"Take a number." "Please be seated and wait for your number to called." "Now serving # 4165." These are not phrases you are probably used to hearing in a hospital or a doctor's office. But according to a recent LA Times article, you will if the advocates of universal health care have their way. Entitled "Universal Healthcare's Dirty Little Secrets", two Cato Institute scholars describe the numerous "hurdles to care" experienced by patients in several countries whose governments provide health coverage.

Simply saying that people have health insurance is meaningless. Many countries provide universal insurance but deny critical procedures to patients who need them. Britain's Department of Health reported in 2006 that at any given time, nearly 900,000 Britons are waiting for admission to National Health Service hospitals, and shortages force the cancellation of more than 50,000 operations each year. In Sweden, the wait for heart surgery can be as long as 25 weeks, and the average wait for hip replacement surgery is more than a year. Many of these individuals suffer chronic pain, and judging by the numbers, some will probably die awaiting treatment. In a 2005 ruling of the Canadian Supreme Court, Chief Justice Beverly McLachlin wrote that "access to a waiting list is not access to healthcare."

But this is not news, really. Everyone has heard about the long waiting lists, about people dying waiting for care. What is news is that the underlying assumption motivating much of the debate doesn't have much empirical support:

You may think it is self-evident that the uninsured may forgo preventive care or receive a lower quality of care. And yet, in reviewing all the academic literature on the subject, Helen Levy of the University of Michigan's Economic Research Initiative on the Uninsured, and David Meltzer of the University of Chicago, were unable to establish a "causal relationship" between health insurance and better health. Believe it or not, there is "no evidence," Levy and Meltzer wrote, that expanding insurance coverage is a cost-effective way to promote health. Similarly, a study published in the New England Journal of Medicine last year found that, although far too many Americans were not receiving the appropriate standard of care, "health insurance status was largely unrelated to the quality of care."