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PDF versionLessons from Abroad to America on Universal Health Care
Mar. 05, 2010
Douglas Kmiec (CNS photo)
When the President’s extraordinary discussion of health care at Blair House was concluding, it was just beginning here in Malta. For several intensely interesting hours thereafter, the U.S. Embassy engaged in an equally extraordinary bit of reverse public diplomacy; that is, America was the student, and this ancient island civilization was the teacher.
As America’s Ambassador here with a penchant for trying to combine an inquisitive academic mind with newly grafted diplomatic effort, I invited the “best and the brightest” of the Malta medical fraternity (and they are legion, including having one of their own as cardiovascular chair at Mayo) to do a thorough public comparison of the universal health care system in Malta with the President’s far more modest, but important, effort at providing health care to millions of uninsured.
Malta has had universal health care for generations, and the discussion took place in the sprawling and new teaching hospital – Mater Dei. That’s right, in Catholic Malta, the public hospital is not at all bashful about acknowledging the mother of God – in name, and as discussed, medical deed.
While it was determined by the distinguished group of doctors and medical faculty and health care administrators that we assembled that the President should build in more cost-containment into his proposal, especially efforts to root out fraud. It was therefore gratifying to see the President build in the Republican suggestions of undercover spot checks.
The medical team here, however, had many more suggestions, including utilizing a single coding and claim form across insurance firms to avoid double billing and unneeded testing. There was a good deal of support as well for moving quickly to a health card that would have billing and medical history immediately available for continuity of treatment and administratively simplified billing.
Much was said about addressing the quality of care, too. The quality of care is very high – much higher – in Malta where health care is a matter of social justice, than in the U.S., which ranks lowest in quality of care among the industrialized nations, and somewhere between Chile and Cuba on measures of successful and satisfying treatment. Frankly, the lackluster record of America in longevity, infant mortality, and disease prevention will need to be addressed very quickly after the Obama measure is enacted.
Putting cost and quality to one side, my Maltese hosts discerned that there is no escaping the fundamental choice: either Americans are willing to help their young and their elderly and their less well off fellow citizens or they are not; either Americans who proclaim loudly respect for life when life is of pinpoint size in utero (a matter of enthusiastic and prayerful approbation here) will likewise affirm the life and health of born men, women and children or they will not. This is the ultimate and unavoidable question – no matter how many times the opposition says the problem is just too big -- for them at least -- to handle.
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Malta is, as already noted, a highly Catholic country, and as spring arrives, the country is abuzz with happiness at the April visit of the Holy Father. He will find abortion is unlawful. Period. Yet, even the most adamant “no exceptions” doctors and nurses here are chagrined by the hypocrisy of how some in Catholic circles in the U.S. continue to hide behind abortion as an excuse for ignoring the plight of those needing care.
The medical ethicists here had a difficult time perceiving how theories of illicit moral cooperation could be stretched to the breaking point to suggest that abortion would be taxpayer funded under the President’s proposal, when any abortion coverage was wholly a function of private choice (which they and I disapprove), but which all must acknowledge exists now as a matter of law.
The law needs changing, the Maltese professionals insist, but it seems a tired and illogical argument to block needed help for that reason even to a culture that has resisted the harsh conditions and hard-heartedness that aid and abet abortion in America.
The President argues that his legislation does not support taxpayer funded abortion and insofar as the Hyde standard is the appropriate metric, and why would he not think that to be? – his legislation is abortion neutral.
Federal dollars do not pay for abortion under the President’s proposal, even as individual citizen dollars tragically still would. It is my view that no dollar, public or private, should be expended to expunge an unborn life. It is also my view that it is not pro-life to let those in need of surgery or prescriptive medicine to go without even the most rudimentary treatments just to demonstrate the claimed wrongfulness of a Supreme Court decision.
The most poignant statement in favor of President Obama’s leadership occurred near the end of the forum at the medical school. One doctor put it sadly, but bluntly, “you know, Mr. Ambassador,” he said, “in Malta we train for medicine because it is a unique way to be needed; to be of service, and in that service, we are fulfilled.” John Paul II, who visited Malta twice during his papacy said it well: We find ourselves by giving ourselves to others.”
