Californians are concerned about their health care. The number of uninsured has increased, as has the cost of health insurance. We question the quality of our health care. We are anxious about rising costs. Some of us look to government for relief, but what role does government actually play? The Orange County Register Commentary section has joined with the Pacific Research Institute, a California free-market think tank, to run a series of articles on the topic of a Healthy California. Today, the institute's director of health care studies, John R. Graham, examines the consequences of SB840, proposed legislation that would impose single-payer health care in California.

Government monopoly health care, a bad idea that California voters rejected in 1994, is heading for a vote in the state Assembly after the November election.

Senate Bill 840, by State Sen. Sheila Kuehl, is the unhealthy child of Proposition 186, which a decade ago voters rejected 73-27 percent. But this time it won't be the people voting. That should concern anyone who wants to preserve what little health freedom the government has left Californians.

Government monopoly health care is a tempting idea for those unaware of its consequences. Advocates usually peddle it under a friendlier name such as "public health insurance" or "single-payer health care." In recent times, the problems that it claims to solve have gotten worse. The costs of health care, health insurance, and the number of uninsured have all been edging up,

According to a recent paper by a liberal research organization, the UC Berkeley Labor Center, the share of working-age Californians with employer- sponsored health insurance has dropped by 2 percentage points between 2000 and 2004, from 66 percent to 64 percent. For workers earning between $9 and $11 an hour, the drop has been a shocking 13 percentage points, from 59 to 46 percent.

Perhaps it's not surprising, therefore, that politicians feel increasingly confident that voters will allow the government to take control of their health care.

Sen. Kuehl introduced SB840 last spring and the Senate voted for it 25-15, along party lines, a sign that government monopoly health care has taken over the minds of California's Democratic Party machine.

Before the Assembly vote, likely to take place sometime after the November special election is out of the way, Californians should take a hard look north at the consequences of government monopoly health care as envisioned by SB840.

THE CANADIAN MODEL

In Canada, government takeover of the health-care system was completed in 1984. Since then, waiting lists for care have grown, while quality and access have declined. This life-threatening trend continued unchecked until this July, when the system finally hit a roadblock. The Canadian Supreme Court ruled in a test case that the government monopoly in Quebec violated the civil rights of patients and doctors.

The doctor in question, Jacques Chaoulli, ran into problems when he set up shop in a van. The government's monopolist health insurer would not pay for house calls, so he figured that by calling his van his "office" he could at least treat his patients in their driveways, if not right in their homes. Unfortunately, the state thought otherwise, and did not pay him.

Because the law effectively prevented patients from paying him directly, Dr. Chaoulli could not give his patients the care that he thought they needed. Also, the government forbids private hospitals, forcing patients who require surgery to line up for rationed operating rooms in government-funded hospitals. While they wait, their health deteriorates.

Sen. Kuehl's plan replicates virtually all the aspects of this inhumane system. In both cases, the government controls 100 percent of health spending on services the state deems essential. Patients have no control over how their health care dollars are spent.

WHAT SB840 WOULD DO

Under SB840, it will be illegal to buy health insurance that competes against that offered by the state agency.

Nor will privately operated hospitals have the right to compete to serve patients. SB840 gives the state immediate control over hospitals' operating budgets and control over capital budgets in the near future. Hospitals will need to seek approval from the state for operating budgets every three years based on estimates of procedures it will do.

SB840 envisions a state health insurance agency that will sweep out all Californians from other programs. Even Medicare patients will be pulled out of the federal program, which allows a role for private insurers, and into the new state monopoly. While a provider may theoretically opt out of the system, he cannot bill extra.

Technically, the Kuehl system would not limit coverage of any particular condition or procedure. But total spending will be limited to a certain share of the state GDP. When that limit is approached or breached, it is inevitable that services will be cut back.

If a doctor thinks that his services are worth more than the fee determined by the state, he cannot ask the patient to pay the difference. In any case, the ability of providers to opt out is limited by reality. The state will tax all Californians to fund the system, and outlaw private insurance. Therefore, only the very rich will be able to pay privately for care anyway.

THE CONSEQUENCES

What will the consequences be for Californians? At first they won't seem so bad. Californians won't lose health insurance if they lose their job, a big plus. Doctors won't have to deal with all that paperwork from different insurers. Although taxes will go up, health-insurance premiums will disappear, which will make health costs invisible to the patient. This is notan advantage, however, but in fact a major drawback.

Under such a system, everybody claims unlimited health care as a "right" without knowing or caring how much it costs. In the longer term, because patients have virtually zero impact on how resources are used, things get very bad.

For 14 years, Vancouver's independent Fraser Institute has been measuring Canada's appalling waiting times for diagnostic and surgical services.

Overall, the median waiting time for all surgeries in 2004 was more than four months, measured from the date a patient first consulted his family doctor until he finally got his surgery. Surgeons reported that it took more than a month longer for them to perform procedures than is clinically reasonable. This is because they could not get operating time at the hospitals.

Orthopedic surgery suffered the worst waiting times: almost nine months. That explains stories of Canadians traveling to the United States for knee or hip operations.

Diagnostic waiting times are also very long. It takes the median Canadian patient more than five weeks to get a CT scan, and three months for an MRI scan.

Many Canadian doctors, like Chaoulli, have had enough and are moving, primarily to the United States. The Canadian government's statistical agency reported that 1.2 million Canadians, out of a population the size of California's, were unable to find a family doctor in 2003. That is hardly a scenario consistent with the "universal" health care politicians are fond of promising.

Since the imposition of government monopoly health care in Canada, the share of physicians in the population has dropped from one of the highest among developed countries to one of the lowest. If SB840 is adopted, we can expect California's doctors to decamp to friendlier states.

Defenders of the government monopoly in health care often point out that it is cheap. Canada spends about 10 percent of its Gross Domestic Product on health care, while the United States spends between 13 percent and 15 percent.

But these measurements do not include lost productivity or quality of life. The Fraser Institute estimates that about 2.6 percent of Canadians are waiting for treatment at any given time, and their suffering is not measured in the government accounts.

There are ways to reduce the cost of U.S. health care without imposing a government monopoly. For example, Americans who have embraced the health savings accounts created by the federal government in 2003, which give them more direct control of health spending, have been able to lower their health costs.

The state's legislators should not fall for a system that will create a tragic shortage of operating rooms, diagnostic technology and doctors. Instead, Californians should demand legislation that gets health care money out of the hands of the politicians and into the hands of the patients who need it.

*In coming months

The Healthy California series will examine the competing drug-discount initiatives on the Nov. 8 ballot and the problem of Californians who are not covered by health insurance.