by Jordan Roberts
Director of Government Affairs, John Locke Foundation
In the June edition of Carolina Journal, I wrote a column titled “American Should Be Skeptical of Single-Payer Promises.” Different flavors of Medicare for all or public options have been a focal point of the 2020 Democratic primary. Many promises have been made about the effectiveness and cost savings if America were to uproot our current system and increase government control. I wrote:
The most substantial effect on the economy would be the almost complete removal of the private sector in health care. Sanders’ program would shift more than half the country into a government plan by removing the market for private insurers. Support for the Medicare For All program fell to 37 percent in the KFF poll when respondents heard private insurance would be eliminated. Through competition and innovation, the American health care system has produced some brilliant modernizations in medicine. Putting control in the hands of the government would likely stifle that innovative drive.
So how would the government, assuming the responsibility for administering the plan, pay for such a large system? Under Sanders’ plan, patients would be subject to no out-of-pocket spending. Instead, taxes would rise, particularly on the wealthy, to pay for the program. KFF poll data show support for the Medicare For All program falls to 37 percent when respondents are told most Americans would be required to pay more in taxes. Moderate estimates put the price tag at about $30 trillion over the first 10 years. The U.S. government is projected to run an $897 billion budget deficit in 2019, adding to our federal debt of $22 trillion. The federal government will have difficulty paying for its growing obligations to Social Security and entitlement programs, let alone the trillions needed to pay for Sanders’ massive new program.
Would everyone get the care they need in a single-payer system? Probably not. Reports from other single-payer countries paint a sobering picture. For example, patients in the U.K. and Canada can experience significant wait times for certain medically necessary services. Support for Medicare For All in the KFF poll fell to 26 percent when respondents were told the system might lead to delays in people getting some medical tests and treatments. Research has shown that when patients are responsible for less of the bill, health care consumption increases, much of it unnecessary. In a country where upwards of 327 million people would be crammed into one health care program, it’s not difficult to imagine the effects on wait times.
I feel the issues I raise in my column are overlooked in the discussion of changing America’s health care system to a single-payer system. Mona Charen wrote about Canada’s universal health care system in a recent National Review article recently a looked at some exact data of the problems in Canada:
It’s true that all Canadian citizens and legal residents (though not illegal immigrants) get “free” health care, but only in the sense that you don’t get a bill after seeing a doctor or visiting a hospital. Medical care is subsidized by taxes, but the price comes in another form as well — rationing. A 2018 report from the Fraser Institute, a Canadian think tank, found that wait times between seeing a general practitioner and a specialist average 19.8 weeks. That’s the average. There are variations among specialties. Those waiting to see an orthopedist wait an average of 39 weeks, while those seeking an oncologist wait about 3.8 weeks.
Canada has the same modern medical technology that the U.S. offers, but Canadians must wait more than a month for a CT scan, more than ten weeks for an MRI, and almost a month for an ultrasound.
Imagine the anxiety of learning that you need an MRI to find out whether the mass in your breast is anything to worry about and then being told that the next available appointment is in ten weeks. In addition to the psychic price, Canadians who had to wait for treatment expended an average of $1,972.00 out of pocket last year, owing to lost wages and other costs. The Fraser Institute also calculated the value of the lost productivity of those waiting for treatment — nearly $5,600 per patient, totaling $5.8 billion nationally. Wait times to see physicians in the U.S. have been creeping up in recent years — perhaps in response to increased demand following Obamacare — but remain much shorter than those in Canada or other OECD countries with nationalized health services.
When there’s an artificial shortage of a good or service, a black market usually follows. I have heard from several Canadians that paying doctors bribes to jump the line is not uncommon. But Canada has another pressure reliever: 90 percent of Canadians live within 90 miles of the U.S. border, and medical centers in Buffalo, Chicago, Rochester, and elsewhere receive tens of thousands of Canadian patients every year.
Politicians promise a single-payer system would deliver excellent health care, lower prices, and efficiency with a single-payer system. I’m not so sure that would be the case if we were to put over 300 million people in the same program.