Ignoring single-payer siren song
Single-payer health care has failed spectacularly everywhere
Government-run, singlepayer health care is apparently back in vogue. The California state Senate recently green-lit a bill that would abolish private insurance and force all residents — including those currently on Medicare and the state’s version of Medicaid, Medi-Cal — into a new government-run plan. The bill has been put on hold by the state Assembly but could be considered as early as 2018, the second year of the legislature’s current two-year session.
New York’s state Assembly approved a single-payer bill this year; the state Senate failed to take action on it before adjourning at the end of June. Nevada’s legislature passed a bill in June that would have allowed any resident to enroll in the state’s Medicaid program; Gov. Brian Sandoval vetoed the measure. Meanwhile, the “Medicarefor-All” bill introduced by Rep. John Conyers, Michigan Damocrat, every year since 2003 has more co-sponsors than ever before.
Even private insurers are wondering aloud about a government takeover of the nation’s healthcare system. In June, Mark Bertolini, CEO of Aetna, said, “Singlepayer, I think we should have that debate as a nation.”
That debate should be a quick one. Single-payer has failed spectacularly everywhere it has been tried. Patients subjected to such systems routinely wait months for care — if they’re able to receive it at all. And those delays can be deadly.
Consider Canada’s government-run system, where “coverage for all” really means “coverage for all who survive long enough to see a doctor.” Last year, the median Canadian had to wait roughly five months between referral from a general practitioner and receipt of treatment from a specialist. That’s more than twice as long as the wait time was a quarter-century ago.
In 2016, Canadians in need of MRIs played the waiting game for 11.1 weeks. Those needing CT scans stood in line for nearly one month.
One report estimated that the spike in wait times between 1993 and 2009 may have been responsible for the deaths of up to 63,000 Canadian women.
It’s no wonder that 45,619 Canadians left the country in 2015 to seek medical care abroad. As Beverley McLachlin, chief justice of the Canadian Supreme Court observed, “Access to a waiting list is not access to health care.”
Patients in the United Kingdom’s singlepayer system, the National Health Service, are also well-acquainted with waiting for care. In 2015, nearly 40,000 patients waited more than 18 weeks to start treatment, following referral. More than 13,000 people waited more than half the year. Those are the worst figures since the NHS began keeping track in 2008.
According to one investigation, substandard facilities and long delays at 14 NHS facilities may have caused up to 13,000 avoidable deaths between 2005 and 2012.
Australia’s single-payer system is a mess, too. A recent report found that more than 14,000 Australian patients waited over a year for elective surgery between 2015 and 2016. More than 7,000 either died waiting for a procedure or were unable to be contacted.
Single-payer has even failed patients stateside. The federal Veterans Health Administration has lurched from scandal to scandal — and America’s military heroes have paid the price.
In 2014, a federal investigation found that workers at the VA in Phoenix had been falsifying records to hide long waits for care. They did so to qualify for some $142 million in bonuses for keeping wait times to a minimum.
As of October 2016, some 38,000 veterans had been waiting for more than 125 days for a doctor’s appointment.
Some VA hospitals are still reporting false information on wait times. A report released this past March by the agency’s inspector general found that waits for new patient appointments for specialty care at the Hampton, Virginia, facility averaged 30 days. The VA officially reported average waits as just eight days. Average waits for mental health appointments were twice as long as the VA officially stated.
With Republican efforts to replace Obamacare struggling in the Senate, Democrats are daring to dream about a singlepayer future.
But patients who value timely, highquality care should hope that the wait for single-payer is permanent.