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ObamaCare: Kiss Your Access Goodbye

ObamaCare: Kiss Your Access Goodbye

By Scott Atlas - June 23, 2009

President Obama and the Democratic Congress repeat a mantra so often that it has become a truism: America's health care system is a scandalous failure, and it is absolutely urgent that we fix it now. The mainstream media nod their agreement, and yet, the polls tell us something else: Eighty percent of Americans say they are satisfied with the quality of their health care. In fact, the overwhelming majority of Americans, about three-fourths, are happy with their current health care coverage. (CNN/Opinion Research Corp. poll, March 2009; Gallup poll, 2007, 2006, 2005, 2004, 2003, 2002, 2001; Quinnipiac University poll, October 2007).

So why, then, does a savvy politician like Barack Obama believe he has room to push for a radical overhaul of health care? The polls also show that the same majority of Americans who rate their own health care consistently join the critics when questioned about the "quality of the system" as an abstract whole. It is this unacknowledged inconsistency of American opinion that gives President Obama the opening he needs to push for what is, at heart, a plan for government-run health care. Perhaps it would concentrate our minds wonderfully, then, if we paused to consider the greatest consequence of ObamaCare: Rationed or restricted access to doctors, therapies and care. To see why, you need look no further than other nations with government-centralized health systems that our President and Congress are intent on emulating.

With ObamaCare, access is sure to be reduced in six major ways.

Number 1: Less access to timely health care, especially by trained specialists

Independent, peer-reviewed studies document that patients seeking care from physicians with specialty training-cardiologists, orthopedic surgeons, and neurologists-must wait far longer for those services under government-run health systems.

* Patients in Canada and the UK wait months longer than U.S. patients for knee or hip replacement surgery, cataract surgery, and radiation treatment.

* In fact, Canadian patients must wait weeks, months, or even more than a year longer just for referral for such care.

Ironically, while Americans contemplate moving toward these sluggish systems, the Canadian and British governments are spending vast sums studying how to reduce their scandalous waitlists.

Number 2: Less access to state-of-the-art drugs that are proven to cure serious diseases, like cancer

Americans-men and women, adults and children-consistently have the world's best survival rates from cancer, both common and rare cancers.

The documented superiority of the U.S. health care system for cancer outcomes is most dramatic when comparing U.S. sur¬vival rates to the most centralized systems, like the government-run universal National Health System of Britain or Canada's wholly government-controlled universal health system.

Why is this so? One critical factor is a lack of access to new drugs proven to prolong survival, and often even cure, these otherwise lethal diseases.

* Nils Wilking from Stockholm's Karolinska Institute, an author of a widely reported publication that compares international cancer survivals, recently explained that nearly half the improvement in cancer survival rates in the United States in the 1990s was due to "the introduction of new oncology drugs." He writes: "No country on the globe does as good a job overall as the United States. Thus, the U.S. government should focus on ensuring that all cancer patients receive timely care, rather than radically over¬hauling the current system."

Why are government-run systems so far behind in cancer therapies?

* The prestigious journal Nature Reviews recently noted that government price controls were key to the lag in availability of cancer-fighting drugs in Europe. Of the 71 drugs receiving marketing clearance both in the European Union and the United States between 2000 and 2005, 73% received approval first from the U.S. FDA. On average, the FDA approval came one year ahead of clearance by the European Medicines Agency. To those who would charge the FDA with rushing its research, the fact is that both agencies have an identical mean approval time of 15.7 months.

When, then, were new drugs available first in the United States? It is because drug developers chose to submit them here first. The lack of government price controls in America allows private companies to recoup and ultimately profit from their huge R&D investments.

Number 3: Less access to modern medical technologies that lead to earlier diagnoses, safer treatments, and better outcomes

Technology innovation to improve health has been the defining characteristic of medical advancement. Scientists expect even more remarkable advances in medicine with the emergence of molecular biology in clinical care. And the high value of medical technology has not been lost on the American public: Eighty percent of Americans say that being able to get the most advanced tests, drugs, and medical procedures and equipment is "very important" or "absolutely essential."

In stark contrast to the United States, countries with government-controlled systems show severe deficiencies in medical technologies, both in their availability and in what is a truly scandalous usage of antiquated versions often operating at substandard levels of function.

Quantity, not just quantity, is an issue. Published data comparing the availability of Magnetic Resonance Imaging (MRI) and Computed Tomography (CT) Scanners in the United States against Canada other OECD countries is striking.

* The gap between Canada and the United States is very large-32 CTs per million people in the United States versus 11.3 per million in Canada; and 27 per million MRIs in the United States versus 5.5 per million in Canada.

* In the UK, the House of Commons itself recently reported a severe underutilization of modern medical technologies in their 60-year-old National Health System, lamenting that their system is "slow to adopt and diffuse new technologies" resulting in it "lagging behind many other countries."

* In Canada, a 2008 study found that its national health care system relies on old and outdated medical technologies for cancer care, diagnostic services, cardiovascular care, neurology, urology, genetics, and general hospital and surgical services.

* According to the Fraser Institute's annual Waiting Your Turn report, the median wait times in 2007 for Canada as a whole were 4.8 weeks for a CT scan, 10.1 weeks for an MRI, and 3.9 weeks for an ultrasound.

Number 4: Less access to choice of doctor and choice of treatments for patients and families

We don't have to only look outside the United States to understand how access to choice is impacted when government controls the system. In a 2006 report from the non-profit Center for Studying Health System Change, nearly half of all U.S. doctors polled said they had stopped accepting or limited the number of new Medicaid patients.

