With the number of uninsured reaching 45 million, healthcare coverage has become one of the top domestic concerns in the United States, and many policymakers, including presidential hopefuls, advocate for expanded government intervention in order to provide every citizen with care.
However, switching to a socialized system may exacerbate problems rather than fix them, healthcare experts from Canada and Europe said Thursday at a panel discussion hosted by the Galen Institute and the International Policy Network.
Before rushing to make wholesale changes to its own healthcare system, the United States could benefit from observing conditions in countries that have already been down the socialized-medicine path, said Helen Evans, director of Nurses for Reform, a London-based advocacy group.
"As I look to the debate in the United States of America, I would urge you to use the market and not more state intervention to reform your healthcare system," Evans said. "Britain has had a pure government healthcare monopoly for much of the past 60 years, which has proven to be one of the greatest public policy failures in modern history."
Britain's current system has led to greater inefficiency, Evans said, pointing to the 10 percent of patients who acquire hospital infections during treatment. Other problems have also resulted, including waiting lists with more than 1 million people, with another 200,000 vying for spots at the bottom.
Other countries have also experienced adverse effects. In Sweden, some patients were sent to veterinarians to cut the number of people on waiting lists, and some individuals travel to neighboring countries for dental care, even though they continue to pay taxes for the public dental program.
As a result, several countries have moved toward reforms that allow for greater competition and market forces in the system.
"The current government in Sweden is making it easier to start healthcare companies and will allow public hospitals to be sold," said Johnny Munkhammar, program director of Timbro, a Swedish policy research institute. "Today, there is also an increasing number of people who buy private healthcare insurance and they go directly to private clinics."
A similar change has occurred in Britain, where more than 6.5 million people now have private medical insurance, and many more have private dental care.
Canadian public opinion has also begun to turn against the country's current healthcare system, said Brett Skinner, director of health and pharmaceutical policy research at The Fraser Institute in Canada.
"Canadians are currently witnessing the failure of their health insurance system and are beginning to reject it," he said.
Canada uses a single-payer system in which the government collects taxes and then pays all healthcare fees acquired in the country. The government prohibits citizens from bypassing the public program and paying for private healthcare, but a recent Canadian Supreme Court ruling may help open up markets for private insurers, Skinner said.
In 2005, the court struck down the single-payer system, ruling it violated citizens' rights to take care of their health because waiting lists prevented them from seeing doctors. Although the ruling only applies to the province of Quebec, similar cases in other provinces, currently being decided, may expand the precedent.
The United States spends far more per capita on healthcare than any other developed nation, and some policymakers have suggested a shift to a more socialized system might help lower costs.
However, the price disparity between healthcare services in the United States and those in other countries may be a signal of lower quality and limited access to care, panelists said.
"The truth is, if Canadians had access to the same quality and quantity of healthcare resources that American patients enjoy, the Canadian single-payer health insurance system would cost a lot more than it currently does," Skinner said.
In 2003, Canadian patients received only half as many in-patient surgical procedures as Americans did, and the average hospital in Canada's largest province, Ontario, was 31 years older than the average hospital in the United States.
While getting rid of market forces entirely may not be a wise solution, allowing them to run wild won't result in positive benefits either, said Len Nichols, director of the health policy program for the New America Foundation, which advocates expanded healthcare coverage for Americans.
"We need to make the markets work for everybody," Nichols told United Press International. "For that to work, you need government mandates."
The United States, which has a mixed system of public and private healthcare providers, could benefit from more government direction, Nichols said, because markets don't always work in the consumer's favor.
"Markets aren't given of God," he said.
Insurance markets, for example, can work against older patients or individuals with chronic diseases because of adverse selection, said Nichols, who was an architect of healthcare reform plan proffered by Hillary Clinton in 1994.
Government could improve healthcare by providing incentives for healthy living and research on best practices in medicine, he said.
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