When my two-year-old cat, Lily, began vomiting and refused her food and water, I took her to my veterinarian who, after a battery of X-rays and other tests, found nothing conclusive. The vet offered a preliminary diagnosis of gastritis, an inflammation of the stomach lining, and sent us home with medication to treat the condition. When twenty-four hours of the treatment yielded no improvement, we returned to the vet, who admitted Lily for observation overnight. The next evening, the vet phoned to say: “Lily is still vomiting and refusing food and water, so we ran a second set of X-rays and a comparison of the two sets revealed that her intestines are bunching as if something’s lodged inside. There’s an emergency veterinary clinic twenty miles away that has an ultrasound machine, which will enable us to see what’s inside. Please come pick up Lily and drive her there; we’ll notify them that you’re on your way.”
The ultrasound revealed a large quantity of thread tangled in Lily’s digestive tract. Unbeknownst to me, she had extracted a bobbin of thread from my sewing kit and swallowed the contents. The condition required surgery, which the vet at the emergency clinic performed that night, removing the thread (which was lodged in Lily’s stomach, small intestine, and large intestine) without complications. Lily remained in intensive care for two days before the vet sent her home with a scar on her stomach, some antibiotics, and a list of instructions for postoperative care. She recovered fully and was back to mischief in short order.
As this story indicates, the state of animal health care in America, in terms of the quality of the diagnostics and treatments available, is in many ways on par with that of human health care. And the fact that advancements in veterinary medicine have progressed in close parallel with those in human medicine should come as little surprise: Animals are important to us. They provide us with, among other things, food, labor, and companionship. To ensure that our animals are respectively tasty, reliable, healthy, and happy, we need the services of well-trained veterinarians equipped with the latest technologies. That demand is nicely satisfied.
Most veterinarians in private practice specialize in either large-animal or small-animal medicine, a division that roughly corresponds to the distinction between livestock, such as cows and sheep, and companion animals, such as dogs and cats. Small-animal veterinary medicine is, in important respects, remarkably similar to human medicine. The skills required in small-animal medicine are, by and large, the same as those required in human medicine,1 and today’s veterinary schools are every bit as rigorous as their counterparts in human medicine. After earning their undergraduate degrees, veterinary students must complete four years of medical training and then pass national and state licensure exams. Those who choose to become specialists must also complete an internship and residency and pass an examination for their chosen specialty.2
The technologies used by veterinarians and those used by medical doctors are similar as well. Vets use many of the same drugs as medical doctors, albeit in different concentrations, doses, and formulations;3 and their facilities are equipped with essentially the same kind of medical equipment to treat essentially the same kinds of medical problems. In fact, a great deal of the medical equipment used in veterinary medicine, including surgical instruments, common devices such as stethoscopes, and CT scan machines, is either identical to that used in human medicine or downsized to accommodate the smaller size of most pets.4 In the United States, advancements in human medicine—whether in training, medications, or facilities—are generally mirrored in small-animal veterinary medicine.
Fortunately for our pets, however, veterinary medicine has not paralleled human medicine in two important respects: accessibility and affordability.
In the case of accessibility, as Lily’s story indicates, veterinary patients rarely face troubles or delays in receiving the care they need. Most veterinary clinics accommodate animals in life-threatening emergencies immediately. And, for nonemergency treatment, pet owners almost invariably are able to schedule an appointment with their vet within a few days of the request. By contrast, human patients in the United States are increasingly unable to schedule appointments with their doctors in a timely manner; they are increasingly subjected to frustrating, painful, and sometimes deadly delays.
