Ig­nor­ing sin­gle-payer siren song

Sin­gle-payer health care has failed spec­tac­u­larly ev­ery­where

The Washington Times Daily - - COMMENTARY - By Sally C. Pipes Sally Pipes is pres­i­dent, CEO and Thomas W. Smith Fel­low in Health Care Pol­icy at the Pa­cific Re­search In­sti­tute. Her lat­est book is “The Way Out of Oba­macare” (En­counter 2016).

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.

ILLUSTRATION BY LINAS GARSYS

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