INTERSECTIONS: US has longest health care waiting times

Our national health care reform debate proves the adage attributed (perhaps in error) to Mark Twain: “A lie can travel halfway around the world while the truth is putting on its shoes.” Remember Sarah Palin’s whoppers about “death panels” in the Affordable Care Act?

One of the worst fibs is that countries with universal health care ration care and that patients die while waiting. US patients in fact wait longest, while suffering and dying at the highest rates. It is true that wealthy and well-insured US patients go to the head of the line; trouble is, we ration and send to the end of the line so many of us who often die waiting, that our system performance overall all is abysmal.

Reminds me when I was a street medic for Cleveland EMS. Caring for the most desperate neighborhoods on the city’s east side, I could see that gleaming, lighted around the night towers of the Cleveland Clinic–and the helicopters ferrying in oil rich Arab sheiks for their cardiac bypass surgery. Does that mean Cleveland health care was the best because filthy with oil cash mobsters got world-class heart care here? No, not when my patients were dying in the streets because they couldn’t see a doctor or afford their meds; it just meant that US health care was for sale, a commodity reserved for the highest bidder.

The Commonwealth Fund has published every several years comparative analyses of health care system performance. I quote from their 2014 report:

“Among the 11 nations studied in this report; Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom and the United States–the US ranks last, as it did in 2010, 2007, 2006 and 2004… … most troubling, the US fails to achieve better health outcomes than the other countries, and as shown in the earlier editions, the US is last or near last on dimensions of access, efficiency and equity.”

This is indeed troubling, that we are not only the most expensive and thus least efficient health care system, but that we are also the least just; i.e., we are last or near last in access to care and equity and fairness. This is because the US is the only nation that believes that private health insurer corporate boardrooms have our best interest at heart.

It is misleading to argue that France, Germany, Switzerland, have private insurance systems. They do, in name only, have private insurers but rates and coverage is government regulated, no one can be turned down, and if you can’t pay the premium, it is paid for you. It is the complete lack of fairness, the outright denial of access to physicians and care that shocks me, and shall shock all of us in the future, just as the facts of slavery in our past shock our sensibilities now. We shall be in awe that we allowed our neighbors to suffer, die and go bankrupt because “the market” found their care to be unprofitable.

Quoting again from the Commonwealth report:

” A higher percentage of people in the US go without needed care because of cost than in any other surveyed nation. Americans were most likely to say they had access problems because of cost. 37% say they did not get needed care, fill a prescription or visit a doctor or clinic when they had a medical problem because of cost. … … Patients in the UK and Sweden were the least likely to report having these cost-related access concerns ( 4% and 6% respectively). Americans also reported negative insurance surprises and the highest rate of serious problems paying medical bills. Physicians in the US acknowledge their patients have difficulties paying for care. with 59% believing affordability is a problem.

The American College of Emergency Physicians reports that fully 80-90% of their members report seeing patients who have suffered as they could not afford or access care. Before we discuss wait times below, let us note that the Commonwealth study reported wait times after patients were referred to a specialist or sent for a diagnostic test. Thus for 37% of Americans noted above, wait times are infinite, they were not able to access needed care at all. This is critical to note–that for many Americans the wait time is permanent, it never ends. Keep this in mind as we read Commonwealth report on timeliness:

It is a common mistake to associate universal or near-universal coverage with long waiting times for specialized care. ( Read the previous sentence again– a mistake to associate universal coverage with long waits.) The UK has short waiting times for basic medical care and non-emergency access to services after hours. The UK also has improved waiting times to see a specialist and now ranks fourth on this dimension with the US ranking third. Patients in the Netherlands, Germany, France and Switzerland have rapid access to elective or non-emergency surgery compared with patients in the US.

Again, it is a mistake to associate universal care for all with delays in care, seeing a specialist or elective surgeries. If this goes against the propaganda one commonly hears in the US, such propaganda being paid for by US health insurers and Big Pharma, then read the above paragraph again. Now, it is true that Canada is having some wait times for specialized elective care–this is NOT a reflection of universal care (read the above paragraph again), it is a reflection of some issues unique to Canada that Canadians are addressing–just as the UK addressed waiting times to see a specialist and now ranks just behind the US.

If universal coverage was the cause of waits, then US Medicare patients would be looking at serious delays. US Medicare patients are not suffering, for many they are safe from predatory health insurers for the first time in their lives (except for privatized Medicare Advantage plan patients, who face restricted, choice, narrow networks while costing taxpayers more). What is often cited is Canadians wait for elective knee or hip replacements–in fact US patients wait also, often voluntarily putting off joint replacements for years on end–and remember that for 37% of US patients without good insurance the wait is infinite.

Lastly, we address the Fraser Institute. The Fraser Institute is a corporate and right-wing funded conservative Canadian think tank, part of whose stated purpose is the replacing of Canada’s universal care with US type privatized health insurance. (Why? One may ask in the name of patient safety.) The Fraser Institute has also accepted large amounts of cash from Big Tobacco and Big Oil, and, no surprise, they argue that second hand smoke is not dangerous and that global warming is of no concern.

Next time you hear horror stories about wait times, rationing and universal health care as being one and the same, 1) consider the source, if it is the Fraser Institute, forget it, 2) remember this is simply not true, and, 3) remember that the US is in fact the most rationed and waiting health care system, and is so based upon the cruelest of determinants–how much of a “market success” you are.

My neighbors are of infinite value and deserve care. How about yours?