Socialized healthcare systems around the world are invariably beset by serious problems such as rationing of care and medicines; the unavailability of cutting-edge drugs; long waiting lists; and the existence of a bureaucracy determining who merits treatment and who does not. Below is a brief overview of three socialized healthcare systems in other countries.
The British System
In July 1948, England established a National Health Service (NHS) that extended government-administered health insurance to all legal residents of the country. Within two years, more than half a million Britons were on waiting lists for hospitalization, surgery, and other forms of care, and some 40,000 hospital beds were taken out of service because of a nationwide nurse shortage. By 1960 the country’s hospital shortage had become so acute that hospitals routinely denied admission to the elderly and the chronically ill, who, once admitted, would have been difficult to discharge because their condition was so fragile.
- In British industrial centers, it was not uncommon for individual doctors to be responsible for the care of as many as 4,000 registered patients each. In many cases, these doctors were able to give each patient only three minutes of their time per visit.
- During the decades since then, the situation has not improved. As of 2008, more than a million Britons in need of medical care were on waiting lists for hospital admission. Another 200,000 were trying to get onto such waiting lists.
- According to the BBC, British patients face an average wait time of 8 months for cataract surgery; 11 months for a hip replacement; 12 months for a knee replacement; 5 months for slipped-disc surgery; and 5 months for a hernia repair.
- In many cases, the condition of patients with diseases that were curable at the time of diagnosis degrades to the point of incurability by the time treatment finally becomes available; other patients become too weak to undergo whatever surgical procedures had originally been recommended for them.
- Each year the NHS cancels approximately 100,000 scheduled operations.
- Most British hospitals are, by American standards, of poor quality. Up to 40% of NHS patients are undernourished during their hospital stays.
- The NHS bases its funding decisions on the recommendations of the quasi-governmental National Institute for Clinical Evaluation and Excellence (NICE), a panel that determines which patients merit preference over others in terms of the treatments for which they are eligible, medications they may be given, and how soon they may have access to a doctor. Because of cost considerations, NICE gives preference to young people over older people, and to healthy people over those with chronic disease or with destructive habits such as smoking or alcoholism. NICE is also explicitly tasked with limiting peopleâs access to many of the latest and most effective drugs, again basing its decisions on what it considers to be most âcost-effective.â
- In recent years, many native Britons have traveled to other countries to undergo major operations that doctors in their homeland lacked the time to perform. As of October 2008, more than 70,000 of these so-called âhealth touristsâ had procured treatment in at least four-dozen other nations.
The Canadian System
- Canada has operated a system of socialized medicine since the early 1970s. During this period, the country has experienced a severe nationwide doctor shortage. For example, more than 1.5 million residents of Ontario (or 12% of that provinceâs population) cannot find family physicians who have time to accept any new patients. Some provinces actually hold lotteries where a few fortunate winners are granted access to medical care that they otherwise would be unable to obtain.
- Between 1998 and 2008, approximately 11% of physicians who had been trained in Canadian medical schools relocated to the United Statesâmainly due to financial considerations. Because doctorsâ salaries in Canada are negotiated, set, and paid for by provincial governments and are held down by cost-conscious budget analysts, the average Canadian doctor earns only 42% as much as his or her American counterpart.
- Of Canadaâs approximately 34 million people, at least 800,000 are currently on waiting lists for surgery and other necessary medical treatments.
- Between 1997 and 2006, the median wait time between a referral from a primary-care doctor for treatment by a specialist increased from 9 weeks to more than 18 weeks.
- A study entitled Waiting Your Turn: Hospital Waiting Lists in Canada, conducted by the Vancouver-based Fraser Institute, reports that Canadian health care patients must wait, on average, 17.7 weeks for admission to a hospital.
- In a 1999 address to to the Canadian Institute for Health Information, Dr. Richard F. Davies, a cardiologist at the University of Ottawa Heart Institute, described how delays in treatment affected heart patients scheduled for coronary artery bypass graft surgery. Specifically, Davies noted that in a single year, â71 Ontario patients died before [being able to undergo this] surgery, 121 were removed from the [waiting] list permanently because they had become medically unfit for surgery,â and 44 left the province to have the surgery performed elsewhereâusually in the United States.
- In a 2004 article in the journal Health Affairs, researcher Robert Blendon and colleagues reported that in Canada, the average wait time for a 65-year-old man requiring a routine hip replacement was more than six months. By contrast, 86% of American hospital administrators reported that the average wait time for such a procedure in the U.S. was less than three weeks.
- In a July 2004 study, Fraser Institute researchers compared the health care systems of 28 industrialized countries belonging to the Organization for Economic Cooperation and Development (OECD). They found that while Canada spent more money on health care than any of the other countries in the sample, it ranked, on average, 24th in terms of such indicators as access to physicians, quality of medical equipment, and key health outcomes. Notably, before the government first took control of Canada’s health care system in the early 1970s, the nation ranked second in terms of these same indicators.
- In August 2006, Canadian doctors elected Brian Day president of their national association. A former socialist who counts Fidel Castro as a personal acquaintance, Day has nevertheless become perhaps the most vocal critic of Canadian public health care. He opened his own private surgery center as a remedy for the long waiting lists and then challenged the government to shut him down. âThis is a country in which dogs can get a hip replacement in under a week,â Day fumed to the New York Times, âand in which humans can wait two to three years.â
The Cuban System
- Leftists revere Communist Cuba for numerous reasons, not the least of which is the government-run, universal health care system that was put in place by Fidel Castro. Many of these admirersâamong the more notable of whom is the filmmaker Michael Mooreâform their impressions of the Cuban health care system from its tourist hospitals, which are, by any standards, clean, well staffed, and of excellent quality. Indeed Cuba, in an effort to attract wealthy foreign tourists who might be willing to spend their money on health care services, has pioneered the practice of so-called âhealth tourismâ through agencies such as Servimed, which markets Cuban medical services abroad.
- But hospitals for ordinary Cubans possess a dearth of even the most basic medicines and medical equipment. They have virtually no access to antibiotics, insulin, heart drugs, sphygmomanometers to measure blood pressure, sterile gloves, clean water, syringes, soap, or disinfectants.
- Cuban hospitals typically feature unsanitary conditions. Hospital gowns, linens, and towels must be provided and cleaned by the patients’ families. Poor sanitation is extended to the medical instruments handled by doctors and nurses; often these items are not properly sterilized and they remain soiled with traces of tissue and blood after their use. Syringes are frequently used to inject multiple patients without any sterilization, and âdisposableâ gloves are likewise used and reused. Consequently, infectious diseases are commonplace in the Cuban hospital population.
- Cuba’s health care system is a disaster not only for patients but also for physicians. Because of the meager salaries paid to Cuban doctorsâon the average 400 pesos per month (equivalent to $20 U.S.)âmany have quit the profession to seek jobs in the only industry that offers them any degree of economic opportunity: the Cuban tourism industry. Former doctors in Cuba can commonly be found driving dilapidated taxis, acting as tour guides, or even working in family inns as waiters or cooks. Those who choose to remain in the medical profession work long hours in dismal conditions.
- It is noteworthy that in the pre-Castro years of the 1950s, the Cuban population as a whole had access to good medical care through association clinics which predated the American concept of health maintenance organizations (HMOs) by decades, as well as through private clinics. At that time, the Cuban medical system ranked among the best in the world; its ratio of one physician per 960 patients was rated 10th by the World Health Organization. In addition, Cuba had Latin America’s lowest infant-mortality rate, comparable to Canada’s and better than those of France, Japan, and Italy.
