'Health care,' more or less

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Originally published 10:16 p.m., June 9, 2007, updated 12:00 a.m., June 10, 2007

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Politicians and pundits lump the terms "health care" and "health insurance" together as though they are the same thing. For example, Sen. Max Baucus, Montana Democrat, recently said, "One in 6 Americans does not have access to health care. And in my home state of Montana, an even greater percentage of people have limited access to health care: 1 in 5 Montanans lack health insurance."

In reality, however, health care and health insurance are quite different. Health care is the products and services used for the prevention, treatment and management of illness. Health insurance, on the other hand, is a way of paying for health care. Specifically, it is an agreement whereby the insurer pays for the health care costs of the insured.

Believing health care and health insurance are the same thing easily leads to some mistaken, if not dangerous, notions. It leads to the beliefs that (1) universal health care and universal health insurance are the same; and (2) that if a nation has universal health insurance, where the government pays for every citizen's health care, that nation will have universal health care, where citizens will have ready access to health care whenever they need it. As the experience of other nations shows, however, universal health insurance often leads to very restricted access to health care.

In nations where the government provides universal health insurance -- such as Canada, Sweden and the United Kingdom -- there are few restraints on citizens' demand for health care. This leads to many citizens overusing health care and creates a strain on government budgets. To keep the costs from exploding, those governments must restrict access to health care by using waiting lists, canceling surgeries or delaying access to new treatments such as prescription drugs. The consequences can be quite harmful.

In 1997, three patients in Northern Ontario, Canada, died while on a waiting list to receive heart surgery. One patient had been waiting more than six months to receive bypass surgery. In Britain, patient Mavis Skeet's cancer surgery was canceled four times, during which time her cancer became inoperable.

This sort of rationing can even reach the top tiers of society. Swedish Prime Minister Goran Persson, for example, had to wait eight months for a hip replacement. As a result, he suffered in great pain and was unable to perform some of his governmental duties. Alice Mahon, a former member of the British Parliament, needs the drug Lucentis to slow her macular degeneration. Because of delays due to the National Health Service not yet having approved Lucentis at the time of her diagnosis, she lost much of the sight in her left eye.

Proponents of universal health insurance often dismiss such stories as "anecdotal." Yet there are plenty of studies in the medical literature showing death and sickness due to restricted access is systematic. An article in the Canadian Medical Association Journal found that, over a two-year period in Ontario, 109 people suffered heart attacks (50 of them fatal) while on the waiting list for a cardiac catheterization.

A study of wait times for bypass surgery in Sweden concluded the "risk of death increases significantly with waiting time." Finally, a study in the journal Clinical Oncology examined 29 lung cancer patients in Britain who waited for treatment. It found more than 20 percent of potentially curable patients instead became terminally ill while on the waiting list.

It is important to note, however, that all these people had health insurance -- that is, their governments would pay for their health care. What they did not have was ready access to treatment. As the Canadian Supreme Court said upon ruling a ban on private health care as unconstitutional, "access to a waiting list is not access to health care."

As the debate over the future of the U.S. health-care system proceeds, it is important that we -- and especially lawmakers who will craft health policy -- understand the very real difference between health care and health insurance. It is vital we realize universal health insurance is not the same as universal health care. Universal health insurance provided by the government leads to rationing of health care that has adverse impacts on health, including death. Thus, we should be highly skeptical of politicians promising to improve our health care system with universal health insurance.

David Hogberg is an adjunct scholar with the National Center for Public Policy Research.

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