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Smart Bombs: No patience for patients?

To me, the central feature of Disneyland is the lines. And yet, it’s The Happiest Place on Earth. Apparently, the wait is worth it. This brings me to health care, because it’s a small world after all.

The Wall Street Journal’s libertarian-minded editorial page fired two salvos last week at Massachusetts’ creation of a near-universal health care system. First, it critiqued the system itself and then it smacked Mitt Romney around for signing off on it when he was the governor. The paper suggested he become President Obama’s 2012 running mate, rather than his opponent.

It should be noted that one state can only do so much when it comes to cost containment. And sure enough, Commonwealth Care hasn’t stopped the upward trajectory seen everywhere. To do that, it will take a national overhaul of our fee-for-service system, with an emphasis on coordinated care, measuring outcomes and rewarding what is effective.

The Journal also criticized the state for its increasing wait times for patients, particularly those who want to see their primary care doctor. This is just goofy.

It’s entirely predictable that if more people have health care coverage, then more people will be making medical appointments. Of course it will take time to adjust the number of doctors to the new demand. The Wall Street Journal sees this as an “Aha!” moment, as if the long lines at Disneyland are a sign of a dysfunctional amusement park. A March poll found that 84 percent of Massachusetts residents are satisfied with its health care system. You might say it’s The Happiest State on Earth.

No lines. If short wait times are the true measure of a system’s health, then the House of Representatives’ deficit reduction plan must’ve made the Wall Street Journal absolutely giddy. It repeals “Obamacare” and cuts Medicaid so severely that up to 44 million more Americans would eventually go without coverage, according to a Kaiser Family Foundation analysis.

The Maytag repairman could relocate to office waiting rooms and community health care clinics and still be lonely, but he’d find a huge crowd at the nearest emergency room.

Regressing. In the heady days of 2001, Washington state voters overwhelming adopted Initiative 773, which increased tobacco taxes. Some of the proceeds were earmarked to add more people to the Basic Health Plan, and enrollment was projected to climb to 172,000 by 2003.

Fast forward to this year’s legislative stalemate, and we see that the House budgets 41,200 people for Basic Health. The Senate budget trims the rolls to 34,000.

But it’s not all bad news. For those who still have health care coverage, those wait times should shorten.

Long and short of it. Are longer wait times an inevitable consequence of universal health care? The Incidental Economist blog features some graphs for comparison purposes. Patients in Switzerland, the Netherlands, New Zealand, the United Kingdom, Austria, Germany and France have quicker access than in the United States. There is more waiting in Sweden, Norway and Canada.

The supply of doctors is also a factor, and the United States has fewer primary care physicians per capita than other nations. Many U.S. doctors are drawn to higher-paying specialties because they are so deep in debt after medical school. Other countries subsidize education at a higher level, so that new doctors can focus on their professional interest, not their loan interest.

Speaking of waiting. Let’s remember how this health care reform movement got started. This country forks over a lot more on health care than any other nation without the superior outcomes one would expect from all that spending. As a consequence, this spending is crowding out other public spending. So teachers, police officers and other government workers are laid off, class sizes increase, college tuition balloons, parks, libraries and museums are shuttered, felons are released early from prison. And on the national level, budget deficits mount.

Those who want to overturn the pending health care reform have a duty to provide a plan that addresses this medical cost monstrosity. It isn’t enough to litigate and pick apart someone else’s plan. Opponents need to produce a formal plan of their own so that it can be evaluated.

Still waiting.

Smart Bombs is written by Associate Editor Gary Crooks and appears Sundays on the Opinion page. Crooks can be reached at or at (509) 459-5026.