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This Is Not Britain. For Better And For Worse.

Tony Blankley takes to the opinion pages of the Washington Times today, trotting out a familiar but frequently effective line of argument.

We can't have universal health insurance, Blankley says, because then our system will end up looking like Britain's, where the government makes everybody wait for services and frequently denies potentially useful treatments.

First the federal government would get regulatory power over insurance. And once that happens, Blankley writes, 

The federal regulators could merely do what the British regulators do:

- Constantly reduce the compensation of doctors and all other skilled health care providers. (As domestically trained American doctors would become scarcer, more not-as-well-trained foreign doctors would be needed).

- Limit the availability of medical technology. (in Canada, patients have to wait months for MRIs, so those who can do so come to America for immediate diagnostic services.)

- Ration available treatment to fit the federal budget requirements. The universal digitalized health data could be used to justify non-treatment on a cost-benefit basis. For example, hip replacement for older people could be denied because they would be unlikely to live long enough to justify the expense.

Well, sure, federal regulators could do that. But would they?

Not likely. A key difference between the Britain and the U.S. is the resources each country devotes to medical care, as the chart below shows:

It's from the Commonwealth Fund, which specializes in international comparisons (and which has, full disclosure, underwritten some of my own research abroad). And in case you can't make out the labels, here's the relevant data. As of 2004, the most recent data I could find, per capta health care spending in the U.K. was $2,546. In the U.S., it was $6,102.

(The bar for the U.K. is third from the right; the bar for the U.S. is the really big one all the way on the left.)

It's true, as Blankely argues, that Obama and other reformers are intent upon bringing health care costs under control. They want to do so because it will ease the financial burden on indivdiuals, employers, and society as a whole.

But that is a long-term project, one that will take place gradually and that will probably never result in U.S. spending approaching British levels. That's why Budget Director Peter Orszag always talks about "bending the curve" on health care spending, as opposed to slashing it. 

The U.S. will always be among the high spenders in health care--as, most likely, will countries like France, Germany, and Switzerland. That's because the culture in each country tends to favor aggressive medical action and puts a high premiums on easy, convenient access to care.

Note that such unfettered access is not necessarily a good thing. The Brits are a lot less likely to get wasteful care. And there are some categories at which they excel, particularly when it comes to primary care. If you're looking strictly at bang-for-the-buck--or, perhaps, bang-for-the-pound--the British are getting a much, much better deal than we are. For more on this, I highly recommend--as I often do--picking up Shannon Brownlee's Overtreated.

Blankley's argument is misleading in other respects, too. Among other things, he would have you believe that Americans never wait for medical services--and always get whatever treatments they want. Fortunately, I don't have to debunk that because Ezra Klein already has, in a new op-ed for the Los Angeles Times. That piece, unlike Blankely's, is worth your time.

Jonathan Cohn