A similar situation exists regarding the prevalence of C-sections in the US. There is a rising concern that we are performing too many C-sections — possibly with convenience to mother and physician more in mind than medical necessity. It is no surprise that the US has one of the worst maternal and infant mortality rates in the developed world.3-4
Hence, Senator Cruz did not offer any objective evidence that the US provides superior health care to its citizens when compared to similarly developed nations that offer universal care.
Rather, when his facts are considered within the appropriate historical and professional context, they suggest that our European colleagues are in fact doing much better than we are, and at a lower cost. In other words, arguing that the US offers superior health care because it allows physicians to perform more unnecessary tests is like arguing that your mechanic is a better mechanic because he changes your oil every 200 feet — a practice that would be expensive and would not improve the functioning of your car. Senator Cruz sees such wastefulness as “people exercising free choice.” Yet in an industry where the consumers must trust the consultants about the products they are buying, this hardly seems like a fair choice.
Predictably, his argument progressed towards the threat that a national health-care system would result in rationing of health care. Senator Sanders made an excellent rebuttal when he commented that the US already rations care based on finances. In those developed countries that offer universal health coverage, they may ration by the acuity of disease. For example, in Europe you might have to wait 95 days, as Senator Cruz quoted, for a knee replacement. But, unlike in the US, you’ll eventually get it. However, if you were in a car accident and injured your knee and needed a knee replacement right away, there is no doubt that you would get care immediately. Urgent care and emergencies are not rationed. Moreover, his anecdotal stories of people waiting for care are not unique to Europe. We have all seen the same and possibly worse here in the US. We just don’t talk about it.
The whole fallacy in Senator Cruz’s argument, and frankly the Republican position, is that our system provides choice and “access” to care. What it truly boils down to is a philosophical question that I have argued previously in prior articles. Is the aim of our health-care system to care for human beings or to generate profits for corporations?
If the goal is profit, then we already have the best health-care system in the world — tailored to maximizing profit for insurance companies, pharmaceutical companies, hospital systems, and medical-device companies.
On the other hand, if the goal of a health-care system is to provide sick individuals with appropriate and timely care in order to maintain a healthy and productive society, then it makes little sense to continue having these moot debates.
Physician fears of losing control of their patients and control over the way they practice medicine are understandable. However, such worries are largely unfounded. Further, for those who view capitalism and free markets as the ultimate American freedom, there is no reason that a for-profit system cannot coexist with a national health-care system, similar to how Medicare currently exists along with private insurers. In fact, I challenge Republicans to offer a public option to whatever alternative they propose for replacing the ACA. If they truly believe in free-market policies, then let a public option be available to compete with private insurers. Then, and only then, would they truly give Americans an opportunity to try both solutions and decide what they really want — actual health care or a theoretical access to health care.
- “Bernie Sanders vs Ted Cruz Obamacare Debate Part 1.” CNN. Updated February 7, 2017. Available: https://www.youtube.com/watch?v=xiymr8RhD_k&feature=youtu.be. Accessed February 21, 2017.
- “Image Wisely. ” American College of Radiology and the Radiological Society of North America. Available: http://www.imagewisely.org/About-Us Accessed February 21, 2017.
- Alkema L, et al. “Global, Regional, and National Levels and Trends in Maternal Mortality Between 1990 and 2015, with Scenario-Based Projections to 2030: A Systematic Analysis by the UN Maternal Mortality Estimation Inter-Agency Group.” The Lancet. 2016;387: 462-474. doi: 10.1016/S0140-6736(15)00838-7
- MacDorman MF, et al. “International Comparisons of Infant Mortality and Related Factors: United States and Europe, 2010.” Natl Vital Stat Rep. 2014;63: 1–6.