In the provision of universal health care, the Maltese have taken this message and given it “life to the full.” Said one of the teaching faculty: “We do not train in medicine to be paid well in excess of our needs or of our countrymen. We frown on those who see hospitals or pharmaceutical or life science research and development, as profit—rather than people – centered. It is a question of empathy, really. We always saw our American brothers and sisters in that way, and we certainly still think of you as problem solvers. You are, aren’t you?"
Indeed, we are – or at least we can be.
Douglas W. Kmiec is U.S. Ambassador to the Republic of Malta; he is on leave from Pepperdine University, and these views are his own not necessarily those of the United States or his university.
You are wrong, of course.
You are wrong, of course. The current proposal, based on the Senate version tries to hide it, but in reality does pay for abortion. Even Democratic members of Congress (who are opposed to abortion) say so. The real proof is the determined resistance to put the Stupak Amendment in the Senate version.
The reality is, that if the President, and the Senate, had been willing keep things at the status quo regarding abortion (as they say they are) and include the Hyde Amendment language in the bill, the pro-life Democrats (and the Bishops) would have supported health-care and this bill would have passed by now.
Very interesting and
Very interesting and thoughtful! Thank you.
Thank you Doug Kmiec for a
Thank you Doug Kmiec for a courageous, well written article that I hope will encourage those in the church who agree with you to speak out in support of health care coverage for all. I also hope it will challenge those in the church who are afraid of how such changes will affect their insurance coverage to trust in Christ's word to us to "Be not afraid, but have faith".
I would add that to hold health care reform hostage in order to gain some leverage in the struggle to end abortions persists in seeing the solution for stopping abortion as linear- There are other factors that affect abortion--one of them is having the health care coverage for the pregnancy and the child. A vote against health care reform could be seen as a vote that would increase abortion rates. as insurance rates continue to climb and fewer people are insured.
We should be pursuing all the avenues that can bring down the rates of abortion, including , but not limited to changes in the law. But I would add- that when our pursuit of changing the law, occupies our time, energy, money, and public discourse- to the neglect of our mission to be and bring Christ to those who do not know Him- we miss the most substantial way to reduce and end abortions- and that is by converting hearts and minds to Our Lord Jesus Christ.
There are no easy answers on how to deal with such complex matters as much as we would like them -- But as Catholics we know Christ is the True and Final Word. I pray we cling to Him, so that we can discourse on these issues in a manner worthy of His Name and, empowered by His Spirit and love for us all, we abide in His will.
Ambassador Kmiec seems like a
Ambassador Kmiec seems like a nice man. His writing will often have a conciliatory and earnest tone. But unfortunately when discussing issues such as health care, his analysis typically veers toward sentimentalism and even at times has a credulous quality about it. His advocacy for “universal coverage” invariably implies government control of health care.
Never mind that the details of the Democrat's health care legislation are an incompressible tangle of market distorting government mandates, taxes hikes, subsidies, and other central planning mechanisms that will further transfer health care decision making away the consumer to the bureaucrat. The Ambassador requests that we put the issue of "cost and quality aside" to consider the notion that more government translates to more communal benevlence toward the individual. The glaring problem with his logic is that if the current bills are implemented, then we can expect to see resources misallocated on a grand scale and the American medical sector will commence a long slow descent into mediocrity and lowered expectations of quality. This will not help the average individual. Much time is spent on the existing shortcomings of the partially private U.S. system. Let’s review a few items from some of the government run systems that allegedly have “universal coverage”:
1) In the U.K. consumer evaluations show that 65% of patients report that their doctor visits are shorter than 10 minutes. Of this number 31% report that a doctor visit is typically less than 5 minutes long. The U.K. system moves people through doctor offices like cattle. One is hard pressed to imagine a less than five minute doctor visit as quality medical care. (a)
