I just completed reading Ensuring America’s Health Care by Christy Ford Chapin about the history of the development if America’s health care system. The book is very detailed about the evolution from AMA control to an insurance company model that is interlaced with decades of legislative initiatives. It is a big hot mess with perversions of incentives, market intrusions, and political opportunism. If you do not have the inclination to dive into this history I recommend an interview with the author by Russ Roberts at Econ talk here. I also recommend an interview with Kevin Smith on free market health care here, about his hospital in Oklahoma that bypasses our insurance model system and only takes cash at time of service.
To those who claim insurance is immune to market forces, I would suggest that the problem is that it is not. If a grocery store was required to get a certificate of need to open up a new store and the competitors got to make the decision what would likely happen to the price of food. What would happen if an association of grocers could determine who is allowed to sell food? What would happen to the price of your auto insurance of you filed a claim for oil changes and preventative maintenance? What happens to anything when you restrict supply and expand demand?
What happens when you believe that the government is the only choice capable of solving this extraordinary complicated problem?
One answer is in today’s Wall Street Journal, Where Do You Want to Get Cancer?
But the drugs require enormous investment and therefore aren’t cheap once they’re approved by the Food and Drug Administration. The United Kingdom’s National Institute for Health and Care Excellence has rejected immunotherapies because they were too expensive, though it has had to relent in some cases after patient protests.
Such government rationing and price controls on drugs are one major reason that countries with socialized medicine like the United Kingdom have lower cancer survival rates than the U.S. The age-adjusted cancer mortality rate is about 20% higher in the U.K and 10% higher in Canada and France than in the U.S. Survival rates for hard-to-treat cancers are also higher in the U.S. than in most countries with nationalized health systems.
According to a study in the journal Lancet last year, an individual diagnosed with pancreatic cancer between 2010 and 2014 had nearly twice the likelihood of surviving five years in the U.S. than in the U.K. The five-year survival rate for brain cancer in the U.S. is 36.5% compared to 27.2% in France and 26.3% in the U.K. For stomach cancer the five-year survival rate is 33.1% in the U.S. compared to 26.7% in France and 20.7% in the U.K.
Diagnostic and treatment advances in the U.S. are also accelerating. Google’s artificial intelligence can now detect breast and lung cancers with better accuracy—meaning fewer false positives and negatives—than radiologists. AI systems are also enabling researchers to identify more genetic links and to personalize treatments.
Even the report’s gloomiest news has a silver lining. Death rates for liver cancer are rising faster than for other forms of the disease, but Hepatitis C drugs could greatly reduce the incidence and have come down 80% in price since 2014. It’s also worth highlighting that the disparity in cancer death rates between blacks and whites declined to 13% in 2017 from a peak of 33% in 1993.
Do you really want the government allocating all of our health care expense?