In praise of U.S. health care

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Twenty years of public policy research on health care recently came home to me in a very personal way when I was diagnosed with prostate cancer.

Because I live in a country with a free-market health-care system, I had a choice of treatments: surgery, external radiation, brachytherapy. I was able to find the doctor and hospital I felt most comfortable with. As a result, I can expect to live a long, healthy, cancer-free life.

If I lived elsewhere, this might not have been the outcome.

In most countries with national health insurance, the preferred treatment for prostate cancer is ... to do nothing.

Prostate cancer is a slow-moving disease. Most patients are older and will live several years after diagnosis. So it is not cost-effective under socialized medicine to treat the disease too aggressively. This saves money, but at a more human cost.

Though American men are more likely to be diagnosed with prostate cancer than their counterparts in other countries, we are less likely to die from the disease. Less than 1 in 5 American men with prostate cancer will die from it, but 57 percent of British men and nearly half of French and German men will. Even in Canada, a quarter of men diagnosed with prostate cancer die from the disease.

The one common characteristic of all national health-care systems is that they ration care. Sometimes they ration it explicitly, denying certain types of treatment altogether. More often, they ration more indirectly, imposing global budgets or other cost constraints that limit availability of high-tech medical equipment or impose long waits for treatments.

Consider this: 7 in 10 Canadian provinces report sending prostate cancer patients to the United States for radiation treatment. In Great Britain, roughly 40 percent of cancer patients never get to see an oncologist.

There are problems with the American health-care system. Too many Americans lack health insurance and/or are unable to afford the type of care I received. We need to do more to lower health-care costs and increase access. Both patients and providers need better and more useful information.

The system is riddled with waste and the quality uneven. Government health-care programs like Medicare and Medicaid threaten future generations with enormous debt and taxes.

Yet we should never forget that America offers the world's highest-quality health care. Most of the world's top doctors, hospitals and research facilities are in the United States. Eighteen of the last 25 winners of the Nobel Prize in Medicine either are U.S. citizens or work here. Half of all the major new medicines introduced worldwide in the last 20 years were developed by U.S. companies. Americans played a key role in 80 percent of the most important medical advances of the last 30 years. By almost any measure, if you are diagnosed with a serious illness, the United States is where you want to receive treatment. That is why tens of thousands of patients from around the world come here every year.

The guiding principle of health-care reform should be the Hippocratic admonition, "First do no harm." Those calling for national health care in America would destroy the things that make American health care so good. More regulation, subsidies and control would simply drain the medical market of the quality, dynamism and innovation that saves lives.

What American health care needs is more choice and competition, not less. We've started down that route through Health Savings Accounts and other market-oriented reforms, but more needs to be done. My Cato colleague, Michael Cannon, and I recently published a new book, "Healthy Competition: What's Holding Back American Health Care and How to Free It," outlining comprehensive market-oriented reforms that would make health care more affordable, expand consumer choice, and preserve the quality of care. We hope it will serve as a starting point in the political debate to come.

But, for now, I for one say, God bless American health care.

Michael Tanner is director of health and welfare studies at the Cato Institute.