The health care mess is complicated. It’s a strange mix of government and private, with perverse tax incentives skewing the entire system. Handing the whole thing to government with the injunction “run this” might seem like the simple answer. But it sure isn’t the rational response.
Just consider the state of socialized systems abroad. Obviously, American health care has more than its share of horror stories. But go where the government runs things and you lose virtually any control over the system.
Consider the state of dentistry in Great Britain. According to the Guardian:
In the Nineties, the trouble for those who could find NHS dentists was not persuading them to start drilling but asking them to stop. Dentists claimed piece rates from a Byzantine charge sheet of 400 different fees. The greedy made money by doing as much work as possible as shoddily as possible, regardless of whether it was needed. In 2000, researchers from the University of Wales estimated that of 1.1 million root fillings done in a year, 90 per cent failed to meet European standards. In almost half the operations, dentists left holes in the fillings. In one case in 20, they didn’t bother with even partially filling the cavity and left it empty.
Meanwhile, the regulatory system might have been designed to discourage whistleblowing. Along with the omerta found in all trades, NHS dentists had gagging clauses in their contracts. So it is impossible to say if the few who were disciplined at the time were monstrous rarities or simply unlucky to have been caught. Whether he was an exception or the rule, Melvyn Megitt confirmed nervous patients’ worst fears when the General Dental Council struck him off in 1999. The council heard that he deliberately snapped the braces of patients to ensure they needed more treatment.
Most barely had time to settle in his chair before he had finished drilling and jabbing. In one year, he had earned £600,000 by seeing 150 patients a day. Stewart Molloy was equally energetic. The council struck him off in 2000 for giving a man who came in complaining about a cracked tooth 18 unnecessary root canal procedures.
To its credit, Labour has been a reforming government. After the Audit Commission concluded in 2002 that ‘the current system also offers a perverse incentive for dentists to carry out work which is unnecessary or cosmetic’, ministers intervened. They cut the hundreds of charges back to three. There never was a golden age when dental care was free at the point of delivery to all. However, Labour did try to revive NHS dentistry. It recruited 5,000 more dentists and increased funding by 40 per cent.
Why then last week did a survey of 5,000 patients produce grotesque stories closer to Marathon Man than Experience, of people pulling out their teeth with pliers or filling cavities with Polyfilla? ‘Because it was easier than finding a dentist,’ explained one patient or, rather, abandoned patient. ‘Because I could not afford the cost,’ said another. Ten per cent weren’t registered with a dentist; 20 per cent were registered but missed treatment because of NHS charges.
Reform the U.S. system? Sure. But not in the British way!