Debunking Republican Healthcare Myths: Wait Times & Rationing

 

Thumbnail photos: アラツク/Wikimedia Commons; Marta Cuesta (creades)/Pixabay

 

Whenever the topic of healthcare comes up and a right-winger is within earshot, assuming that he's not too busy calling somebody a "cuck" online, an argument that you'll invariably hear made against publicly-financed healthcare is that such systems lead to the twin problems of intolerably long wait times and an unacceptable rationing of care.

Here, I'm going to take a very close look at this subject, examining the data from a variety of countries in several key areas of healthcare. I'm not going to be hiding from any data or inconvenient facts to make my position look better; instead, I'm going to do my best to provide a very thorough and honest examination of how the different healthcare systems on offer compare to one another in terms of wait times and rationing.

We will be looking at a lot of different numbers here, and I'm not sure why I feel the need to plant that warning here, because how the fuck else do you expect to investigate the subject without examining the data? But, in case you're worried that this is going to be nothing more than a bland recitation of statistics, I'm also going to make some general points on this subject as well as debunk some of the flaws and shortcomings in the right-wing arguments that I come across. And, as always, I'll be sure sprinkle in a healthy dose of mediocre and offensive jokes.

We hear an argument on this subject being made in a Steven Crowder video entitled "The TRUTH About Universal Healthcare! (from a Canadian)." In this video, he goes undercover using a hidden camera to expose the grisly details of the Canadian healthcare system. Given that this is Steven Crowder we're talking about, frankly I'm surprised that he didn't dress up in drag for the occasion! Maybe we'll see that in part 2 of this video?: "Steven Crowder Undergoes Sex-Change Operation To Own The Libs—Forced To Wait 5 Months In Canada!"

In his video, he drops the following statistics:

 

"Consider that the average wait time to see a specialist in Canada is 17.3 weeks, and that as of 2008, over 2.8% of the country's popuation are on waiting lists to receive special treatment, and there are bound to be a few unhappy campers!"

 

A big problem I have with the approach many conservatives take is that they'll look at a specific example like this and assume that this is the norm in more-progressive healthcare systems. An examination of the data, however, will show that Canada happens to have the very longest wait times in this particular area.

(For simplicity's sake, I'm going to classify a nation's healthcare system into one of three categories in this video: public, private, or mixed. There's obviously a lot more nuance to each country's system, but if you're looking for a dissertation on their complex differences, you're not going to find it here.)

In 2016, the Commonwealth Fund collected healthcare data from 11 countries, and on the specific question of specialist wait times, they found the following: Canada, with its public system, does, indeed, have long wait times: 59% of patients waited at least 4 weeks to see a specialist—compared to only 25% of patients in the United States with its private system.

(Healthcare classifications & highlights added by me)

How did some of the other countries on the list perform? In Switzerland, which has a private system, only 26% waited at least 4 weeks. We also see low percentages from Germany and the Netherlands, both of which have a mixed system, with 27% waiting at least 4 weeks to see a specialist in Germany compared to 29% in the Netherlands.

On average, countries with public healthcare systems do have the longest wait times: For these 4 countries—Canada, Norway, Sweden, and the UK—an average of 50% of people waited over 4 weeks to see a specialist. For mixed systems—which we see in Australia, France, Germany, the Netherlands, and New Zealand—the average was 37%. So in this particular area of specialist visits, the United States does perform better than public or mixed systems do, on average.

However, two countries with mixed systems do perform just as well as the United States does, so this seems to indicate that a private healthcare system is not necessary for short specialist wait times.

Another argument of this kind was written by Aaron Bandler of The Daily Wire:

 

"The Left has a penchant for constantly citing Britain's National Health Service (NHS) to support their clamors for socialized medicine. However, the NHS is failing . . . Patients face exorbitant waiting times. A report from the Patients Association found that 'tens of thousands of' patients seeking routine surgeries had to wait over 18 weeks . . . Additionally, more major operations, such as hip and knee replacements, had average wait times of over 100 days."