A 2009 survey of major U.S. cities reported average wait times of more than two weeks for new patients to see a cardiologist or orthopedic surgeon; nearly three weeks to see a family physician; and more than three weeks to see a dermatologist, obstetrician, or gynecologist. Those who fall on the wrong side of these averages may wait six months to a year for an initial appointment. And, notes the survey, because physician-to-population ratios in metropolitan areas are generally higher than elsewhere, “it may be reasonably inferred that physician access could be more problematic in areas with fewer physicians per capita.”5
Those seeking emergency treatment are even more likely to be delayed. A 2008 federally funded report found that wait times in emergency rooms have “been rising steadily, from 38 minutes in 1997, to 47 minutes in 2004, to 56 minutes in 2006.” Although half of the emergency room patients accounted for in the report waited 31 minutes or less, many patients wait hours for emergency treatment.6 Beatrice Vance, an Illinois resident, visited an emergency room in 2006 while suffering from an apparent heart attack. She waited two hours and ten minutes from the time she checked in. Her wait ended when she collapsed and died in the waiting room.7
As to the differences in affordability between veterinary care and human medical care, Dr. Christine Merle, a veterinarian and certified practice manager, points out that “prices for basic veterinary care have not risen much in the last 30 years, while in human medicine the cost of services has skyrocketed. It is less expensive to treat your dog than your child for the same illness.”8
Consider Lily’s case in this regard. The care she received cost slightly under $6,000, a reasonable price given that it included: two visits to my regular veterinarian, both of which took place outside what are considered standard business hours for human doctors; a visit to an emergency after-hours care center; two sets of X-rays; diagnostic blood work; intravenous fluids; an overnight observation; an ultrasound; major surgery performed at 9 o’clock on a Saturday night (a mere hour after the diagnosis); two days in the emergency clinic’s intensive care; and various medications.
Had Lily been human, her care would have cost many times what I paid—and not because treating humans is inherently more demanding than treating cats. In fact, Lily’s care would have cost closer to $3,000 had she, like a human patient, been able to articulate how she was feeling or confess to having swallowed thread, thus obviating the detective work required to diagnose her problem. Rather, the equivalent care for a human would have cost more because prices for essentially the same goods and services are generally higher in human medicine than they are in veterinary medicine. An ultrasound, for instance, involves the same equipment and the same process whether the subject is a cat or a human. But whereas Lily’s ultrasound cost $450, the same procedure at human medical centers in my area costs $1,098 on average.9 The price disparity is even greater where X-rays are concerned: Whereas Lily’s X-rays cost only $150 each, those for humans in my area cost $1,102 on average.10 And whereas the surgery to remove Lily’s intestinal blockage (plus the two-day stay at the emergency clinic) cost $3,500, that same surgery and stay for a human runs in the neighborhood of $15,000.11 Granted, there are necessary differences between animal and human facilities, in particular the size of the equipment used and room and board requirements, but these alone do not account for the enormous differences in price.
While the quality of health care for animals in the United States is generally comparable to that for humans, it is substantially more accessible and much less expensive. What accounts for this dramatic difference? Government interference.
Government interference in the marketplace for human medicine reduces accessibility and drives up costs. For instance, although Medicaid and Medicare purport to increase accessibility for the elderly and the poor, these programs actually reduce accessibility to health care for the elderly, the poor, and everyone else. As Lin Zinser and Paul Hsieh point out in “Moral Health Care vs. ‘Universal Health Care’” (TOS, Winter 2007–8): “Because of the low reimbursement rates paid by Medicaid and Medicare, many recipients have no regular primary care physician and can get decent care only through the ER.” Compounding the problem is the Emergency Medical Treatment and Labor Act (EMTALA), which forces hospitals that accept Medicare to admit and treat anyone and everyone who shows up.
The effect of this law is that anyone can walk into an emergency room at any time and receive treatment—without concern for payment. If a bum wants a free meal and a warm bed for the night, all he has to do is walk into the ER and say, “Doc—I feel like an elephant is sitting on my chest!” By law, the emergency room doctor and staff have to run tests until they can prove that he is not having a massive heart attack and can be safely discharged.
The results of such government mandates, unsurprisingly, are longer waits and increased costs for everyone.
