I have an op-ed in the Los Angeles Times today harping on one of my favorite statistical points: The absurd contention that America doesn't ration access to health care. The real lightbulb moment on this came when I was digging through some Health Affairs survey data tracking problems patients in different nations had accessing care. The numbers showed that 38 percent of Britons and 27 percent of Canadians reported waiting four months or more for elective surgery. Among Americans, that number was only 5 percent. The waiting lines were real. But the same study also had what I came to consider an inverse data set. Twenty-four percent of Americans reported that they did not get medical care because of cost. Twenty-six percent said they didn't fill a prescription. And 22 percent said they didn't get a test or treatment. Those latter numbers are probably artificially small: If you can't afford to see a doctor, you never know that you can't afford the treatment she would recommend. In Britain and Canada, only about 6% of respondents reported that costs had limited their access to care.Five percent of Americans wait and six percent of Canadians and Britons are priced out. The numbers mirror each other. The question, in other words, is not whether you ration care, but how you ration it. It also casts our smug attitude towards care access in a new light. If someone can't afford care, we record their waiting time as zero. You don't wait for what you can't have. But a more accurate accounting would record that wait as infinite, or it would record when the patient eventually ends up in the emergency room because the original ailment went untreated. Research like this raises a simple question: Would you rather wait four months for an elective surgery or be unable to get it altogether? That -- and not whether we ration care -- is the choice between the Canadian and American models. Meanwhile, Germany, Japan, France, England, and other don't have a problem with care affordability, the uninsured, or waiting lines. We've managed to center the debate around two bad options and then trick ourselves into think we've got the better end of the deal. It's no way to conduct a debate.Department of Corrections: In the op-ed, I state, incorrectly, that our system "costs more than twice as much per person as that of any other country." It doesn't. It costs more than twice as much as the OECD average, but some countries do manage to pass our 50 percent mark. In particular, Norway, the next-highest spender, and one of the more heavily private systems around, spends about 67 percent what we do per capita. THE MYTH OF WAITING LINES.
I have an op-ed in the Los Angeles Times today harping on one of my favorite statistical points: The absurd contention that America doesn't ration access to health care. The real lightbulb moment on this came when I was digging through some Health Affairs survey data tracking problems patients in different nations had accessing care. The numbers showed that 38 percent of Britons and 27 percent of Canadians reported waiting four months or more for elective surgery. Among Americans, that number was only 5 percent. The waiting lines were real. But the same study also had what I came to consider an inverse data set. Twenty-four percent of Americans reported that they did not get medical care because of cost. Twenty-six percent said they didn't fill a prescription. And 22 percent said they didn't get a test or treatment. Those latter numbers are probably artificially small: If you can't afford to see a doctor, you never know that you can't afford the treatment she would recommend. In Britain and Canada, only about 6% of respondents reported that costs had limited their access to care.Five percent of Americans wait and six percent of Canadians and Britons are priced out. The numbers mirror each other. The question, in other words, is not whether you ration care, but how you ration it. It also casts our smug attitude towards care access in a new light. If someone can't afford care, we record their waiting time as zero. You don't wait for what you can't have. But a more accurate accounting would record that wait as infinite, or it would record when the patient eventually ends up in the emergency room because the original ailment went untreated. Research like this raises a simple question: Would you rather wait four months for an elective surgery or be unable to get it altogether? That -- and not whether we ration care -- is the choice between the Canadian and American models. Meanwhile, Germany, Japan, France, England, and other don't have a problem with care affordability, the uninsured, or waiting lines. We've managed to center the debate around two bad options and then trick ourselves into think we've got the better end of the deal. It's no way to conduct a debate.Department of Corrections: In the op-ed, I state, incorrectly, that our system "costs more than twice as much per person as that of any other country." It doesn't. It costs more than twice as much as the OECD average, but some countries do manage to pass our 50 percent mark. In particular, Norway, the next-highest spender, and one of the more heavily private systems around, spends about 67 percent what we do per capita. 