 

It's important to point out that they're talking about surgeries for non–life threatening conditions here. If you need emergency surgery in the UK—let's say you get wheeled in on a stretcher with 15 stab wounds and you're on the brink of death—they're not gonna be like: "Alright, let's add him to the bottom of the list! See you 100 days from now, asshole—assuming you haven't died by then! *doctors diabolically laugh together like supervillains*"

No, if it's an emergency, you're gonna get treated right away, and the surgeries are clearly getting prioritized based upon the urgency and importance of the surgery. And I've got news for you conservatives: the same thing happens in the United States!

Let's look again at the Commonwealth Fund study: In the US, 4% of patients waited 4 months or longer for non-emergency or elective surgery, whereas 32% waited between 1 and 4 months. By comparison, in the UK, we found that an identical 32% waited 1 to 4 months, whereas 12% had to wait 4 months or longer. So while he frames these wait times in the UK as an outrageous scandal, when you compared the UK against the US, all we're really talking about is a minor difference of 8%.

How do some of the other countries do this in area? Let's start with the public systems. As we can see in the table, they don't do terribly well, averaging 14% of people who wait 4 months or longer. For the mixed systems, we see an average of 6% of patients waiting 4 months or longer; France and Germany have only 2% and 0% who wait this long.

Another way to look at this data is to ask: What percentage of people wait less than 1 month for elective surgery? The US leads the pack at 61% followed closely by Switzerland at 59%. Australia comes in at third with 57% and France comes in at fourth with 51% waiting less than 1 month for non-emergency surgery.

So, once again, the conclusion we can reach from this data is that, on average, public systems have the longest wait times, with mixed systems having shorter wait times—only slightly longer than those seen in the United States and Switzerland with their private systems.

In a way, Bandler sort of answers his own question in his article: In one section he describes the exorbitant wait times in the UK, and in another, he points out that "the NHS is facing staff shortages." Couldn't that be partially responsible for the long wait times? If there are fewer doctors available to see patients, clearly there's going to be a longer waiting line formed behind each one of them—and that means more time spent in the lobby flipping through a car magazine that 15 people have coughed on that day.

(By the way, is that not the dumbest fuckin' idea you've ever heard? Shared reading material for sick people to take turns touching and holding in front of their face? The hospital staff is like: "Hang on a sec, we gotta change that weird paper thing that you sit on while you wait for the nurse; let me put on some gloves and here's some hand sanitizer for you to apply, and on your way out, make sure that you sneeze on the one newspaper that's available today.")

Anyway, how would privatization alleviate the problem of NHS staff shortages? This is a question that Dr. Bob Evans explores in a panel discussion on healthcare.

 

"Interviewer: But what we hear is if there are 100 people on a wait list, and 10 of them can go to the private surgery clinic, now there are only 90 people waiting for public healthcare, so what's the problem?

Dr. Bob Evans: And at the private surgery clinic, they will get care from the same doctors. It would be different if doctors were not working on both sides of the street, but they are! That's the point! When you have a two-tiered system, you steer patients who can afford to pay to the private side, and then you charge them more. The United Kingdom has demonstrated this ever since the introduction of the National Health Service in 1948.

And it's normal, economic behavior. You'd do the same thing unless you were sort of, more charitably inclined. Say, 'well, I've got a group of people on this waiting list who have money, and they're willing to pay me, and I'm gonna see them now.'

And I'm not gonna create new hours in the day from which I can now see these people privately and see patients as expeditiously in the public sector. There's kind of a notion here that, somehow, if you privatize part of the delivery system, doctors will appear from Mars!"

 

This, I think, is a very interesting argument. However, one counter-argument could be that by privatizing the system, in part or in whole, since doctors could charge more, this might incentivize more people to become doctors in the first place because of the prospects of making more money. This is certainly possible, although I would like to see some empirical support for this idea.

And not that I'm opposed to private, supplementary care, but I don't see why such a problem couldn't be dealt with within a public system: If staff shortages are a problem and higher pay would reduce the problem, why not just increase pay within the public system? You might say: "Aha! But that means taxes are gonna have to be raised!" And? If doctors are making more money under both systems, at the end of the day, you're going to pay for it either through your tax dollars or through your out-of-pocket spending.

