Sally C. Pipes - The False Promise of Single-Payer Health Care

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A GOVERNMENT TAKEOVER of the US health care system has never looked more plausible.

Support for the idea is at an all-time high, according to Gallup. Two-thirds of Democratic voters favor it; even one in four Republicans is on board. Medicare for All bills have been introduced in the House and Senate, with record numbers of cosponsors.

Senator Bernie Sanders has emerged as one of the dominant forces on the political left, thanks in part to his call for single-payer health care. That call was the linchpin for his 2016 presidential campaign. The passion his supporters exhibited for single-payer has prompted many leading Democrats around the country to embrace the idea.

Under single-payer, a single entity pays for health care services. The only entity with the heft to shoulder that responsibility is the government.

If single-payer were to take hold in the United States, private insurance coverage would be outlawed. About 160 million people who get health benefits through workroughly half the populationand more than twenty million people who purchase insurance on their own would lose their private coverage and have to enroll in a new government-run plan.

Supporters of single-payer claim it can ensure universal coverage for significantly less than a privately administered system. A single government insurer doesnt have to spend money on marketing. Its administrative costs may be lower, given its scale. And as the only buyer of health care, it can theoretically drive a hard bargain with doctors, hospitals, and drug companies.

Outside the United States, single-payer is the norm. The United Kingdoms National Health Service was the worlds first single-payer system; it formally launched in 1948. Almost all doctors and nurses in the United Kingdom work directly for the NHS.

Canada, too, has a single-payer system. Health care providers dont technically work for the Canadian government, but it retains exclusive rights to cover services defined as medically necessary. Doctors cannot accept payments for such services from patients; they must bill their provincial government.

Even in the United States, certain segments of the populationseniors, the poor, military veteransare subject to single-payer.

Its siren song is appealing. Who wouldnt want free, universal coverage that eliminates premiums, deductibles, copays, provider networks, complicated bills, and the like?

Unfortunately, the reality of single-payer doesnt comport with that promise. Long wait times, substandard care, lack of access to innovative treatments, huge public outlays, and spiraling costs are endemic to single-payer.

Those pushing for a government takeover of the US health care system argue that the United States is the only developed country that doesnt guarantee health care to its citizensand that every other country spends less for better-quality care.

I live 50 miles south of the Canadian border, said Senator Bernie Sanders, the pied piper of single-payer health care. For decades, every man, woman and child in Canada has been guaranteed health care through a single-payer, publicly funded health care program. This system has not only improved the lives of the Canadian people but has also saved families and businesses an immense amount of money.

But the supposedly free care offered by countries like Canada comes at an extremely high cost.

Patients living under single-payer are subject to long waits for subpar care and shortages of everything from cutting-edge medical technology to hospital beds. These outcomes are the natural product of government-run systems that struggle to keep costs under control.

To paraphrase former British prime minister Margaret Thatcher, socialized health care systems abroad are running out of other peoples moneyand are rationing care as a result.

I spent the first four decades of my life in Canadaand can say firsthand that the picture Sanders paints bears little resemblance to reality.

Canadas health care system is defined by its waiting lists. In 2017, Canadians faced a median wait time of 21.2 weeks between referral from a general practitioner and receipt of treatment from a specialist, according to the Vancouver-based Fraser Institute. Thats more than double the 9.3-week wait the typical Canadian faced in 1993, when Fraser began tracking wait times.

Sanders should know as much. Danielle Martin, a Canadian doctor and supporter of single-payer, told the senator in a September 2017 interview, We do have a problem with wait times for what we call elective or non-urgent procedures.

Yet Sanders implored Canadians in October 2017 to be a little bit louder in their defense of their health care system. Only 64 percent of Canadians say theyre proud of their health care system.

The waits in Canada arent just for minor procedures. Canadians routinely queue for months, often in pain, for heart surgery and knee transplants. In November 2017, a family doctor in Ontario reported that one of her patients was facing a four-and-a-half-year wait to see a neurologist.

There are more than eighty-five thousand peoplealmost 2 percent of the populationawaiting surgeries in British Columbia, according to the provinces own data. Nationwide, more than one million peoplenearly 3 percent of Canadianswere waiting for procedures in 2017, according to the Fraser Institute.

If you apply that same rate to California, some seven hundred thousand peopleall of whom would nominally have health coverage under single-payerwould be on a wait list. Thats greater than the population of the states capital, Sacramento.

The Canadian Institute for Health Information says that 20 percent of Canadians have to wait a week or more to see a family doctor. Wait times for emergency room treatment are longer in Canada than in ten other industrialized countries, according to the Commonwealth Fund.

Canadians have to wait for diagnostic tests as well. In its 2017 report, the Fraser Institute found that the median wait time for a CT scan in Canada was more than four weeks. For an MRI, it was almost eleven weeks; for an ultrasound, just under four weeks.