By mandating that doctors and hospitals treat patients at a financial loss, EMTALA violates the rights of doctors and hospitals to set the terms of their business. Consequently, doctors who are unwilling to lose money or who are tired of treating dishonest patients withdraw from emergency rooms. This leads to more overcrowding, longer waiting times, and, in some cases, the closing of ERs. As the remaining ERs become still more overcrowded and understaffed, the quality of emergency room services necessarily declines, harming honest patients who have genuine emergencies.
EMTALA also causes cost-shifting, the practice of doctors and hospitals trying to make up for the money they are losing on Medicaid and Medicare patients by increasing the fees of patients who . . . do pay their bills. This raises the costs for responsible and conscientious patients, who indirectly subsidize the irresponsible and the unconscientious.12
Of course, the government plagues practitioners with a multitude of other regulations: HIPAA regulations, for example, force doctors to engage in costly and time-consuming record-keeping practices for the sake of government tracking. FDA regulations prohibit researchers, pharmaceutical companies, and doctors from acting in accordance with their own best judgment, thus delaying the availability and driving up the costs of life-serving treatments, medications, and equipment.13
By contrast, the government does not force veterinarians to treat those who cannot pay for their services, nor does it suffocate veterinarians with costly record-keeping requirements or hindrances to the development and procurement of veterinary drugs and equipment. Such intrusions and their consequences—long waits for care, cost-shifting, and the like—are absent from veterinary medicine.
Also absent are the huge market distortions caused by long-entrenched government interference in human health insurance—resulting in today’s mind-numbing complexity and high costs. Consider a few relevant facts: Prior to government intervention (beginning in the 1930s), health insurance worked much like car insurance does today—individuals purchased it to cover catastrophic and potentially bankrupting illnesses rather than routine medical expenses. During the Great Depression, the government granted Blue Cross and Blue Shield tax-exempt nonprofit status and other advantages, enabling them to quickly achieve force-backed market dominance. To compete, for-profit insurance companies began offering plans similar to those offered by Blue Cross and Blue Shield: prepaid medical care in which all costs were covered by the insurance company, which paid doctors directly. As Zinser and Hsieh explain, “This new model was a disaster in the making. In addition to minimizing incentives for insured customers to comparison shop for medical services, it also minimized incentives for doctors and hospitals to compete on price.”14
The distortions this government favoritism caused were soon entrenched in the marketplace by further meddling. The Stabilization Act of 1942 froze wages but allowed employers to increase employee compensation by offering new benefits—such as health insurance. As a result, many employers began providing prepaid health insurance to their employees, thus tying health insurance to employment. In 1943, the IRS decreed that employees were exempt from paying income taxes on health care benefits paid by their employers, and that employers could deduct amounts spent on health insurance from their taxable income. This gave employees a huge financial incentive to seek insurance benefits from employers, and it gave employers a huge financial incentive to provide such benefits.
These and other government interferences gave rise to our current system in which consumers have come to expect health insurance as part of their employment compensation—and to expect it to cover even the most trivial treatments.
In this government-spawned system, consumers are largely insulated from the costs of their treatments. Insured patients generally incur a nominal co-payment ($10–$40) or nothing for visits to their doctor. Only after services have been rendered and the insurance payments calculated by means of intricate rules and formulas does the patient receive an indication—in the form of a billing statement, with practically indecipherable codes, figures, and language—of how much his health care actually costs. Zinser and Hsieh synopsize the effect that this price insulation has had on the accessibility and affordability of health care in America:
Employers and insurers dictate everything from which doctors and specialists employees will be permitted to visit under the plan, to the kinds of benefits that will and will not be provided, to the co-payments and deductibles that will be paid. Because third parties are paying for both insurance and health care, the employee-patient-customer has little choice in what kind of insurance or who provides the health care he receives—and plenty of incentive to visit a doctor anytime he has a runny nose. The fact that third parties pay for all health treatments increases the administrative costs for doctors as well as insurers, and those costs are passed on to consumers.
