Universal Coverage Means Less Care and More Money

The reported success of the Affordable Care Act (ACA or ObamaCare) is based on enrollment numbers. Millions more have “coverage.” Similarly, the predicted disasters from repeal have to do with loss of coverage. Tens of thousands of deaths will allegedly follow. Activists urge shipping repeal victims’ ashes to Congress—possibly illegal and certainly disrespectful of the loved one’s remains, which will end up in a trash dump.

Where are the statistics about the number of heart operations done on babies born with birth defects, the latest poster children? How about the number of babies saved by this surgery, and the number allowed to die without an attempt at surgery—before and after ACA? I haven’t seen them. Note that an insurance plan doesn’t do the operation. A doctor does. The insurer can, however, try to block it.

Also missing are figures on the number of courses of cancer chemotherapy given, or not given, or the time from diagnosis to death in cancer patients before and after ACA. Five-year survival of cancer patients in the U.S. is generally better than in countries that have universal coverage, or the type of plan progressives want to import. Again, the insurance plan isn’t medicine. You can get medicine without insurance, and if you have insurance it might refuse to pay.

There are selected comparisons of change in mortality rates in states that did or did not expand Medicaid (such as New York vs. Pennsylvania). On the other hand, mortality did not decrease in one state (Oregon). These estimates—guesstimates really, are based on the weakest type of data, and the differences may have nothing to do with Medicaid. Maybe it was better AIDS treatments. We hope that the FDA does not use evidence this poor to evaluate drugs.

But what effect did ObamaCare have on overall U.S. mortality?

Between 2014 and 2015, U.S. mortality rates increased for the first time in decades. This primarily affected less-educated whites. Is ObamaCare the cause? There are many factors involved, drug abuse probably being the most important. But I suspect that if repeal had happened in 2012 or 2013, it would have been blamed.

We hear many complaints about medical bankruptcies. These happen because patients got their treatment, and then got a bill. Often the bills are outrageous, and hospitals may be ruthless in collection efforts. That is a serious problem, but it is not caused by lack of universal coverage. And remember, bankruptcy is a way out of debt. Creditors take a haircut. In contrast to medical debts, student loans cannot be discharged by bankruptcy but follow a person for life.

Medicaid expansion may have alleviated fears of medical bankruptcy, but we don’t know that more patients got treatment. In single-payer Canada, there is no fear of a medical bill. But there might not be any treatment either.

We do know that after Medicaid expansion “nonprofit” hospitals are banking windfall profits, while charity is essentially gone. In Oregon, Medicaid enrollment increased from 626,000 in 2013 to 1,056,000 in 2016. Providence Health & Services now has the biggest pile of cash reserves of local companies—$5.8 billion vs. $3 billion for Nike. Hospitals are using the cash to buy new assets, not to lower prices or improve quality. They pay their executives like a Fortune 500 company.

The experts advocating for universal care know very well that resources are limited, and that spending (“costs”) must be contained. They also understand that the burgeoning bureaucracy and its minions and retainers must be well paid. So the answer is to cut services. Some plans “incentivize” doctors to make more money by skimping on care. Others call for a “global budget”—the deliberate creation of scarcity. When the money is gone, treatment is canceled. There will be fewer beds, fewer CT scanners, fewer drugs, and fewer doctors. But all will be fair. No rationing by price, just by waiting lines, political pull—and death. There will be no medical bills to pay after a service, if you get any service. Only taxes in advance, service or no service.

That’s why the universal care advocates count enrollees, not the number of services, and constantly harp on “excessive” treatment, even while planning to make patients wait months for an appointment.

Jane Orient, MD is Executive Director of the Association of American Physicians and Surgeons (AAPS) since 1989. She is currently president of Doctors for Disaster Preparedness. Since 1988, she has been chairman of the Public Health Committee of the Pima County (Arizona) Medical Society.

15 replies »

  1. Steve, infantilism seems to reside in this ‘mine is bigger than yours’ response. I agree with you. People should read the actual studies when needed, but you should learn to read the prior replies and assess their context before replying. In this case my citation was not a study and I fully explained what I was pointing out using the number quoted (see my response to Jonathan and Peter. There was no need to go to Canada’s government statistics so that a .gov site is listed..

    Additionally, I note how frequently you draw conclusions based upon evidence, but frequently don’t supply the citation when asked. You brag about your hospital and practice using it as a source of information, but when asked by a third party I note that you didn’t respond with the name of either organization. That is fine, but then one can never tell whether you are puffing or not.

    Maybe you can put your ideology on a back burner and actually respond in a professional manner where both of us might have some real agreement. We are both after the same thing, right? … reasonable access, cost and quality.

  2. Nah, I actually read the articles, including the methods section. Try it sometime. Heck, if you would even read the article you cited you would realize that half of the cases in your piece are from Ontario, meaning the good folks of Windsor are using docs in the Detroit area, often because they work there. If you are going to cite data from a libertarian think tank, at least make some effort to understand it.


  3. “There are tons of articles debunking the Canadian claim.”

    Interesting statement if we only knew what claim you were trying to debunk .It sounds like you use a bathroom scale to determine the difference between good and bad evidence.

  4. Tis a shame this place lets the anti-vaxxers post, but then she falls in line with a lot of other people here who post often so they will probably just overlook that. (Wonder if she subscribes to the worm theory of pre-eclampsia?)