2) “A mountain of evidence points to rationing in government controlled universal health care systems (which leads to a) shortage of doctors, nurses and beds (and difficulty with obtaining treatment)…In the estimation of the World Health Organization, 25,000 British cancer deaths per year would not have occurred in the United States.”(b)
3) The U.S. media usually does not write about the scandals that occur within the U.K. health system. Last year it was reported that between 2005 to 2008 up to 1,200 people died at one government run hospital in Stafford due to patient neglect, filthy conditions and under staffing. Patients were frequently left in soiled bed clothes, suffered malnourishment and left untended in their rooms by hospital personnel Doctors cite that they were frequently intimidated by administrators to discharge sick patients to keep down costs. One doctor said that "the patients are clearly aware that our main intention is to get them out of hospital at the first opportunity." The Stafford hospital simply stopped publishing patient evaluation ratings when they fell below acceptable levels.(c)(d)(e)
4) A Canadian study reports that “In 2007 an estimated 1.7 million Canadians were unable to find a regular family physician” and "median wait times (to see a doctor) in Canada are almost double the wait that physicians consider clinically reasonable." (f)
5) A Canadian study reports that in 1970 Canada had the second highest doctor to patient ratio among OECD countries. But due to government policies Canada’s doctor to patient ratio has plummeted to 23rd among OECD countries. (g)
6) It is well known that Canadians will leave their country to receive medical care – typically to the U.S. One study estimates that the number of people that fled Canada for treatment elsewhere increased by 23% from 2008 to 2009.(h) A recent notorious case was when Danny Williams, the Premier of Newfoundland went to Florida for heart surgery. Indignant Canadian doctors insisted that they had the capabilities to treat the premier. Mr. Williams said that although “he has the utmost confidence in our (Canadian) health care system” his doctors advised him that it as in his best interests to go to the U.S. for his treatment. (i)
7) In 2007 an estimated 70,000 UK citizens left their country to receive needed medical care in other countries. (j)
8) Meanwhile “universal” does not mean equal access. An English study has concluded that, “social inequalities in health care continue to be a major (and increasing) problem.” A politically well connected Englishman will often receive superior care than a mere common individual. Meanwhile, data shows that people in Canada of lower socio-economic status receive much lesser care than a wealthier Canadian in areas that require special treatment such as cardiovascular diseases. (k) A study by the Institute for Clinical Evaluation Sciences showed that wealthy residents of the province of Ontario were 38% more likely to receive an MRI than a poor Canadian. (l)
9) An OCED study that reviewed the problem of long waiting times for surgical services in government run European health care systems noted that government bureaucrats will intentionally plan for medical scarcity, "because of the combination of opportunities for government to squeeze capacity, in the interests of saving public expenditure, and the absence of activity-related financial incentives for providers.” (m)
The above examples are endemic to central planning and are a direct result of government mandated scarcity to control costs. In the U.K. and Canada the health care systems are primarily top down government centralized control and consumers have little say when bureaucrats reduce medical access. The goal of government health care is not to provide exceptional care to the individual person but to provide cost effective care for the collective masses. (n) Government control of health care has always been and always will be an incredibly bad idea – even if it is advocated by a nice man like Ambassador Kmiec.
Footnotes
(a) Regina E. Herzlinger, Consumer Driven Health Care, San Francisco: Josley Bass 2004, p. 180 to 181
(b) Ibid p 180
(c) "Families call for criminal investigation over Stafford Hospital”, The Sentinel, 3/18/09
(d) Martyn Halle, "Doctor tells MPs of intimidation at Stafford Hospital", Telegraph Media Group, 6/13/09
(e) Rebecca Smith, "Bosses at Scandal-Hit Stafford Hospital Escape Scot-Free", Telegraph Media Group, 2/24/10
(f) Brett J. Skinner, “Realities of Health Policy in North America: Government is the Problem, Not the Solution”, Fraser Institute, Vancouver, British Columbia, V6J 3G7 Canada, 2008, p11
(g) Nadeem Esmail and Michael Walker, “How Good is Canadian Health Care? 2008 Report”, Fraser Institute, Vancouver, British Columbia, V6J 3G7 Canada, December 1, 2008 p 54
(h) “Fraser Forum”, Fraser Institute, Vancouver, British Columbia, V6J 3G7 Canada, February 2010, p 18 to 20.
