Want a free couch? Check the alley. How about a luxury car, cheap? Hover over Craigslist ads for a few months until a desperate seller unloads one. Want first-class tickets for a last-minute trip? Be prepared to pay a lot. Rule of thumb: quality, speed, price. You get to pick two, at most.
In health care, if you want good medical care but don’t want to pay much, expect to wait. That’s what they do in Canada, where the median wait time for a hip replacement is nearly five months. The median wait in England is three months. That’s not counting the patients who lost appointments during the physician strike in April. Both England and Canada have government-run health care systems that provide “free” services to patients.
By contrast, the medium wait time for a hip replacement in the United States is three weeks. The U.S. system is far from a true free market. At veterans hospitals, some patients are dying to get an appointment, literally. Patients enrolled in Medicaid are having a harder time finding providers who are willing to take new patients. Forty percent of orthopedic surgeons are unwilling to take new Medicaid patients, for example, because the government reimbursement rate for providers is low and paper work burdens are high. Although Medicare reimbursement is better than Medicaid, the proportion of doctors not taking new Medicare patients is higher than those not taking new privately insured patients.
Many Americans insured under the Affordable Care Act’s exchange plans face a similar dilemma. Just because they have insurance doesn’t mean they can find a provider who will take it. The exchange plans generally have narrower lists of participating doctors and hospitals than traditional, individual plans or employer-provided plans.
The problem is likely to get worse as insurers pull out of the exchanges. In Colorado, UnitedHealth has announced it will no longer participate in the state’s exchange. Turns out it’s more expensive to provide care than original projections suggested, even with government subsidies. Sicker patients are enrolling and some are leaving once they’ve gotten the treatments they want.
UnitedHealth is withdrawing from the exchanges in most states — and it isn’t the only one. Exchanges in Alaska, Alabama, and Wyoming now have just one insurer.
The laws of economics cannot be broken. When demand for services exceeds supply, prices rise. This signals more providers to enter the field or provides an incentive for existing providers to work more to meet the demand. Government cost controls, however, remove that incentive. The result is a shortage of willing providers. The result: wait in line.
Some Coloradans want to take the state out of the current, heavily regulated market (the frying pan) and toss us into a fully socialized system (the fire). The passage of Amendment 69 in November would put all Colorado residents into a government-run system similar to England’s.
This would have tragic repercussions. Waiting for a hip replacement is painful. Waiting for cancer treatments is deadly.
In spring 2014, I visited a dear friend fighting a losing battle with cancer in England. He had been misdiagnosed for months and experienced endless delays for MRIs and other diagnostic tests, and even surgery. When chemotherapy reduced his white blood cell count, doctors refused to give him a Neulasta shot, a drug routinely given to patients in the U.S. to rebuild the immune system during chemo. Because the NHS rations the expensive drug, he was denied. Instead, they suspended chemo.
When I arrived, he was sharing a hospital room with three other patients. He was waiting — yes, waiting — for a bed to open up in a hospice center.
Patients deserve better. We must reject increased government intervention in health care and move toward a patient-centered free market system with greater competition, innovation, and patient choice.
Krista Kafer (tokrista@msn.com) is co-host of “Kelley and Kafer” airing 4 to 7 p.m. on 710 KNUS and a professor of communication at Colorado Christian University.
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