Five Strikes Against Single-payer Healthcare

In baseball, when you get three strikes, you’re out. There have been at least five strikes called against single payer (SP). Shouldn’t we hear from an umpire?

Whether you call it single payer, socialized medicine, universal health care, Veterans Administration (VA) Hospital System, ObamaCare, Public Option, or National Health Service, these are all different names for the same thing: government-controlled healthcare. Details vary but all single payer-type systems have one thing in common: a central authority that controls both supply of dollars and providers, as well as demand for goods and services.

Strike #1: Italy's price controls

In the early 1990s, headlines in Italy newspapers screamed about “Costo dei Farmaci!” (cost of drugs). The Italian government responded in classic single payer fashion -- they imposed strict (low) price controls. Drugs that used to cost people $300/month were suddenly and artificially priced at $5-10/month. Consumers were happy with these below-cost prices. The indigenous Italian pharmaceutical industry, which had previously had both vibrant R&D and robust manufacturing, was decimated financially and ceased to exist within three years.

As a result of government price controls, Italy now must buy its pharmaceuticals from elsewhere, pay what is charged, and then subsidize their patient population for the difference between their artificially low consumer price and the true, market-based cost. This may seem affordable to the individual, but that money must come from somewhere, and eventually “somewhere” means the Italian people.

Strike #2: Avoidable deaths in Canada

In 1998, Dr. Ciaran McNamee, a surgeon in Alberta, Canada sued his Provincial government on behalf of patients. He had scientific evidence proving that Canadians were dying needlessly while waiting “in line” for their medical care. The treatments were approved by the government but could not be provided in a timely manner.

As in all other single-payer systems, the Canadian government decides how much money to allocate to care such as chemotherapy, burn units, replacement parts, heart surgery, etc. The budget -- not patients’ medical needs -- drives the availability of medical care in Canada. In this way, Canada’s single-payer system produces death-by-queueing.

Strike #3: Medical rationing at the NHS

Like Canada, Great Britain has a single-payer system, called the National Health Service (NHS). Unlike Canada, the NHS rations medical care by denying authorization for care. First, the government allocates a certain amount of money to the healthcare system based on negotiations among political parties and lobbying groups. It fully funds the bureaucracy. Then an agency called NICE (National Institute for Clinical Excellence) says which treatments will not be approved based on how much money is left over. Life-saving treatments are no longer available, viz., kidney dialysis over the age of 55 years. Finally, patients simply… die. (It’s cheaper.)

Great Britain’s single payer system employs death-by-budget.

Strike #4: VA system in the U.S.

The crisis in our VA system was highly publicized in 2013-14, but was not new. The problem has been ongoing for decades. The VA is a single payer in every important sense, as Washington controls both supply and demand.

The result is too few care providers to serve our veterans, viz., doctors, nurses, psychologists, etc.; not enough prosthetic limbs or complex drug therapies; and too few burn beds as well as operating rooms.

Congress magically solved the problem by “finding” an additional $16.3 billion. Of course, that money is a band-aid, admittedly a huge one but palliative nonetheless. It does not fix the root cause, which is the single-payer approach. Furthermore, that money will come out of the Pentagon’s budget, meaning less armor on our “armored” vehicles, fewer smart bombs, and no new weapon systems.  

Strike #5: Vermont’s single payer

The latest “swing-and-miss” strike came from the Green Mountain State (Vermont). In the 2012 gubernatorial election there, the major issue was single-payer healthcare. Peter Shumlin, the Democrat candidate, vowed to “make it happen.” His Republican challenger, Robert Milne, claimed single payer wouldn’t work and couldn’t/shouldn’t be done. Shumlin won by just over 2000 votes.

One of the prime architects of Vermont’s Green Mountain [single-payer] Healthcare Plan was Jonathan Gruber, of recent infamy. His report assured Shumlin and the people of Vermont that his Plan would save money. He then sent a bill to Vermont for $400,000.

On December 17, 2014, Governor Shumlin announced that he was cancelling Green Mountain Healthcare. It was simply too expensive and would have imposed crushing new taxes on the citizens of Vermont. Coverage by the mainstream media was… “muted.”

That was strike #5 by single payer at bat.

Next Strike: Medical rationing coming soon to the U.S.

The next pitch will come from ACA’s Independent Payment Advisory Board (IPAB). While we cannot know whether it will be a ball or strike until the umpire calls it, I can predict a strike with absolute assurance. IPAB was based on England’s NICE. We know that NICE is the medical rationing arm of the NHS. It decrees what medically effective therapies will be declared “Not Cost Effective,” which makes them unavailable for doctors to use on patients’ behalf.

In single payer systems, the budget wins every time over the welfare of patients.

Single payer is a proven failure

The American Founders intended the States to function as idea incubators. A State would try something. If it worked, that idea could then be expanded to encompass the entire Republic through the federal government. If the idea failed, the damage would be limited, and the country at large would be spared a bad outcome.

Vermont served very well as such an incubator. It tried single payer and found that it doesn’t work. We should ignore the inevitable excuses, rationalizations, and name-calling, and learn from the Green Mountain State’s experience. Unfortunately, some people need more than one knock on the head before they give up their magical thinking.

Let’s add up all the prior “strikes” against single payer: death-by-queueing among U.S. veterans as well as Canadians; Italy’s massive drug subsidies; England’s draconian medical rationing; and then there is Spain–the sickest nation in Europe where health care was declared “a right” in the 1978 Spanish Constitution.

It is crystal clear that single-payer healthcare systems provide neither affordable nor timely health care to the people they serve. Single payer is out!

Dr. Deane Waldman MD MBA is author of The Cancer In Healthcare; Adjunct Scholar (Healthcare) for Rio Grande Foundation public policy think tank; Emeritus Professor of Pediatric, Pathology and Decision Science; and member, Board of Directors of New Mexico Health Insurance Exchange. Opinions expressed are solely the author’s and do not necessarily reflect those of the Board.