(i) “Gold Medal Mess”, Investors Business Daily, 2/23/10
(j) D. Huddleston, “Inequalities in Socialized Medical Care”, American Thinker Magazine, 2/23/09
(k) Herzlinger p. 181
(l) Huddleston
(m) Jeremy Hurst and Luigi Siciliani’ “Tackling Excessive Waiting Times for Elective Surgery: A Comparison of Policies in Twelve OECD Countries” , OECD Working Papers 2003, Directorate for Employment, Labour and Social Affairs, Paris, France, JEL classification: I11, I18, H4. The OECD is based in Paris, France, and publishes international economic and social data.
(n) Huddleston
1) There is a typographical
1) There is a typographical error above in my 3/7/10 posting: the word “incompressible” in the second paragraph should be “incomprehensible.” Although a typo, I looked up some synonyms for “incompressible”. Words with similar meanings include “impenetrable”, “impervious”, and “rigid”. Maybe it is not such a bad word to use when discussing Mr. Obama’s “health care reform” initiative since the 2,100+ pages of current legislation is “impenetrable” to understanding, “impervious” to logic,and will create a "rigid" national structure that will result in very expensive mediocrity.
2) Below is an interesting but sort of depressing vignette by sociologist Charles Murray on the mediocre quality of services provided by the federal government:
“As a senior citizen, I am privy to arcana that you youngsters are not. Namely, I recently obtained my very own personal Medicare card. Listen up. Your wallet is stuffed with sturdy plastic credit cards or laminated identification cards, many with photographs and lots of encoded data. Even the basic cards you might get from your county (library card) or state (driver’s license) are probably close to state-of-the-art. You want to know what a Medicare identification card is like? It is a little larger than the standard size for credit cards and driver’s licenses. (Of course. Couldn’t have the federal government make a card that will fit in a stack with all the other cards you use.) It has no magnetic strip. It is plain vanilla text and fonts—no security features whatsoever. It could be counterfeited by a sixth-grader with a scanner. It is made out of flimsy paper that would barely qualify for a really cheap business card. This, for Medicare benefits, for Pete’s sake. It’s pathetic.
Actually, it is shoddy and incompetent, as are so many things that the federal government does.” (a)
FOOTNOTE
a) Charles Murray, “You want to know what Health Care will be like when the Federal Government Runs It?, AEI blog, 7/1/09
The World Health Organization
The World Health Organization ranks healthcare systems based on outcomes. The holder of the #1 spot is FRANCE, which has a SINGLE PAYER SYSTEM. Abortion is an immoral act worthy of our attention, but this article is correct when it notes that many American Catholics hide behind abortion. In our country, the primary function of the Catholic church is to carry the water for the Republican party. This is Christ’s church? Christ’s church doesn’t bat an eyelash when 90% of tax revenues are spent on the machinery of death? Christ’s church does nothing to force the government to stop the poor and wretched from dying in our streets? Christ’s church has decided that centralized political authority is inefficient and ineffective (a truly outrageous stance for members of the Catholic Church!) and that the invisible hand of the market will cure our societal ills? I would like note that those who howl at the horrors of bureaucracy never point the finger at the military, the largest bureaucracy in our government. A bureaucracy best known throughout world for their “collateral damage,” a polite way of saying, “oops we just killed 30,000 civilians, 30,000 non-combatant children of God”. Our imperial violence marches on, unchecked by the body of Christ, but when it comes to providing healthcare to all people then these “Good Catholics” are roused into action to speak out against it. Apparently the Catholic Church carries the water for the insurance industry as well. The Church was purchased with the blood of martyrs and now “Good Catholics” expend their energy keeping healthcare from the poor and desolate. Look at the shambles that is our healthcare system. I am sure it looks awfully nice to those in the upper middle class, hiding somewhere in suburbia. Guess what, out here in the city I have seen dead people on the street. That is what an unchecked free market delivers, dead people in our streets. In a time when the middle class is moving into extinction, is the best move to make sure only the privileged receive healthcare? That is justice?? If that is the case Christian charity is as good as a knife in the back. This is why I am done with the Catholic Church in America. I can only stomach so much hypocrisy.
“I was naked, and you gave me clothing. I was sick, and you cared for me. I was in prison, and you visited me.” Matthew 25:36
I have to say that the
I have to say that the universal health care system in Malta is excelent. Actually, it's in almost all European countries. France also have very good health care system, and many hospitals in Paris work very well. I think that health care system in Europe is much better then in USA.
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