Something you'll notice when you read conservative writing on this question—aside from "Wow! This is trash!"—is that they will present you with a statistic on wait times in a certain country, but they often won't compare it to anything. They simply throw out a statistic in isolation and say "Oh my goodness! How terrifying!"—without even showing us that it's dramatically worse than the system we have in the United States, and without demonstrating that this is the norm under public healthcare systems. Perfect example of this from Aaron Bandler of The Daily Wire:

 

"Here's what the NHS had to deal with right before January 1 . . . Nearly a quarter of [accident & emergency department] patients [in the UK] waited at least four hours to be seen"

 

Ok, and how does this compare to wait times in the US, or wait times in other countries with public or mixed healthcare systems? All he's doing here is looking at this one piece of data in isolation. The title of his article is: "7 Things You Need To Know About Britain's Failing Nationalized Health System." It's a failure in comparison to what? Clearly he means in relation to some alternative healthcare system, but no data is presented to show that his preferred system excels in this particular area! So this is basically a comparative analysis without the comparative analysis.

Commonwealth Fund data from 2016 shows that 8% of ER patients in the UK waited for 4 hours or more. In the United States, however, 11% of ER patients waited 4 hours or longer. So Bandler points to this data from the UK as proof that their healthcare system is a faulty one that we shouldn't seek to emulate, yet the very data that he's using to make his case shows that this is an even worse problem in the United States! Using his own logic here, shouldn't we conclude that the US healthcare system is an even greater failure than the one of the UK? And shouldn't a person using data to support their case make sure that the data actually does support their case?

Other countries on the list fare even better when it comes to ER wait times: In France, Germany and the Netherlands, the percentage of people that waited 4 hours or more were 2%, 3%, and 4%, respectively.

Another way to look at this data is to ask: What percentage of people waited less than an hour in these countries? The highest percentage was seen in the Netherlands, where 65% of people waited less than one hour. This was followed by 59% in New Zealand, 58% in France, 57% in Switzerland, and fifth on the list was the United States where 55% of people waited an hour or less in the ER.

An average of 18% waited 4 hours or more in public systems versus 6% in mixed systems. Compare this to private systems, where an average of 9% waited this long. Yet again, public systems have the longest wait times, although in this area, mixed systems actually outperform private systems (and the United States in particular.)

Perhaps you're asking yourself, why the discrepancy in the data? Why does the Commonwealth Fund data say only 8% of UK ER patients waited 4 hours or more, whereas this Daily Wire data indicates that nearly 25% waited this long? Well, that's because Aaron Bandler, not surprisingly, is very selectively cherrypicking a one-week period that he can use to best smear the UK's healthcare system. As we read on the source that he links to for this claim, DailyMail.co.uk, this data is "for the single week leading up to January 1."

NOBODY who's interested in seriously analyzing the performance of a healthcare system would restrict themselves to looking at a single one-week period—especially the one-week period that overlaps with some of the year's major holidays.

Christmas and New Year's time—the week during which this data was collected—is a time when people are stuffing themselves full of all kinds of unhealthy foods, drinking large amounts of alcohol, using knives to cut open the plastic packages around their many gifts, surrounding themselves with unbearable family members who make them want to blow their brains out, and so forth, so it's reasonable to assume that this is going to be a time of the year when hospitals are getting a higher influx of patients than normal—and thus, we'd expect longer wait times than normal.

It strikes me as deceptive to show this data without explaining that, at this time of the year, hospitals see many more ER patients than normal. Bandler did write "Here's what the NHS had to deal with right before January 1," but he doesn't provide the crucial caveat that this data is not representative of how the UK healthcare system generally functions, and that's just inexcusable.

There's also every reason to believe that we'd see a similarly high rate of long wait times in United States ERs around this same time of the year. As they write on MedicalCityHealthcare.com,

 

"'I only eat like this around the holidays.'

'I don’t drink very often, but there are so many social functions this time of year.'

. . . Any of these sound familiar? They do to virtually every ER doc in the United States, some of whom coined the term 'Christmas Coronary' to describe the more than 30% increase in heart attacks and heart-related problems that occur in the winter — specifically on Christmas, the day after Christmas and on New Year’s Day. That’s because many Americans celebrate the holidays with sudden binges of alcohol and food that puts added stress on weakened hearts."

