Single-Payer National Health Insurance around the World Part V

by admin on 01/10/2015 2:38 AM

Lives at Risk by John C. Goodman, Gerald L. Musgrave, and Devon M. Herrick

(Continued from the October 2014 HPUSA Newsletter)


Despite the official rhetoric, over the course of the past decade almost every European country with a national health care system has introduced market-oriented reforms and turned to the private sector to reduce the costs of care and increase the value, availability and effectiveness of treatments.19 In making these changes, more often than not these countries looked to the United States for guidance.

  • About seven million people in Britain now have private health insurance; and since the Labor government assumed power, the number of patients paying out of pocket for medical treatment has increased by 40 percent.
  • To reduce its waiting lists, the British National Health Service (NHS) recently announced that it will treat some patients in private hospitals, reversing a long-standing policy of using only public hospitals;21 and, the NHS has even contracted with HCA International, America’s largest health care provider, to treat 10,000 NHS cancer patients at its facilities in Britain.
  • Australia has turned to the private sector to reform its public health care system to such an extent that it is now second only to the United States among industrialized nations in the share of health care spending that is private.
  • Since 1993, the German government has experimented with American style managed competition by giving Germans the right to choose among t he country’s competing sickness funds (insurers).
  • The Netherlands also has American-style managed competition, with an extensive network of private health care providers and slightly more than one-third of the population insured privately.
  • Sweden is introducing reforms that will allow private providers to deliver more than 40 percent of all health care services and about 80 percent of primary care in Stockholm.
  • Even Canada has changed, using the United States as a partial safety valve for its overtaxed health care system; provincial governments and patients spend more than $1 billion a year on U.S. medical care.

In each of these countries, growing frustration with government health programs has led to a reexamination of the fundamental principles of health care delivery. Through bitter experience, many of the countries that once touted the benefits of government control have learned that the surest remedy for their countries’ health care crises is not increasing government power, but increasing patient power instead.27


This book is not intended as a defense of the existing health care system in the United States. To the contrary, we count ourselves among its harshest critics.

Our goal here is to dispel certain myths about health care as delivered in countries that have national health insurance. These myths have gained the status of fact in both the United States and abroad, even though the evidence shows a far different reality.

In this book we will examine the critical failures of national health insurance systems without focusing on minor blemishes or easily correctable problems.

In doing so, our goal is to identify the problems common to all countries with national health insurance and to explain why these problems emerge. Most national health care systems are in a state of sustained internal crisis as costs rise and the stated goals of universal access and quality care are not met. In almost all cases, the reason is the same: the politics of medicine. The problems of government-run health care systems flow inexorably from the fact that they are government-run rather than market driven.

We have chosen to focus primarily, though not exclusively, on the health care systems of English-speaking countries whose cultures are similar to our own. Britain, Canada and New Zealand in particular are often pointed to by advocates of national health insurance as models for U.S. health care system reform. In amassing evidence of how these systems actually work, many of our sources are government publications or commentary and analysis by reporters and scholars who fully support the concept of socialized medicine.

The failure of national health insurance is a secret of modern social science.

Not only have scholars failed to understand the defects of national health insurance, too often advocates and ordinary citizens hold an idealized view of it. For that reason, we present much of the information in the form of rebuttals to commonly held myths.

Read this introduction at . . .

Read the Twenty Myths . . . (Expanded from the twenty myths of 1991, previously reviewed in 2003)

In April we will review Part II: The Politics And Economics Of Health Care Systems

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