Flaws with Single-Payer

Sally speaking 1

Editor’s note: Today’s blog is part two of a three part series featuring PRI’s CEO & President Sally Pipes’ health care speech delivered at Reason Weekend on March 18th. 

Despite the obvious failures of Obamacare and Medicaid, Democrats still can’t get enough of public health care.

Sen. Bernie Sanders (I-VT) may have said that Medicare for All “ain’t going to happen” in the next two years because of our divided Congress. But his single-payer dream remains a guiding light for the next generation of progressives.

Meanwhile, blue states like California and New York are continuing to push for government takeovers of their health insurance systems.

This past November, Oregon voters ratified a constitutional amendment that establishes a “right” to affordable health care. It’s unclear how Oregon will deliver on that right.

Washington State’s publicly sponsored health plan has struggled to get off the ground. But the state’s leaders are trying to give that public option more power to dictate prices to providers. The ultimate goal is no doubt a public plan with every government advantage at its disposal that can put private plans out of business.

American progressives may not realize what they’re pushing us towards. But lawmakers in countries with single-payer systems certainly do.

In January, In Canada, Ontario Premier Doug Ford announced that the province would begin expanding private care to alleviate the stress on Canada’s government-run system. Announcing the change, Ford quoted a CEO who told him, “There’s only two places in the world that have the health care that we have . . . Cuba and North Korea.”

Before she resigned, Scottish First Minister Nicola Sturgeon said in January that Scotland’s NHS was under “severe” pressure and bemoaned that emergency room wait times were “far higher than they should be.”

You know things are bad when politicians in Canada and the United Kingdom, who have done nothing but sing single-payer’s praises for years, are admitting they have a problem.

The acknowledgment may be new. But the problems have been there for years.

In both Canada and the United Kingdom, the government guarantees health care free of charge at the point of service. That effectively makes demand for health care unlimited. Supply, of course, is scarce.

Anyone with a basic understanding of supply and demand can see that this will lead to overworked doctors, underserved patients, seemingly endless lines, and poor outcomes.

Those are a lot of problems to cover. Let’s start with the healthcare providers.

Over 75% of Canadian nurses were burnt-out in 2021, as were half of Canadian doctors.

Things are even worse in the United Kingdom, where overworked doctors are quitting in droves. Of the roughly 3,200 doctors who resigned from the NHS in 2022, more than 10% cited burnout as the reason.

Thanks in part to this exodus, Britain’s healthcare system is currently short around 9,000 doctors. Most of the doctors who left are more senior, which increases pressure on younger doctors, and thus feeds a cycle of burnout.

A dwindling number of doctors lengthens the already long waits for care that patients in single-payer countries face. Last year Canadians had to deal with a median wait of 27 weeks to get specialist treatment after receiving a referral from a general practitioner. That’s up about two weeks from 2021 — and almost triple the 9.3-week median wait in 1993.

Wait times vary wildly across the country. In Prince Edward Island, patients had a median wait of 65 weeks for specialist treatment, the longest of any province.

In the United Kingdom, some 7.2 million people were waiting for treatment as of November 2022. More than 400,000 of those patients had been waiting more than a year.

Patients across the Atlantic must also contend with a different type of wait crisis — “bed blocking.” As the March issue of Reason chronicled, around one in seven beds — 13,000 beds a day — as of July 2022 were occupied by patients who are healthy enough to be discharged but have nowhere else to go.

That’s due in part to the fact that there are no adult home care workers to take care of them. One in every 10 of those positions is unfilled, a total shortage of 165,000.

Because so many beds are blocked with patients waiting to be discharged, incoming patients are frequently left to idle in ambulances. According to National Health Service data released in January, the average ambulance response time for patients suffering stroke, chest pains, or severe burns was 93 minutes at the end of last year, five times the recommended target.

Ambulances took nearly 11 minutes to reach patients classified as experiencing “life-threatening” health events, including those suffering heart attacks.

Fewer than half of patients seeking treatment at the United Kingdom’s biggest emergency rooms were treated within four hours of checking in, a record low for an already struggling system. The number of people admitted to emergency rooms who waited more than 12 hours to be treated rose 44% between November and December of last year, the highest that number has been in 12 years.

While all of these waits are bad throughout the year, they are particularly terrible in flu season. The NHS gets so overrun with patients each year that the phenomenon has a name: the “Winter Crisis.” At the beginning of this year, Ukrainian refugees were reportedly returning to their war-torn home country for urgent medical care, rather than contend with the lines in England.

Patients in Canada and the United Kingdom also suffer from diminished access to pharmaceutical treatments. That’s because in single-payer systems, the government is the sole purchaser and controls which drugs patients can have access to. These countries will deny coverage for certain novel treatments to cut costs — and patients pay the price.

In a paper published by The Galen Institute, Doug Badger quantified how single-payer systems’ price controls have cut off patients from novel drugs. He found that patients in the United Kingdom had access to just 60% of new drugs that came on the market between 2011 and 2018. In my native Canada, patients only had access to 44% of those drugs.

In contrast, patients in the United States had access to 89% of drugs released in that seven-year window.

Those discrepancies in access to novel therapies have real implications for cancer survival. The United Kingdom has a cancer mortality rate of 222 patients per every 100,000 people — one of the highest of any developed country. Canada has a mortality rate of 200 patients per every 100,000 people. In the United States, meanwhile, the rate is just 182 per 100,000.

Canadians and Britons pay dearly for their “free” care — not just in waits but in cold, hard cash. A typical single Canadian doled out more than $4,900 in taxes for health insurance in 2022; the average Canadian family of four was on the hook for nearly $16,000 in taxes to cover their public health benefits.

Britons pay about £2,647 per person — about $3,200 — in taxes each year to fund the NHS. And even that’s not enough. The NHS is slated to get nearly $4 billion over the next two years, and experts warn that even that funding boost is insufficient to keep it afloat.

Is it any wonder that 13 percent of Brits now have private coverage?  And the number is growing quickly.

Clearly, government-run healthcare systems are not the cure-all advocates claim them to be. Given single-payer’s myriad failures, it only makes sense to seek solutions in the free market.

Sally C. Pipes is president, CEO, and the Thomas W. Smith fellow in healthcare policy at the Pacific Research Institute. Her latest book is “False Premise, False Promise: The Disastrous Reality of Medicare for All,” (Encounter Books 2020).

Nothing contained in this blog is to be construed as necessarily reflecting the views of the Pacific Research Institute or as an attempt to thwart or aid the passage of any legislation.

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