 

Looking at the year-round data is much more informative, and actually comparing this data between the countries shows that the United States does not reign supreme in this area.

We see a similar pattern of foolishness repeat itself in a Daily Wire article written by Hank Berrien, where he quotes The Daily Telegraph writing the following:

 

"'The NHS figures show the number waiting at least a week to see their GP has risen by 56 percent in five years, with one in five now waiting this long.'"

 

Hey, at least he's not self-servingly cherrypicking the very worst data from a one-week period! Maybe the next time they're swapping shitty ideas in the break room, he can give his colleague a couple of pointers in this area?

Once again, you'll notice in the article that this data is not compared against data from any other country. If you actually did look at the numbers in other countries, you'd see that these numbers are not significantly greater than those we see in the United States.

The 2016 Commonwealth Fund data shows that, in the UK, 15% of patients had to wait 6 days or longer to see a doctor. By comparison, 16% of patients in the United States waited 6 days or longer. 5% in the UK waited 2 weeks or more compared to 7% in the US. So once again, data is being cited in an attempt to discredit the UK's healthcare system, yet the UK actually slightly outperforms the United States in this area!

Other countries do even better than both the UK and the US: In Australia, only 7% of patients wait 6 days or longer to see a doctor, compared to 4% in the Netherlands and New Zealand. Only a scarcely detectable 1% of patients in these three countries waited more than 2 weeks to see a doctor, with all three countries having mixed healthcare systems.

By contrast, Germany, another mixed system, has long wait times in this area, with 27% of people waiting 6 days or longer to see a doctor. I think I actually know why this is the case for Germany: Every German word has like 23 letters in it, so it just takes them for-fucking-ever to have a conversation with their doctor!

The average percent of people who waited 6 days or longer in mixed countries was 12% compared to 21% in public countries. For the United States, 16% waited this long. The average who waited over 2 weeks was 2% in mixed and 7% in public systems—compared to 7% in the United States.

So although Hank Berrien points to this area as one where the UK's healthcare system does poorly, a look at the data shows that the UK actually does slightly better than the United States. Not only that, but mixed systems, generally, outperform the United States, and public systems have only slightly longer wait times than the US in this area.

Now that we've looked at wait-time data in several different areas, let's see if we can draw some sort of a general conclusion about how certain countries or healthcare systems perform.

The United States has the shortest wait times in two of the four areas: specialist visits and elective surgery. In the other two areas, however—ER visits and regular doctor visits—the United States is outperformed by mixed systems. In the two areas where the United States does best, France, Germany and the Netherlands, with their mixed systems, don't trail too far behind.

The general conclusion we can reach about the United States is that it's not quite as exceptional as right-wingers would lead you to believe: in two areas, it does best, and in the other two areas, it does average. So we can say that the United States is above average in this area—that is to say, it has below average wait times.

How do the public healthcare systems perform? In all four cases, public systems, on average, were outperformed by the United States: in two cases—specialist visits and elective surgery—they were outperformed significantly, and in the other two cases—ER and doctor visits—they were only slightly outperformed.

Finally, the mixed systems, on average, had shorter wait times than the United States in two areas—doctor and ER visits—and longer wait times than the US in the two other areas—non-emergency surgery and specialist visits. And in all four cases, the mixed systems had shorter wait times than the public systems.

To summarize the general conclusions even more briefly, the United States and mixed systems have similar wait times, and public systems have the longest wait times. Obviously wait times are only one component of a healthcare system's quality, but now you and I finally know where the different countries and systems stand in relation to one another in this particular area.

PragerU thinks they're making a clever point when they trash the VA in a video entitled: "Single-Payer Health Care: America Already Has It." There, Pete Hegseth argues the following:

 

"Among veterans, horror stories about the VA abound. These stories were tragically brought to light in 2014 when whistleblowers in Phoenix revealed that 1700 veterans there had waited an average of 115 days just to receive an initial appointment. According to the VA's official policy, that wait time should have been no more than 14 days. As if that wasn't bad enough, the Phoenix VA then lied about it, releasing falsified wait lists to the public to cover its tracks.

