Single-payer health care is generally defended with “heart-wrenching” virtue signaling divorced from any cost, economic, or financial reality. The idea that any scarce service or commodity is a right and therefore should be free is fanciful, but impossible. With an indebtedness of $38 trillion and growing, adding greater than $40 trillion as estimated for the cost of “Medicare for All” would absolutely drive the country into insolvency. Even without single-payer, the potential for a debt crisis exists. But passing this horrendous, immoral debt onto future generations is already the reality.
The Canadian example
I recently listened to a commentary by a proponent of the Canadian single-payer health care system. Using this as an example of single-payer seems appropriate. Canada is a country of only 30 million people. This demographic, with the significantly different array of social issues, makes comparison to U.S. health care difficult at best.
Despite this relatively small population, the number of people awaiting elective surgery at any given time is 1 million people, and awaiting specialist care is also 1 million people. They have some of the longest wait times for sophisticated diagnostic testing such as MRI or CT scans. Approximately 40,000 patients annually seek care in the U.S. Their cost per patient is $11,500 annually in taxes. They have the lowest ratio of doctor to citizen in the developed world. This reflects poorly on the ability to retain present and future physicians.
They have not been able to contain costs even though care is rationed on the basis of defined financial payments to each individual province. They are beginning to experiment with market-based approaches to health care. In general, when apples are compared to apples, quality and outcomes of care are better in the U.S. The U.S. remains clearly number one in medical innovation, including drug development. The number of Nobel Prizes for medicine have more U.S. recipients than the rest of the world combined.
Innovation and economics
What is the proper amount of GDP for the health care industry, how is this concluded, and why is it assumed we are spending too much? Maybe other countries are spending too little. Since 1960, the percentage of income spent on food, housing, and health care has basically remained the same.
There is no single-payer system that does not eventually deal with its increasing costs other than by controlling pricing. This must result in one or more forms of rationing.
Market-based solutions
We can do better than this with market-based solutions to insurance, the financing side, and competition on the provider side. The additional cost burden imposed by professional liability is unique to the U.S. and has been said to account for 25 cents of each dollar spent on health care.
What we do not need is a government takeover of our great health care system with politically driven changes and increasing bureaucratic control to what is in all honesty the very best health care in the history of the world. Though general statements are risky, it can be stated confidently that government programs are particularly distinguished by the inefficiencies, fraud, and abuse intrinsic to them.
A safety net for the truly uninsured needy in this country can be accomplished relatively inexpensively without a government takeover of 17.5 percent of the economy. In fact, it could likely be done on a state-by-state basis with minimal involvement in care models by the government through private market solutions.
We can do better than almost anything offered by a single-payer, socialized, Canadian-style health care model.
Allan Dobzyniak is an internal medicine physician.
