In this paper,
Introduction
as a partial safety valve for its overtaxed health
care system; provincial governments and
we examine 12
patients spend more than $1 billion a year on
Despite overwhelming evidence that single-
popular myths
U.S. medical care.8
payer health care systems do not provide high-
about national
quality care to all citizens regardless of ability to
In each of these countries, growing frus-
pay, proponents of socialized medicine tout
tration with government health programs
health insurance.
such systems as models for the United States to
has led to a reexamination of the fundamen-
emulate. Ironically, over the course of the past
tal principles of health care delivery. Through
decade almost every European country with a
bitter experience, many of the countries that
national health care system has introduced
once touted the benefits of government con-
market-oriented reforms and turned to the pri-
trol have learned that the surest remedy for
vate sector to reduce health costs and increase
their countries' health care crises is not
the value, availability, and effectiveness of treat-
increasing government power, but increasing
ments.1 In making such changes, more often
patient power instead.9
than not those countries looked to the United
In this paper, we examine 12 popular
States for guidance. About seven million people
myths about national health insurance. We
in Britain now have private health insurance,
have chosen to focus primarily, though not
and since the Labor government assumed
exclusively, on the health care systems of
power, the number of patients paying out of
English-speaking countries whose cultures
pocket for medical treatment has increased by
are similar to our own. Britain, Canada, and
40 percent.2
New Zealand in particular are often pointed
to by advocates of national health insurance
To reduce its waiting lists, the British
as models for U.S. health care system reform.
National Health Service recently announced
In amassing evidence of how these systems
that it will treat some patients in private hos-
actually work, many of our sources are gov-
pitals, reversing a long-standing policy of
using only public hospitals;3 the NHS has
ernment publications or commentary and
analysis by reporters and scholars who fully
even contracted with HCA International,
support the concept of socialized medicine.
America's largest health care provider, to
treat 10,000 NHS cancer patients at HCA
facilities in Britain. Australia has turned to
Myth No. 1: In Countries with
the private sector to reform its public health
National Health Insurance
care system to such an extent that it is now
second only to the United States among
Systems, People Have a
industrialized nations in the share of health
Right to Health Care
care spending that is private.4
Since 1993, the German government has
In fact, no country with national health
experimented with American-style managed
insurance has established a right to health
competition by giving Germans the right to
care. Citizens of Canada, for example, have
choose among the country's competing sick-
no right to any particular health care service.
ness funds (insurers).5 The Netherlands also
They have no right to an MRI scan. They have
no right to heart surgery. They do not even
has American-style managed competition,
have the right to a place in line. The 100th
with an extensive network of private health
person waiting for heart surgery is not enti-
care providers, and slightly more than one-
third of the population is insured privately.6
tled to the 100th surgery. Other people can
and do jump the queue.
Sweden is introducing reforms that will allow
One could even argue that Canadians have
private providers to deliver more than 40 per-
fewer rights to health services than their pets.
cent of all health care services and about 80
percent of primary care in Stockholm.7 Even
While Canadian pet owners can purchase an
MRI scan for their cat or dog, purchasing a
Canada has changed, using the United States
2