Phoenix turned out to be the norm—not the exception. The VA's Inspector General found systemic problems across the country. In Fort Collins, Colorado, for example, clerks were instructed to falsify records to show the doctors were seeing more patients than they actually were. In Columbia, South Carolina, delays in diagnosis in treatment directly lead to the deaths of multiple patients. The VA program there had nearly 4,000 backlogged appointments despite a $1 million grant earmarked to reduce delays."

 

As always, I have a lot to say here. First and foremost, let me state the obvious: Every single one of us should find the falsification of data to be completely unacceptable.

But for our purposes, the key question is: What are the actual VA wait times? As we read on DisabledVeterans.org,

 

"While VA’s own wait time scheduling system shows 10 percent of veterans wait longer than 30 days, IG’s evaluation revealed an estimated 18 percent of veterans are waiting longer than 30 days."

 

I think we should be a bit skeptical of this data, however, because it is coming DisabledVeterans.org; who knows what kind of stump-arm the author of this article was typing with? (Boyyy, that was a fucked up joke, wasn't it? Take a deep breath, ladies and gentlemen: You'll survive.)

18% waiting longer than 30 days is a fairly large percentage and obviously we'd like that number to be lower, but based upon Pete's presentation, I would've expected it to be much worse. We're told in this video that the average wait time in Phoenix was 115 days; Pete then says "Phoenix turned out to be the norm—not the exception." Clearly Phoenix was not the norm if only 18% of veterans waited longer than 30 days—nevermind what percentage waited 115 days.

Perhaps he meant Phoenix was the norm in the sense that data falsification was pervasive, but the way he presents this one statistic and then says "it's the norm" could very easily give the misimpression that wait times of this duration are standard across the VA. It just strikes me as a bit misleading.

Pete Hegseth is doing what I constantly see conservatives do when it comes to healthcare: cherrypicking the most outrageous numbers they can find to give the misimpression that single-payer systems are much worse than they actually are.

He also points out that the VA program in Columbia, South Carolina had over 4,000 backlogged appointments. Once again, he's just cherrypicking one example of a poorly performing city. Here's the real kicker, according to Pete: they had this many backlogs despite them receiving a $1 million grant to address them!

He apparently expects us to drop our jaws and pledge our allegiance to the free market at this point, but when we're talking about health care, $1 million really isn't that much. There are individual doctors who make half that amount in a single year! Let's assume that the average doctor is getting paid $200,000 per year. (Doctors watching this video are like: "Pfft, only $200,000? Fuckin' losers." And then they speed away in their Maserati while holding up a middle finger. That's what doctors are like in real life, right?) $200,000 per doctor amounts to an additional 5 doctors on staff, and assuming it's a hospital with 100 doctors, a roughly 5% staffing increase very well may not be enough to handle the backlog of patients.

If a person was truly interested in getting a general idea of how the VA functions, they wouldn't play this little game that conservatives play where they look exclusively at the single worst examples of performance they can find; they would ask: what conclusions can be reached from an examination of the data, overall? We've already seen what this data shows on VA wait times, but how about the general question of patient satisfaction?

According to a 2015 Gallup poll, 78% of veterans or those in the military are "satisfied with the way the health system is working." By comparison, 77% on Medicare are satisfied, as are 75% on Medicaid. If these single-payer programs in this country truly were so disastrous, why would we see satisfaction rates this high?

And why are people on these single-payer programs more satisfied than people who receive insurance either from their employer—69% of whom are satisfied—or people whose insurance is paid for by themselves or a family member—65% of whom are satisfied? If privatization is the answer, then why does the polling data indicate that privatization is not the answer?

By the way, 41% of the uninsured are satisfied with our healthcare system? Why is that number not 0%? "What are you talking about? Healthcare is great in this country! I go in there, spend a ton of money, and I think about killing myself afterwards! It's great!"

The data makes clear that the people who use our country's single-payer systems are more satisfied with their health care than those in the private marketplace. And recall that the VA was Pete's chosen example of a shitty single-payer system, yet the data reveals that it's outperforming the private system. When the best example you can think of to make your case actually undermines your case, that is nothing short of embarrassing.

