Wait times and single-payer health care

The Veterans Affairs scandal may seem like it can’t get any worse – yet bad news continues to mount.

An audit of the VA hospital system has revealed that over 57,000 patients have been forced to wait at least 90 days for an appointment.

More than 63,000 patients in the past decade have requested appointments that were never even scheduled. And many have died while waiting for care.

These are the natural consequences of a government-run, single-payer health care system – whether it’s in Phoenix or a foreign nation, like Canada or the United Kingdom.

Single-payer’s champions claim that the system can restrain health costs by reducing administrative spending. One payer theoretically has more market power to demand better prices – and can streamline spending on claims processing and the like that’s currently handled by insurers.

But single-payer systems are prone to cost overruns. Between 2007 and 2012, the VA’s budget grew faster than its patient population – a 76 percent bump in spending, versus a 13 percent increase in the number of patients.

Yet the system is still cash-strapped. The Congressional Budget Office estimates that the VA is staring at a 75 percent budget shortfall.

The same is true of single-payer systems abroad. The one in Canada – the country of my birth – is $537 billion in the red. Taiwan’s has had to borrow heavily to cover excess costs.

Single-payer administrators effectively have one option for containing ballooning costs – rationing. They artificially restrict access to drugs and services. Patients experience those restrictions in the form of long waits – or outright denials of care.

This causal chain played out to dangerous effect in the VA. The Phoenix facility at the heart of the scandal stashed at least 1,600 vets on secret waiting lists. About 7,000 were backlogged at facilities in Columbia, South Carolina, and Augusta, Georgia.

Forty-five percent of vets suffering from mental health issues – among the most serious threats to their post-combat well-being – have had to wait 14 days or more just to get an appointment. In one particularly egregious case, a soldier who had served a 10-month tour in Iraq came home only to face a four-month wait for a mental health appointment at a VA hospital in South Carolina.

These delays in treatment are even worse in single-payer systems abroad.

According to the latest research from the Fraser Institute, a think tank, the average Canadian has to wait 18 weeks between referral from a general practitioner and receipt of treatment from a specialist. Those north of the border are collectively waiting for more than 928,000 procedures. Nearly 3 million people are on waiting lists in the United Kingdom.

Rationing doesn’t just come in the form of restricted access to doctors.

System administrators also routinely deny coverage for cutting-edge drugs and treatments.

The VA system maintains a restrictive drug formulary that covers only about a third of the medicines available to Medicare patients. Every year, the United Kingdom’s National Health Service denies about 52,000 patients coverage for basic services like cataract operations and varicose veins treatment.

Single-payer rationing also exerts a huge human toll.

Consider the case of Edward Laird, a 76-year-old Navy veteran. He faced an astonishing two-year delay to get a biopsy for cancerous blemishes that ultimately cost him half his nose.

For 71-year-old veteran Thomas Breen, a months-long wait to get treated for a urinary tract infection proved fatal. No less than 18 veterans at the now-infamous Phoenix facility died before getting care.

It’s hard to square these realities with the conclusions of the VA’s defenders, like Princeton economist Paul Krugman, who has described the Veterans Health Administration as “our little island of socialized medicine in the United States. And it does very well.”

In Canada, long wait times have played a role in the deaths of 44,200 female patients over the last two decades. More than 8,600 Australians in that country’s single payer system have died while on waiting lists.

Over the last four years, more than 50,000 British patients have had to wait two months or more for chemotherapy, radiotherapy or cancer surgery.

The VA scandal is far from over. As the full extent of the agency’s failure comes into focus, the lesson for national policymakers should be clear – single-payer health care is disastrous. Long, dangerous wait times are inevitabilities. They aren’t a bug of single-payer – they’re a feature.

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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