- Del Meyer, MD - https://delmeyer.net -

Universal Access or Restricted Access

As pressure builds for some form of “universal access” under a government system, even by some branches of organized medicine, some reminders of the effects of such a one-tiered system worldwide are timely.

Canada: 1997 found 11% more patients waiting for treatment than in 1996. Statistics in Canada found that more than 1 million Canadians felt they needed–but did not receive–care in 1994, and 30% of these patients were in moderate or severe pain. Despite the fact that 21 cents of every dollar earned by a Canadian worker in 1995 was spent on health care, they still purchased about $1 billion worth of medical services in the US each year. The unfunded health care liabilities are expected to increase from $1.1 trillion to $3.7 trillion over the next 50 years.

Britain: Tony Blair’s “Waiting List Action Team” is charged with reducing the waiting period for a doctor’s appointment to no more than 18 months for non-life-threatening ailments.

France: 70% of physicians participated in a one-day strike to protest forfeiture of fees collected beyond the designated growth ceiling.

Germany: Drastic budget cuts are expected to result in long waiting times. Some ophthalmologists are traveling to Italy to perform procedures.

Nicaragua: The country’s 3,000 doctors have been on strike against the government for over two months demanding a 1,000% salary increase. The current salaries are about $100 a month.

New Zealand: Dr Richard Feiertag brought articles from the Wellington, New Zealand, Evening Post, after a recent visit. New doctors will soon be barred from starting work in Wellington City to avoid a health budget blowout. A government spokesman said that when more doctors were practicing in an area, more claims are submitted for government subsidies (payments); limiting the number of doctors would in no way limit people’s access to doctors. This just limited doctor expenditure. (Please pause here and re-read governmental logic.) The government was just trying to have a national consistency in the GP/patient ratio which was 7 per 10,000 population nationally and the 8.4 in Wellington was just too high. (The USA has about 30 physicians per 10,000 of which about one-fourth or 7 are listed in primary care by the World Almanac.)

Also Down Under: The New Zealand Herald reported that the government is trying to make sure the neediest patients receive surgery first. A July 1, 1998, date has been firmly set for two years on a point system so that patients could receive surgery within six months if they score enough points. However, 48,000 patients had been dumped from the waiting lists because of limited funds. At the last minute the Minister of Health decided thousands more should get surgery and he was searching for funds. Mr Ruru, the national director of medical and surgical services said the minister’s move was to make the new system politically acceptable. . . Should every hernia, gallbladder, and prostate operation is a political decision?

Seniors are up in arms over the Medicare restriction from obtaining medical care outside of Medicare. Medicare responds they are not limited since their doctor can provide that care, although afterwards the doctor is prevented from seeing any Medicare patient for a period of two years… If Medicare is one-half of a doctor’s practice–which the doctor would lose–and if overhead is 50%, this would reduce take- home pay to zero. The doctor would be working full-time to pay rent, staff and other expenses. A recent Wall Street Journal editorial implied that British and Russian citizens have more rights than American Medicare beneficiaries.

Surprise public health raids of hospitals in New York by nurses and investigators occurred to check on whether medical residents were working without adequate supervision or going without sleep. Surgical residents were most vocal in denouncing the governmental laws and continued to resist them.

Data Deficit: In 1963, Milton Friedman asked John Cowperthwaite, financial secretary to Hong Kong and disciple of Adam Smith, about the paucity of statistics. He replied, “If I let them compute those statistics, they’ll want to use them for planning.”

Back to New Zealand: If the plan produces an extra 48,000 on the waiting list with limited access which makes the statistics look bad, just dump the waiting list and eliminate access to make the statistics look good.

Moral: Universal Access equals Restricted Access in Government Medicine.