We see more fine-grained data on VA satisfaction from a 2011 Pew Research survey: They found that 12% of veterans rated the VA as "excellent," 39% as "good," 35% as "only fair," and 9% as "poor." So clearly there's room for improvement and the system is far from perfect, but it's also not the nightmare that conservatives make it out to be.

Before we move onto the subject of rationing in healthcare, let's take a look at the general healthcare satisfaction rates of people in various countries. In that 2016 Commonwealth Fund study, they presented the following proposition: "On the whole, the [healthcare] system works pretty well and only minor changes are necessary to make it better." Only 20% in the United States selected this option. That is abysmal. The second-lowest percentage was 31% in Sweden, with the highest percentage being 60% in Germany who selected this option.

The average for public systems was 42% and the average for mixed systems was 48%. I find this very interesting: Recall that public systems had longer wait times, on average, than mixed systems; yet the percentage who think these systems work "very well," with only "minor changes" needed to make the system better, is almost the same for both systems. This is a clear indication that healthcare satisfaction boils down to more than just wait times, and when conservatives fixate exclusively on the wait times, they're failing to take into account other positive aspects of these systems that arguably make up for these longer wait times: aspects like cost, quality of care, not having a healthcare industry which corrupts their government to the core, and so forth.

Another proposition presented was the following: "Our health care system has so much wrong with it that we need to completely rebuild it." The United States was, once again, dead last, with 23% of people selecting this option. The average for the public systems was 7%, with the average for mixed systems being 5%. Looking at the data in this way makes clear once again that the satisfaction rates are nearly identical for public and mixed systems—despite their differing wait times.

The takeaway conclusion here is unescapable: The people in countries with either public or mixed systems are significantly more satisified with their healthcare than we are here in the United States. If wait times and rationing were truly the grueling problems that conservatives make them out be, why would we see satisfaction rates like this? Is the conservative prepared to argue that they know better about the overall quality of these systems than the people who are living within these systems? This is the single most informative question to ask about the overall desirability of a country's healthcare system, and it makes undeniable that conservatives are simply on the wrong side of this argument.

I should say a word or two about Switzerland at this point. You'll notice that I classified it as "private,' and you'll also notice that overall satisfaction rates are high, with wait times being among the lowest of all the countries. This might indicate to you that perhaps a private system could also deliver superb results—and perhaps the US system would improve if we simply moved in the direction of even more privatization? This is, of course, the position of conservatives: remove the burdensome regulations, give the companies a freer hand to do what they like, and our country's healthcare system will improve, overall.

Here's the thing, however: While it made the most sense to me to classify Switzerland's system as "private," it is a heavily regulated private system. As Wikipedia describes, insurers in Switzerland are not allowed to make a profit off of the baseline insurance that's legally required for all Swiss citizens; they can only profit off of supplemental plans. Good luck convincing a majority of conservatives that a) purchasing health insurance should be a legal requirement, and b) that insurance companies should be legally prohibited from profiting off of their main service. The laws and corporate constraints that allow the Swiss system to excel would be seen as utterly unacceptable to conservatives in America.

The United States does have aspects of its healthcare system where the government plays a heavy role—namely, Medicare, Medicaid, and the VA. However, when you compare the predominant, private segment of the United States system against that of Switzerland, what you find is that, within our system, there's a much greater degree of privatization, with companies having a much freer hand and being much less restricted by regulation.

So while you might look at the data and suspect that perhaps less regulation is the answer, the Swiss system actually indicates that more regulation would improve our system. The right-wing fantasy is one of unregulated capitalism; the Swiss reality features heavily-regulated competition. I hope I've cleared up any potential confusion here.

Now that we've thoroughly examined the question of wait times, let's switch gears and take a look at the related subject of healthcare rationing. Big surprise!: This is another area where misinformation and ignorance runs rampant on the right-wing. Hank Berrien of the Daily Wire writes the following:

 

"For those who extol the virtues of socialized medicine, and protest that it could never, never, ever lead to rationing, here’s a wake-up call from Great Britain.

