Problems with single-payer health insurance

Although Americans soundly rejected "socialised medicine" back in 1993, when the Clinton administration proposed wholesale changes in the health care industry, former Delaware Governor Pete du Pont says self-appointed health care advocates are pushing incremental steps toward national health insurance.

National health insurance is socialised medicine – but proponents are using a less threatening term: "single-payer system." In theory, a single-payer system would reduce the number of different organisations with which physicians and hospitals must file claims. Many public health advocates assume the administrative savings would be sufficient to fund coverage for the uninsured. Likewise, consumer groups would like to pocket any savings in the form of lower premiums. Yet the truth is there will be no "savings" to fight over.

In all single-payer systems, consumers are insulated from the direct cost of health care because it is paid for through taxation. Consequently, they tend to consume more. Single-payer systems employ several tactics to artificially reduce consumption, including outright rationing of care, short-changing capital investment, and reducing the number of physicians.

  • To adopt a single-payer system with resource allocation similar to Canada, for instance, the U.S. would have to fire around 171,000 physicians.

  • The remaining doctors would have to see, on average, 921 additional patients per year to match the average number of patients seen by Canadian physicians – likely reducing the length of time physicians spend with patients.

  • Furthermore, long waits would be required – in 1999, for example, the median wait for a CT scan and an MRI across Canada was five weeks and 12 weeks, respectively.

    Finally, as a monopoly, a single-payer system can reduce funding for particular services or refuse to cover services deemed too expensive. Consumers would have to accept whatever costs and benefits were offered.

    Source: Pete du Pont (NCPA policy chairman), Single-Payer Health Care By Any Other Name Is Still A Monopoly, April 2, 2002.

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    For more on Assumptions Behind Health Care Reform

    FMF Policy Bulletins 30 April 2002
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