Further government health-care mandates have only exacerbated the problems. “Benefits mandates” force insurers to cover such services as alcohol rehabilitation, autism diagnoses, and cervical cancer vaccinations—whether or not the insured wants such benefits. “Mandatory guaranteed issue” regulations force insurers to accept all those who apply in a given market regardless of their state of health or lifestyle choices. “Guaranteed community rating” regulations force insurers to charge all those in a given community the same premium regardless of salient factors such as age, weight, and health history. And “guaranteed renewability mandates” force insurers to renew policies so long as premiums are paid on time.
When combined, these . . . mandates eliminate the financial consequences to individuals related to their lifestyle choices, for good or ill. Consumer-patients have no financial incentives to get regular screening exams, to eat a healthy diet, to exercise regularly, or to avoid unhealthy or dangerous activities. Consequently, those who voluntarily choose healthy lifestyles are forced to subsidize the higher health care costs of those who do not.15
Government intrusions in health insurance are driving up the prices and reducing the accessibility of health care for all Americans.
The government-created distortions that wreak havoc on human heath care in America, however, are almost entirely absent in veterinary care. No Medicare or Medicaid equivalents exist—and no government-created incentives herd animals like people into prepaid insurance plans. In fact, few pet owners purchase veterinary insurance for their animals, an implicit recognition that, for most people, the cost of veterinary care is generally appropriate and manageable. Pet owners interact directly with veterinarians to determine the best treatment and to negotiate fees. And owners are usually content to pay their bills on-site at the time of service.16
Moreover, veterinarians offer a wide variety of cost-savings options, such as new-pet discounts; multi-pet discounts; discounted services during weekly vaccine clinics and slow months; wellness packages that combine spaying/neutering, checkups, and vaccines; and other market-driven discounts. Some veterinarians even offer payment plans to pet owners in financial straits, while others “keep an ‘emergency fund’ for pets in an accident or other emergency situation.”17
If human medicine in America were freed of government intervention, such market-driven alternatives would arise in that field as well. Unfortunately, American intellectuals and politicians are seeking not to reduce government intervention in the medical marketplace but to increase it.
What should we expect if they succeed? We need not speculate, as other countries have already tested the waters.
In Great Britain and Canada, where the government controls medicine completely (or almost completely), patients may pay little or nothing for their care—directly. But they do pay: in taxes, reduced accessibility, and compromised quality. And in these countries, the disparity between medical care for humans and medical care for animals is even more pronounced. Theodore Dalrymple writes of his experiences with Great Britain’s socialized human medicine versus its relatively free veterinary medicine:
In the last few years, I have had the opportunity to compare the human and veterinary health services of Great Britain, and on the whole it is better to be a dog. As a British dog, you get to choose (through an intermediary, I admit) your veterinarian. If you don’t like him, you can pick up your leash and go elsewhere, that very day if necessary. Any vet will see you straight away, there is no delay in such investigations as you may need, and treatment is immediate. There are no waiting lists for dogs, no operations postponed because something more important has come up, no appalling stories of dogs being made to wait for years because other dogs—or hamsters—come first.
The conditions in which you receive your treatment are much more pleasant than British humans have to endure. For one thing, there is no bureaucracy to be negotiated with the skill of a white-water canoeist; above all, the atmosphere is different. There is no tension, no feeling that one more patient will bring the whole system to the point of collapse. . . . In the waiting rooms, a perfect calm reigns; the patients’ relatives are not on the verge of hysteria, and do not suspect that the system is cheating their loved one, for economic reasons, of the treatment which he needs. The relatives are united by their concern for the welfare of each other’s loved one. They are not terrified that someone is getting more out of the system than they.18
Americans can look forward to this even greater divide between human and veterinary care if we continue down the path toward complete government control of medicine.