The Telegraph reported:

'Under the latest restrictions, [obese] patients in the catchment area who have a BMI of 30 or more will be barred from routine surgery for non-life-threatening conditions for a year, although they may secure a referral sooner if they shed 10 per cent of their weight.'

Smokers’ operations will be postponed for six months, but they can get on surgeons’ waiting lists earlier if they offer evidence they have stopped smoking for at least eight weeks."

 

I have to say, of all of the potential examples of rationing in healthcare, this is the one that he points to to express his indignation? Keep in mind that this is only "routine surgery for non-life-threatening conditions" that these fatties and smokers are banned from, so it's not like they're being denied essential care to save their lives; it's not like an obese person in the UK gets wheeled into the ER needing emergency heart surgery and the doctors are like "Ha ha! Too bad for you, you fat bum!"

And it's worth reiterating that the ban gets reversed if they quit smoking or lose some weight, so this policy is incentivizing healthy behavior and good habits! (You could say that the goal of this policy is to turn these fat losers into fat losers.) Obese people and smokers are huge fiscal drains on health care resources—literally, in the case of obese people—so this policy doesn't strike me as the worst thing in the world.

Now yes, you might say it's unethical to intentionally leave certain groups of people in pain for longer than is necessary, but it's not like the NHS is just doing this to fuck with them; clearly their resources are constrained and this is the most reasonable approach they could think of to alleviate the situation within their existing system. On top of that, at least these people can nullify this policy by simply kicking the idiotic habit of smoking or improving their health and physical appearance by losing weight.

And let's get real here: The NHS isn't forcing you to smoke a pack a day; this is ultimately your decision. Yes, genetics and environment play a role, and it's harder for some people than others, but at the end of the day, smokers can kick the habit and fat people can lose the weight, and any argument to the contrary is just a lie or an excuse. I'm sure I'll get flamed for this non-controversial statement in the comments section, so fire away—and try not to cough all over your fuckin' greasy keyboard in the process.

(By the way, if you people aren't supporting me on Patreon already, what is wrong with you? Head on over there and help to support the production of more of the content that you love and crave—and receive some patron-only perks in the process.)

Hank starts out his article by writing:

 

"For those who extol the virtues of socialized medicine, and protest that it could never, never, ever lead to rationing, here’s a wake-up call from Great Britain."

 

Sorry, who is arguing that public healthcare will never lead to rationing? When you're dealing with finite medical resources, you have to make decisions about how to allocate these resources. Yes, it would be wonderful if we lived in a world where we had an unlimited supply of money and doctors and medical equipment to throw around, but this is the real world, where money and doctors and supplies are limited and rational decisions need to be made about how to best distribute these resources.

As Scheunemann and White put it in a publication entitled "The Ethics and Reality of Rationing in Medicine,"

 

"Rationing is unavoidable because need is limitless and resources are not."

 

I also think the term "ration" is a bit misleading here, because when I think of rationing, I imagine a starving group of soldiers during WWI desperately splitting three potatoes and a single tin of sardines among all ten of them. The reality of the situation in medicine is nothing like this; all we really mean when we talk about rationing in healthcare is deciding upon how to best allocate limited resources in high demand. This process of rationing, while perhaps undesirable, is an inevitable part of healthcare—and it's also not something that private healthcare systems are immune from.

Yes, that's right; I've got news for you people: This doesn't just happen in countries with public healthcare systems; rationing takes place in the United States, as well. When you have to schedule a doctor visit 5 days from now because their schedules are full, that's rationing. When the soonest they can book you for your shoulder surgery is three weeks from now, that's rationing.

We also have a form of rationing unique to the United States: It's called: "I can't afford health care, so I'm shit out of luck." CNBC reports that 12% of American adults lack health insurance altogether, and a 2009 study by Andrew Wilper et al found that 45,000 Americans die each year due to lack of health insurance.

The Commonwealth Fund reports that 19% of Americans—just in the past 12 months—skipped a medical test, treatment, or follow-up recommended by a doctor specifically because of the cost. Compare this to the average of 4% who responded this way in public systems and the 8% who responded this way in mixed systems.

