What Michael Moore left on the cutting room floor

http://www.chicagotribune.com/news/opinion/chi-oped0626sickojun26,0,7362264,print.story?coll=chi-newsopinioncommentary-hed

By Helen Evans, director of Nurses for Reform, a pan-European network of nurses dedicated to consumer-oriented reform of European health-care systems

June 26, 2007

Michael Moore's denunciation of America's health-care system is about to hit the silver screen. In the film's trailer, a desk attendant at a British hospital smiles while explaining that in Britain's National Health Service, "everything is free." But for free hospital care, Britons pay an awfully high price.

Just ask the nearly 1 million British patients on waiting lists for treatment. Or the 200,000 Britons currently waiting merely to get on NHS waiting lists. Mr. Moore must have missed those folks.

Curiously, though, many American policymakers seem to think that a government-managed, NHS-style system is the answer to all of America's health-care woes. Before heading down that road, however, America's leaders ought to actually investigate Britain's experience with state-sponsored medical care.

Upon launching its state health service in 1948, the British government promised that it would provide its citizens with all the "medical, dental and nursing care" needed, so that "everyone -- rich or poor -- [could] use it." To make good on its plans, the government nationalized more than 3,000 independent hospitals, clinics and care homes.

But today, after nearly six decades of attempting to make socialized medicine work, the NHS is in a perilous state.

Consider waiting lists. Across Britain, patients wait years for routine -- or even emergency -- treatments. And many die while waiting.

Indeed, the NHS cancels around 100,000 operations because of shortages each year. In a growing number of communities, it is increasingly difficult for people to simply get an appointment with an NHS general practitioner for a regular checkup.

Further, when it comes to keeping patients healthy, NHS hospitals are notoriously unfit. After admittance to state hospitals, more than 10 percent of patients contract infections and illnesses that they did not have prior to arrival. And according to the Malnutrition Advisory Group, up to 60 percent of NHS patients are undernourished during inpatient stays.

Consequently, many Britons have turned to outside practitioners for treatment, and the private health-care market has boomed. Today, more than 6.5 million people have private medical insurance, 6 million have cash plans, 8 million pay out-of-pocket for a range of complimentary therapies, and 250,000 self-fund each year for private surgery. Millions more opt for private dentistry, ophthalmics and long-term care.

Meanwhile, despite the state's continued claims that it can deliver quality health care to all, government ministers are increasingly willing to quietly outsource health care to the private sector. In other words, instead of directly providing health care through the NHS, the British government is shifting to simply paying the bills.

In 2000, Tony Blair's government authorized the treatment of state-funded patients in private hospitals for the first time. More recently, the government has made it clear that it would like all NHS hospitals to be recast as Independent Foundation Trusts able to attract private investment.

But even with these efforts, the British government has found it hard to cover its expensive obligations. So in addition to waiting lists, substandard care and increased outsourcing, the government has adopted outright rationing to control costs.

Through a concept called "Health Technology Assessments," the United Kingdom now empowers government-appointed experts to dictate which drugs, procedures and treatments are available for public consumption. Charged with controlling costs and watching the bottom line, these bureaucrats are expected to save money -- not lives.

Already, this system has barred the purchase of Herceptin, a lifesaving breast-cancer drug. Alzheimer's patients have had trouble obtaining Aricept, a drug that improves cognition in those afflicted with the degenerative disease.

The criteria for these denials of care are kept from the public. And patients who could be saved needlessly die.

Rationing, as history proves time and again, is always a recipe for horror.

The U.S. health-care system certainly has its shortfalls. But the solution to America's woes can't be found in the U.K. -- no matter how many movie tickets Mr. Moore sells.

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Helen Evans is director of Nurses for Reform, a pan-European network of nurses dedicated to consumer-oriented reform of European health-care systems.