhattan.

Clinton’s wife, Senator Hillary Rodham Clinton, said that when doctors at Columbia-Presbyterian saw the extent of the blockage, “[t]hey did advise him to have bypass surgery, and to do it as soon as he could.” Columbia-Presbyterian admitted the former president Friday and performed a successful quadruple bypass Monday.

The time frame is important.

President and Senator Clinton’s greatest health-care legacy is their attempt to pass the Health Security Act in 1993 and 1994. At the time, it was said that 39 million Americans lacked health insurance. President Clinton made “health coverage that cannot be taken away” his administration’s top priority, and planned to make good on that promise by turning America’s health-care system over to the federal government.

Under the Clinton Health Security Act, the federal government would have compelled all Americans to buy health coverage, dictated what type of coverage they would receive and where they would purchase it, set prices for coverage and medical services, and encouraged states to form their own single-payer health-care systems.

The power of individuals to make countless choices about their health care would have been handed over to government, and the few remaining market mechanisms that contain costs and promote quality would have been lost.

The Economist wrote of the Clinton health plan, “Not since Franklin Roosevelt’s War Production Board has it been suggested that so large a part of the American economy should suddenly be brought under government control.”

Critics warned that socialized medicine would have the same effect in America as it has in other countries.

When government makes medical care “free,” people demand medical care without regard to cost. Governments can’t keep up with the excess demand and therefore must find some way of allocating care amid shortage conditions. Most choose to make patients wait.

According to Nadeem Esmail and Michael Walker of Canada’s Fraser Institute, the median wait for an appointment with a cardiologist in Canada’s single-payer health-care system was 3.4 weeks in 2003. The wait for urgent bypass surgery was another 2.1 weeks on top of that, while the wait for elective bypass surgery was an additional 10.7 weeks. Canadian doctors reported that a “reasonable” wait would be 0.9 and 6.1 weeks, respectively. Great Britain and New Zealand have even longer waiting times for bypass surgery.

Esmail and Walker cite studies confirming that longer waits for heart surgery result in a higher risk of heart attack and death.

In fact, they report that American hospitals act as a “safety valve” for Canadian patients who face life-threatening shortages: “The government of British Columbia contracted Washington State hospitals to perform some 200 operations in 1989 following public dismay over the 6-month waiting list for cardiac bypass surgery in the province. … A California heart-surgery centre has even advertised its services in a Vancouver newspaper.”

Had America had followed his lead ten years ago, President Clinton might not have been able to get his diagnosis and surgery appointment so quickly.

Instead of waiting overnight for an appointment with a cardiologist, he might have had to wait the 3.4 weeks Canadians do.

Instead of waiting three days for quadruple-bypass surgery, he might have had to wait over two weeks.

Instead of receiving care from what Senator Clinton called “one of the great hospitals in the world,” President Clinton might be looking for a safety valve.

Since the Clinton health plan was defeated, untold patients have been aided because America’s health-care system, whatever its faults, was not subjected to the shortages and waiting lines that plague other nations.

But the future is less certain. Sen. John Kerry is aggressively promoting his $1 trillion health-care plan that borrows heavily from the Clinton health plan. Kerry too seems to believe that having government issue a paper guarantee of “coverage” is the same thing as having access to medical care.

Truth be told, presidents and senators will never have a hard time getting medical treatment. Esmail and Walker report “a profusion of recent research reveals that cardiovascular surgery queues are routinely jumped by the famous and politically-connected.” It’s the rest who have to wait. Despite the Canadian government’s egalitarian rhetoric, “low-income Canadians have less access to specialists, particularly cardiovascular ones, and have lower cardiovascular and cancer survival rates than their higher-income neighbours.”

I join all Americans of good will in wishing President Clinton a speedy recovery. And I hope they will join me in wishing Senator Kerry’s health plan a quick, painless death.

Michael F. Cannon is director of health-policy studies at the Cato Institute and author of the study, “Mrs. Clinton Has Entered the Race: The 2004 Democratic Presidential Candidates’ Proposals to Reform Health Insurance.”

Michael F. Cannon — Mr. Cannon is director of health-policy studies at the Cato Institute and co-author of Healthy Competition: What’s Holding Back Health Care and How to Free It.


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