  5. There are tons of articles debunking the Canadian claim. Lots of good data, especially since socialist countries actually have the ability to track that kind of data. In essence, lots of Canadians work in the US. (People forget how close Detroit is to Canada just as an example.) If you work in the US and go back to Canada, sometimes you require medical treatment while in the US. Finally, I live and work in PA. Have friends in Vermont and New York. (Former and current program directors.) Keith they nor we see much in the way of Canadians. They really aren’t flocking here. Best article is from Health Affairs at link. Aaron Carroll has a nice review of the article with spiffy charts.



    That said, it is true that some parts of Canada have decided it is cheaper to send patients to the US for care than start a new program their own that won’t treat many people.


  6. I love that THCB allows this sort of stuff. Of course things were better when we just paid doctors with chickens. I think Jane is in the Make America Chicken Farmers Again club — or MACFA. Why isn’t that on more hats?

    Of course the reason surgeons like Jane and her colleagues (including HHS Sec Tom Price) are rich is because of government direct payments and indirect subsidies. but it is funny to hear about these state supported professionals complaining about government largesse that helps those way less fortunate than themselves.

    And if you think it does, READ THE DAMN OREGON MEDICAID STUDY. Poor people who went on Medicaid may have had the same physical outcomes but they had a lot less stress and more money. Which I think is a decent trade off for taxing rich people like Jane (and me) more.

  7. Jonathan, my point was not that going abroad was bad, rather Canadians were willing to pay more for healthcare abroad even though if they remained in Canada such healthcare would be free. In the US it is a different story. Out of pocket costs are very high so there is a financial benefit to going abroad.

    Why are Canadians going abroad? Likely it is do to access in a reasonable time frame since the cost is supposed to be zero and Canadian care when given in a timely manner is quite good. Perhaps it is for earlier treatment and the higher tech items where the US leads in quality and experience.

    Americans going abroad is understandable. Do you have a source for your number? I always wonder about these numbers since we have so many of our military service people abroad, businesses and so many people leaving the US for treatment aren’t even citizens. I don’t doubt your number. I just want to know an accurate one.

    As an aside since I don’t want anyone to think Canada doesn’t have good medical care, in the CONCORD study of common cancers I mentioned earlier the Canadians came out quite high, I think in the top 5.

  8. Allen, I’m not judging but the estimates I have seen for the number of Americans going abroad for medical care are all over 1,000,000. So, twice the rate at which Canadians do it. It’s unclear how many of those Canadians or Americans who went abroad would have been able to receive care at all in their home countries (vs. would have had to wait longer than they wanted or would have had to pay more than they wanted to). In any case, the home-based market for care seems to be failing twice the proportion of Americans as Canadians.

  9. Jane “abortion-causes-breast-cancer, vaccines-cause-autism, Hillary-is-dying” Orient, ‘eh?

  10. Peter, your use of statistics is atrocious. You require some remedial education on that subject.

    Firstly, you are trying to create a number based upon total population when you should be setting up that number based upon the number of sick requiring significant care. There are other subsets that should be considered in this example. The number obtained in this example is a relatively real number compared to the numbers provided by questionaires asking respondents how they feel.

    Secondly, I didn’t use the 52,000 to prove Canadian Medicare is a failure. Actually it is pretty smart not to invest too much money on certain things if one can get the value at a less expensive price. I would never suggest Canadians adopt the American system or any other system. There are too many trade offs so peoples all over the world should decide based upon their needs. I even made it clear I wasn’t placing a value judgement on Canada since I support the ability of Americans to obtain their care anywhere in the world and would support insurer’s paying for it. In fact that is one way of saving money.

    Thirdly, the statement Jason responded to involved individual expenditure of money, but the relative equivalent of 500,000 Americans (52,000 Canadians) were willing to pay for care outside of Canada. That demonstrates that personal care in Canada is valued by many since so many travel when they can get their care for free in Canada.

  11. “these cross country questionaires are very poor evidence of anything.”

    Yes, yet you point to them as proof Canadian Medicare is a failure. 52,000 is about .14% of population – WOW, what a denunciation of universal care. One bit of evidence would be polls asking Canadians if they would prefer the “American system”.

    You say wait times are proof of failure, but also want restrictions on access to care here and you support more people uncovered.

  12. Jason, these cross country questionaires are very poor evidence of anything. Feed a thousand hungry people from a third world nation spam and they will say it was a great meal. Feed that to a well fed American or Canadian and they will likely say it stinks. I love Canadians because they are so patient and accepting. They even queue up.

    No value judgement implied but “Estimated 52,000 Canadians sought medical care outside Canada”
    http://www.cbc.ca/news/canada/windsor/estimated-52-000-canadians-sought-medical-care-outside-canada-fraser-institute-says-1.2997726 52,000 Canadians is the approximate equivalent of 520,000 Americans seeking care outside the US.

  13. “In single-payer Canada, there is no fear of a medical bill. But there might not be any treatment either.”

    As a Canadian, I would appreciate a source on this claim beyond anecdotal evidence. Yes, wait times can be an issue but many studies show that Canadian health care is more accessible than the US. For instance, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1483879/.

  14. Book interviews 50 NJ docs. Consistent insurance company denial of benefits. Ditto with NJ mental health data.