Democrats all over the country are loudly raising their voices for socialized medicine, no doubt determined to finally put in place that crown jewel of the egalitarian welfare state. Echoing arguments from previous fights over health-care socialism, they tell us all about affordability and accessibility and all the other good things it will bring.
What they don’t tell us about is the reality of single-payer health care: high taxes, rationed care and higher mortality rates.
In my review last summer of data on health care access I concluded that our health-care system, imperfect as it is, at least still lives up to its purpose
Plain and simple: the reason why we have a more expensive health care system is that we actually provide health care.
A single-payer system works like managed care in Medicaid: its foremost function is not to provide health care, but to contain costs. This is painfully visible in Europe, the pinnacle – or dungeon – of government-run health care.
For example, as my article from last August explained, people in other countries are more likely to die of cancer than Americans are. For breast cancer, e.g., we have the highest survival rate, beating every country with single-payer health care.
Another important metric is the nurse-to-bed ratio. Here, the United States beats almost every single-payer system. This is more important than it might seem at first glance. Better staffing allows medical staff to be less stressed out at work, therefore make fewer mistakes and are more likely to pick up on patients’ needs before they become problems.
Access to medical technology is also different. Americans rightfully expect to be able to get a CT scan when they need it; in every other OECD country except Australia, patients have to wait longer – sometimes much longer – than here.
Mandatory referrals are another method for health-care rationing. Under socialized medicine, patients have to start their journey to treatment by seeing a general practitioner. That is where the waiting begins. Once they get to see him, a referral to a specialist is by no means guaranteed. Cost containment is one of the factors that general practitioners have to take into account when writing referrals.
Those patients who get a referral then move on to the next waiting list: to see the specialist. In Sweden, e.g., this means waiting weeks, even months. As of November 2018, eleven of the country’s 21 health care districts reported excessive waiting lists for specialist consultation. One third or more of the patients had to wait more than 60 days.
Just to see a medical specialist. When they finally got to see that specialist, they had to line up for treatment. In 14 of the 21 health care districts, at least one third of the patients had to wait more than 60 days for treatment. In one district, more than half the patients had to wait more than 60 days.
The same government that forces Swedes into these lines has also put a law on the books that guarantees every patient treatment within 90 days. Does it surprise anyone to learn that one in four patients had to wait more than 90 days for treatment?
The Canadian system is a bit better, but not exactly something to write home about. According to the Fraser Institute’s annual Waiting Your Turn review,
- The median waiting time between referral from a general practitioner to receipt of treatment has increased by 113 percent in the past 25 years;
- The waiting time from referral to consultation with a specialist had increased by 136 percent, to a national average of 8.7 weeks;
- The waiting time from consultation to treatment had increased by 97 percent, averaging eleven weeks.
In five of Canada’s ten provinces, patients had to wait on average six months or more from a specialist referral to treatment. Nationally, Canadians had to wait on average four weeks for radiation oncology, ten weeks for elective cardiovascular surgery, 26 weeks for neurosurgery and 39 weeks for orthopedic surgery.
How many Americans in need of knee replacement would accept having to wait more than nine months for surgery?
As for diagnostic technologies, the Fraser Institute reports:
Canadians could expect to wait 4.3 weeks for a computed tomography (CT) scan, 10.6 weeks for a magnetic resonance imaging (MRI) scan, and 3.9 weeks for an ultrasound.
They also explain that waiting times exceed what is deemed to be clinically reasonable:
Specialists are also surveyed as to what they regard as clinically “reasonable” waiting times in the second segment covering the time spent from specialist consultation to delivery of treatment. Out of the 96 categories (some comparisons were precluded by missing data), actual waiting time exceeds reasonable waiting time in 72% of the comparisons.
Oblivious to these facts, Democrats across America are in full campaign mode to create a single-payer system. This campaign spans from local governments through states all the way to Congress. For example, according to MSN.com, New York City Mayor de Blasio
is set to roll out an ambitious $100 million plan to provide a “public option” to provide healthcare to serve New York City’s 600,000 uninsured — including undocumented immigrants. “This has never been done before in this country in this kind of comprehensive way — it’s going to be for the first time a guarantee of healthcare,” de Blasio said Tuesday morning on MSNBC’s Morning Joe. “We’re going to guarantee healthcare for New Yorkers who need it.”
As if to drive home the point about cost containment, de Blasio’s plan allots a whopping $167 worth of health care per uninsured person. Given the going rates for anything in New York, plus taxes and other fees on health care, this will probably give each one of them an annual 15-minute chat with the receptionist at the local public hospital.
Perhaps sensing the arithmetic problem with his plan, MSN reports that the mayor
said the city would be expanding an already existing public option. Though he did not specify which program, on Monday DocumentedNY reported he was poised to expand ActionHealthNYC, a pilot that provided reduced health costs in a managed care framework at public hospital facilities.
Plain and simple: government-run medicine means managed care, and managed care means cost containment above all. Medicaid is a good example: currently, 65 percent of all people enrolled in the program are on managed-care plans, yet those plans only represent 43 percent of total Medicaid costs. This is not surprising, given how even the federal government admits that cost management is the first goal of managed care in Medicaid.
The single-payer delusion is also taking California by storm (and we are all very surprised). The Daily Wire has the story:
[Governor] Gavin Newsom doubled down on claims he made earlier this month that he’d turn California into a single-payer healthcare state, telling the Pod Save America podcast that he plans on expanding Medicare to cover every Californian — even illegal immigrants.
There is a slight problem with Newsom’s plan. Medicare is a federal program. The state of California has no jurisdiction over it.
Perhaps Newsom his hoping that the federal government will happily pick up the tab for his new program? After all, Newsom’s record from his tenure as mayor of San Francisco is not exactly one of fiscal responsibility. The Daily Wire again, quoting Newsom:
“I did universal health care when I was mayor, fully implemented regardless of pre-existing conditions, ability to pay, and regardless of your immigration status.”
Thanks in part to this program, Newsom left San Francisco with a $576 million deficit for his successor to deal with.
How much is he going to increase the hole in the La La State’s budget?
Incidentally, the Daily Wire observes that health care professionals in California are not exactly enthusiastic about Governor Newsom’s plans:
doctors and California’s healthcare administrators are against the prospect of a fully single-payer system, largely because it will tank their salaries, and they’re planning on opposing any legislation designed to make big changes.
It remains to be seen if Gavin Newsom listens to facts and reason. His fellow Democrats in Congress do not seem to want to do that. From the Fiscal Times:
Speaker Nancy Pelosi (D-CA) said last week that she supports holding hearings on Medicare-for-All legislation, and on Tuesday House Budget Committee chair Rep. John Yarmuth (D-KY) sent a letter to the Congressional Budget Office requesting a comprehensive analysis of how a single-payer health system would work in the U.S.
The federal government can certainly make a single-payer system “affordable” if it wants to. All that is needed is systemic rationing that restricts access to health care to the point where people no longer think it is worth the while to try to see a doctor.
There really are no other paths to “affordable” health care – at least not through more government involvement. Jim Kelly, writing for the Foundation for Economic Education, dispels the myth that for-profit health insurers make excessive profits. Contrary to what health-care socialists often suggest, there is only about two percent of insurer profit margins for government to do away with.
Nor is there much to be saved on the prescription-drug front; as Kelly notes, the federal government already has Medicare, and there are no discernible bulk-buy savings to be found in that system.
America still has a world class health care system. We can keep it that way, but to do so we need to move in the exact opposite direction from what single-payer advocates want: we need to get government out and leave the rest to patients and medical professionals.
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Image credit: CMSRC | CC BY-SA 3.0.
