Medicine

Socialized Medicine and excessive wait times.

By Chris Rangel MD ⋅ August 12, 2007 ⋅  Email this post ⋅  Print this post ⋅ Post a comment

 (a follow up to Part I) - A 22 year old English woman died from a rare (but treatable) brain tumor after waiting almost 13 weeks for an MRI of the head. Dr. Luba had the following to say;

“The NHS used to be a much better system. The Tories cut funding greatly when they were in control in the 80s. It still hasn’t quite recovered. . If she had been a well insured woman in the US, she would have gotten that MRI. If she were one of the working poor with no insurance, the outcome would probably have been the same.”

Actually, had this happened to a woman with a rare brain tumor in the 1980’s the result would have been the same and would have been considered inevitable. In the 1980’s MRI imaging was very new. Advanced (expensive) neuroimaging was not routinely used for things like chronic headache back then. However, a tremendous amount has changed in medical care in the last 25-30 years and the problem is that socialized health care systems like the NHS have not been able or willing to provide the capital to invest in modernizing their systems.

In 1986 the number of MRI scanners per 1 million population (corrected) in the US was 4.6 and only 0.2 in the UK. In 1997 this number had increased to 16 in the US but was only 3.4 in the UK. This technology gap continues today and includes everything from MRI to CAT scanners, mammography imaging, to lithotripsy, etc, etc. and this technology gap is common to socialized health care systems regardless of the country. Despite recent efforts to close this technology gap, both Canada and the UK still lag far behind such countries as the US, Japan, and Switzerland.

The result is waiting times for advanced imaging (MRI and CAT scans) that are unheard of in the US. The average wait to get a routine MRI is on the order of months to years in both Canada and the UK. Even stat or urgent scans tend to take a tremendous amount of time. As we saw in the case of the woman who died, a three month wait for an urgent scan is far better than 6 - 12 months yet still horrible. The longest I’ve ever had a patient wait to get an MRI was about 2-3 weeks and this was due to patient scheduling conflicts with work more than anything else.

To blame the British Torry (conservative) government of the 1980s for this mess is at best simplistic. The problem appears to be inherent to the very nature of socialist systems and is not anything new. The capital investment in advanced medical technology in the free market system of the US is profit driven while in the UK this is under the direction of governmental central planning. Remember central planning? This is the same system that failed to supply enough toilet paper for the Russian people before the fall of the Soviet Union.

In the UK, NHS central planning determines not only capital investment but how much funding each MRI scanner gets for operating costs including the salaries of the radiology techs. In most cases there is only enough funding for a few thousand scans each year. This is why wait times are so long. Health care resources are determined by the government and not by need or demand. Such a system is prone to problems like inaccurate planning and chronic underfunding since any government has other funding priorities and any planning is subject to political squabbling and compromise. Yes, politics is a big factor in this mess but it’s simplistic to say that the problem is due to the political party in power (that itself is just political rhetoric).

Ironically, the US has the largest government funded health care program in the world (Medicare and Medicaid) but it outsources almost all of the covered services to the private free market and so is not dependent upon the micromanagement of central planning. It is also very well funded. But it’s far from perfect. Americans utilize far too much expensive health care and the system does not cover 45 million. But the answer is not the horribly mismanaged and underfunded socialist systems of Canada and the UK. The answer is in between.

Dr. Luba’s comments are also troubling because a comparison is made between the failings of a socialist health care system in the UK and the lack of universal health care here in the US. I’m not sure what Dr. Luba is trying to say. Is a socialist system that fails 100% of its members when it comes to the supply of advanced medical technology not worse than or better than a system that fails to fund the needs of 15% of the population? Is providing universal health care much more important than providing efficient and quality health care to the vast majority of the population?

*Please note: Michael Moore was not available to comment on this story.