They also report that, in the past 12 months, 18% of Americans either didn't collect prescription medication or skipped doses purely because of the cost. And that is no surprise, because prescription drugs in this country are extremely expensive; just ask Rush Limbaugh! Under both public and mixed systems, only 5% answered this question in the affirmative.

When people in the United States are doing things like skipping doses or cutting their pills in half, how's that for literal rationing? And who knows what is the additional number of people that die from foregoing treatment or medication in America because of the cost?

Tens of thousands of people die every single year in the United States because of these financial barriers to our healthcare system. This is a vastly, incomparably-more serious, systemic healthcare failure than fat people and smokers having to wait a bit for non-essential surgery if they can't do themselves the favor of losing weight or quitting smoking. So spare me your crocodile tears for these people.

There's also a very important point that needs to be made and understood here—so take your little pecker out of your hand and pay attention: The financial barriers to our healthcare system almost certainly reduce the wait times in our country.

Think about it: 12% of US adults lack health insurance and 19% regularly skip recommended treatments or visits for financial reasons. This doesn't even factor in the many people who, just as a general rule to save money, avoid doctor visits for everything except the most serious or urgent of conditions.

People who otherwise would be in the healthcare system stay out of it purely because of its exorbitant cost in the United States—and this means that wait times are going to be shorter because there's a smaller percentage of people trying to access the country's healthcare system at any given time. So the very wait times that conservatives point to as proof of the exceptional quality of our healthcare system are actually partly the product of its extreme dysfunction.

Another example of rationing is featured in an article written by Sally C. Pipes entitled "The false promise of single-payer healthcare." (That totally sounds like a pornstar name, by the way: Sally C. Pipes? Yeah, I bet she does!)

 

"There’s . . . a severe shortage of essential medical equipment. Canada ranks 14th among 22 OECD countries in MRI machines per million people, with an average wait time to use one at just over eight weeks. Canada ranks a dismal 16th in CT scanners per million people, with an average wait time of over 3.6 weeks.

The United States ranks second in MRI machines per-capita, and fifth in CTs."

 

Ok, this is one particular example where the United States does well and Canada does poorly. But to frame this as if it's an indictment of single-payer systems, generally, is not justified when you consider that countries with similar systems have no such problems.

Here we see a chart showing the number of MRI units per million people as of 2016, courtesy of Statista.com, with the United States coming in second place. As we can see, Japan is ranked number 1, Germany is 3, and Italy is 4. The healthcare systems of these countries are public-private blends. South Korea is number 5 on this list, and it has flat-out single-payer healthcare.

What about CT scanners? 2016 data from Statista.com shows that, yet again, Japan is number 1, Australia is number 2, the United States is 3, Iceland is 4 and South Korea is 5. Iceland has a mixed system, bordering on single-payer, and, of course, Australia has a public-private blend.

So despite what right-wingers will argue when they only shine a spotlight on one poorly-performing country, this narrow area of access to MRI or CT machines can't be used to discredit single-payer systems or systems with heavy government involvement.

By the way, this strikes me as a somewhat strange argument: "Canada's healthcare sucks because of their per-capita access rates to MRI machines." It's such a narrowly specfic critique of their healthcare system. I don't know about you, but MRI units per million people probably doesn't even make my top-30 list of healthcare priorities.

Well, as much as I'm sure you're all enjoying yourself, it is about that time that we wrap up and ask ourselves: What are some of the key conclusions we can reach on this subject?

Public systems have the longest wait times in comparison to private and mixed systems—whose wait times are about the same, on average. Worth noting is the obvious point that there are plenty of countries that fall into these categories that weren't included in my analysis, and these very well could have tipped the balance in one or another direction.

Another key point is that rationing is an inevitable part of healthcare—and the United States has uniquely high rates of financial rationing. Furthermore, low wait times in the United States are partially the result of high cost, and wait times are only one component of a country's healthcare quality. General satisfaction data shows that people are more satisfied with public or mixed systems than they are with the heavily private system that we have in the United States—and this applies both between countries and within the United States.

Rather than taking a big picture, honest approach to the subject, the right-wing, agenda-driven argument in this area often revolves around cherrypicking the absolute worst data they can find to paint a much darker picture of these healthcare systems than actually exists in reality.