July 26, 2004

Barbarians at the Gates

by Michael F. Cannon

Michael F. Cannon is director of health policy studies at the Cato Institute and author of the report, "Mrs. Clinton Has Entered the Race: The 2004 Democratic Presidential Candidates' Proposals to Reform Health Insurance."

If you're not thrilled about watching the Democratic National Convention tonight, I have a video recommendation: The Barbarian Invasions. Set in Canada with French dialogue and English subtitles, it won last year's Academy Award® for best foreign film, and -- wait, where are you going?

Americans should give this film a try if only to see how much worse being sick would be if government controlled our health care. The Barbarian Invasions documents the mediocrity, rationing, mindless bureaucracy, corruption, and elitism that inevitably would follow. A few years ago, audiences cheered when Helen Hunt tore into HMOs in the movie As Good As It Gets. What As Good As It Gets was to managed care, The Barbarian Invasions is to socialized medicine.

When the millionaire son of a dying Canadian professor returns home from England, he finds his father in a hospital ward where patients on gurneys pack the hallway. Ironically, a completely vacant ward lies one floor below. The professor faces a six- to 12-month wait for PET scan, and doctors routinely call him by the wrong name.

This is not the stuff of fantasy. Health care in Canada is distributed by government and the result is chronic shortages (e.g. hospital staff, PET scanners). Vancouver's Fraser Institute issues an annual report detailing just how long government-created shortages force Canadians to wait for medical care.

The wait between referral from a general practitioner and treatment from a specialist now averages nearly 18 weeks -- over four months. The time between seeing a specialist and treatment is typically double what Canadian physicians consider "clinically reasonable," and many die waiting. Overall, waiting times got 90 percent longer between 1993 and 2003. Sometimes, increased government spending "was actually correlated with increases in waiting times," corroborating Nobel Prize-winning economist Milton Friedman's observation that putting government in charge of the Sahara Desert would soon lead to a shortage of sand.

These problems are not confined to Canada. In June, the Stockholm Network published a poll that measured attitudes toward health care in eight European countries with socialized medicine.

In Great Britain, 98 percent of citizens rate waiting times as "important." Yet only 18 percent said their National Health Service does a good job reducing them. The average across all eight countries was similar: about 95 percent rate wait times as important, while only 25 percent feel their system does well in this regard. Not surprisingly, a net 67 percent believe the quality of care would stay the same or get worse in 10 years, while a net 73 percent believe reform is urgent or desirable.

The Barbarian Invasions also captures the inequality of schemes that are supposed to provide equal care for everyone. As any good millionaire son would, this one takes his father to Vermont, where cash secures a PET scan with no wait. After the father refuses to be moved to a U.S. hospital ("I voted for Medicare! I'll accept the consequences!"), a series of bribes secures a private, well-furnished room in the vacant ward below.

Again, art imitates life. Health care in Canada is anything but equitable. The Fraser Institute reports low-income Canadians have less access to care and worse health outcomes, while "cardiovascular surgery queues are routinely jumped by the famous and politically-connected." Those who can afford it avoid waiting by purchasing care in the U.S.

Though it portrays much suffering, the film leaves open the question, who are the barbarians? A bureaucratese-speaking hospital administrator's initial and unconvincing reaction to a bribe -- "This is silly. We're not in the Third World" -- is suggestive.

Despite ample warning signs, some are trying to lead the U.S. in that direction. Sen. Hillary Rodham Clinton recently renewed her call for a government-controlled health care system. Sen. John Kerry, the presumptive Democratic nominee for president, has a health care reform plan that Sen. Clinton endorses as a good first step. Sen. Kerry's home state of Massachusetts has given initial approval to a constitutional amendment that would require such a system.

Unfortunately, Sen. Clinton won't have a chance to watch The Barbarian Invasions tonight, as she will be introducing her husband (and perhaps discussing health care) in a speech to the Democratic National Convention in Boston. But if watching political conventions isn't your cup of tea, you might rent The Barbarian Invasions to get an idea of what being sick would be like in the world Sen. Clinton envisions.

Revised: August 16, 2008 14:42 -0400, All Rights Reserved (c) Dr. Andre Kulisz 2002 - 2008