Again, no mystery about why . . . when government dictates prices on services, those services become unavailable. And because of inappropriate government dictates on medical care coverage, it is the patient who suffers most. Directly or indirectly, choice becomes limited, and health care becomes rationed.

And yet the rhetoric of the Obama Administration is eerily similar to the language of Canada's government Medicare program, which baldly asserts that Canadians get "medically necessary services." The administration also sounds much like the UK's House of Commons Task Force, which recommended "techniques for determining the cost-effectiveness of new technologies" with "nationally approved standards for the commissioning of new technologies." Like his nationalist counterparts, President Obama also has plans for a Federal Health Board to set "evidence-based standards" for benefits of insurance and quality for medical procedures, as well as a federally directed development of health IT standards, rather than allowing private sector innovation to yield what is best in a competitive marketplace.

ObamaCare will likely sacrifice another key differentiator of our medical care, the excellence of the American physician. As our government dominates insurers, will the best and the brightest continue to choose to endure the years of training and sacrifices for a career in medicine? Will they want to pursue a career where wages are defined by government, and where medically naïve government employees with the sole mission of lowering costs dictate medical care options to physicians and their patients?

Number 5: Less access to choice of health insurance coverage

A key component of the Administration's proposal is expected to include a "public option" for insurance for those presently not eligible for Medicare, Medicaid, SCHIP or the various government health insurance plans. This "new option" would actually reduce access and choice of health insurance coverage to Americans. This will happen even though there will be no requirement to drop current private coverage.

Why? The answer is an effect known as "crowd-out." Recent experience shows that public insurance expansions mainly crowd out private insurance coverage, rather than provide coverage to those otherwise uninsured.

* Dr. Jonathan Gruber illustrated crowd-out in a 2007 NBER report showing that the numbers of the privately insured falls by about 60% as much as the number of publicly insured rises (and is much larger when family-wide effects of eligibility are considered).

* The Robert Wood Johnson Foundation showed that crowd-out raises the costs of expanding coverage. It is more likely to occur among people with moderate incomes who have greater access to employer coverage and ability to pay for it.

* Dr. Lara Shore-Sheppard reported that public health insurance expansions increased the likelihood that small business employers will limit their coverage.

There are other reasons why Americans should care about crowd-out of private insurance.

First, while intended as a means to reduce insurance costs, costs to the government (meaning the taxpayer) end up dramatically increasing.

* Consider the very recent experience in Hawaii. Only seven months after offering the only statewide universal child health care insurance program in the country, Hawaii had to end the program. Why? Because public funds had essentially replaced private coverage that children already had. In fact, over 80 percent of those taking up the state health insurance for children were already covered by private insurance.

Second, the Administration plans to devise a Federal Board to determine the "appropriate" insurance benefits for Americans. Government bureaucrats will decide by government mandate what insurance must cover. Ironically, government-defined insurance mandates themselves are a primary cause of expensive health insurance.

Similar government mandates requiring specific benefits have grown from only a handful in the 1960s to around 2,000 at present, according to the Council for Affordable Health Insurance. Mandated benefits currently increase the cost of basic health coverage from a little less than 20% to more than 50%, depending on the state.

You might wonder why all Americans would be forced by their government to pay for benefits many don't want or value, like massage therapy, acupuncture, in vitro fertilization, and chiropractor care. With government insurance becoming more dominant as crowd-out occurs, it will be far easier for politicians to add even more mandates to what they consider "necessary" coverage for our families.

Number 6: Less access to the leading innovators and innovations in health care

By virtually all accounts, the vast majority of all the innovation in health care in the world comes out of the U.S. health-care system, whether you judge it by the number of clinical trials, or the sources of the most important medical advances in recent history, or the number of patents, or the number of scientific journal publications, or the home of Nobel Prize winners.

American excellence is at risk with government-centralized health care.

First, access to innovative care will be stifled by the centralization of government power in a Federal Health Board, where government employed bureaucrats are empowered to assess what is "appropriate" medical care. This unprecedented intervention by our government, interposing bureaucrats whose goal is reigning in costs directly between doctors and patients, is specifically and openly intended to limit choices on new diagnostic methods and recently developed treatments.

Second, heavy handed government has been shown to stifle innovation in medicine (as we have seen in access to new drugs, medical imaging technology, and safer medical devices in Europe, Canada, and other countries where government controls health care). Just a decade ago, more than two-thirds of all drug research was conducted in Europe. Now, 60% is conducted in the United States. Because Europe's government-dominated health care systems dictate prices, there is a serious negative impact on innovation. From 1998 to 2002 there were only 44 new drugs launched in Europe, compared to 85 in the United States.

Third, with government as the overriding, dominant payer to doctors, the already announced plan to shift payments from highly trained specialists to family physicians and other generalists will undoubtedly dissuade many of the best and brightest - the source of those innovations - from even pursuing such rigorous subspecialty fields.

After repeated lecturing about our disastrous health care system, the message is clear: This is a rescue of the highest priority, a full scale emergency, "code blue" ... and it must be implemented stat, as my medical colleagues might say. What really is urgent is careful deliberation before costly changes are made that could force Americans to lose precious access to what most of the world envies.

Our government should best heed the principal maxim taught to all doctors everywhere--primum non nocere--first, do no harm.

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Scott W. Atlas is a Senior Fellow at the Hoover Institution and a Professor at Stanford University Medical Center.

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