Rather than admire the accessibility and affordability of veterinary care from afar, let us recognize that these values can be had in human health care—if we liberate it from government interference and thereby set doctors, patients, and insurers free to contract by voluntary consent to mutual benefit. If we want to make available for people the kind of widely accessible and reasonably affordable high-quality medical care that is now available for animals, we need, as it were, to start treating people like animals.
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1 “Animal Health: Veterinarians,” American Veterinary Medical Association, revised February 2009, http://www.avma.org/animal_health/brochures/veterinarian/veterinarian_brochure.asp.
2 “Becoming a Veterinarian FAQs,” Aardvarks to Zebras, http://aardvarks2zebras.org/becoming-a-veterinarian/ becoming-a-veterinarian-faqs/.
3 Kara Rogers, “The Animals’ Medicine Cabinet: Human Drugs and Clinical Trials for Animals,” Encyclopædia Britannica’s Advocacy for Animals, May 18, 2009, http://advocacy.britannica.com/blog/advocacy/2009/05/the-animals%E2%80%99-medicine-cabinet-human-drugs-and-clinical-trials-for-animals/.
4 See http://www.spectrumsurgical.com/index.php or http://www.medical-tools.com/index.php for comparison pricing between vet and human surgical instruments and tools.
5 Merritt Hawkins & Associates, “2009 Survey of Physician Appointment Wait Times,” http://www.merritthawkins.com/pdf/mha2009waittimesurvey.pdf.
6 Mike Stobbe, “Average ER Waiting Time Nears One Hour,” Boston.com, August 7, 2008, http://www.boston.com/news/nation/articles/2008/08/07/average_er_waiting_time_nears_one_hour/.
7 “Tired of Waiting for the Doctor? You’re Not Alone,” MSNBC, November 20, 2006, http://www.msnbc.msn.com/id/15487676/.
8 Ann Marie Falk, “Examining the Cost of Veterinary Care,” College of Veterinary Medicine—University of Illinois, September 8, 2003, http://vetmed.illinois.edu/petcolumns/index.cfm?function=showarticle&id=397.
9 http://www.newchoicehealth.com/Directory/CityProcedure/California/San%20Jose/59/Abdominal%20Ultrasound. Estimates obtained using a location-specific price calculator available at this site. Accessed March 6, 2010.
10 http://www.newchoicehealth.com/Directory/CityProcedure/California/San%20Jose/81/Abdominal%20X-Ray. Estimates obtained using a location-specific price calculator available at this site. Accessed March 6, 2010.
11 http://www.healthcarefees.com/inpatientSurgery/appendectomy.php. This site gives $11,150–$18,768 as the cost of an appendectomy—a similar but somewhat easier surgery to execute than Lily’s enterotomy—with a two-day hospital stay. Anecdotal evidence from physicians and online forums (see, e.g., http://ehealthforum.com/health/topic8529.html) indicates that many patients and insurance companies are paying upwards of $30,000 for this procedure.
12 Lin Zinser and Paul Hsieh, “Moral Health Care vs. ‘Universal Health Care’,” The Objective Standard, vol. 2, no. 4, pp. 22–24.
13 For more information about the FDA’s role in driving up health care costs and lowering quality, see Stella Daily, “How the FDA Violates Rights and Hinders Health,” The Objective Standard, vol. 3, no. 3, Fall 2008, p. 95.
14 Zinser and Hsieh, “Moral Health Care,” p. 12.
15 Zinser and Hsieh, “Moral Health Care,” p. 20.
16 The fact that pet owners have the option of putting a pet to “sleep” does not change the fact that costs for treatments are dramatically less for animals than for humans.
17 Janet Tobiassen Crosby, “Pet Health Insurance: Is This an Option for Your Pet?” About.com: Veterinary Medicine, http://vetmedicine.about.com/cs/insuranceinfo/a/pethealthinsura.htm. Accessed January 28, 2010.
18 Theodore Dalrymple, “Man vs. Mutt,” Wall Street Journal, August 8, 2009, http://online.wsj.com/article/SB10001424052970204908604574334282143887974.html.