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Commentary By Charles Hughes

No Bernie, Single-Payer Is No Panacea

Economics Healthcare

Senator Sanders recently embarked on a tour of the Canadian health care system as part of his push to bring single-payer to the United States. But problems with the provision of healthcare in Canada and the United Kingdom show that, despite what Sanders might tell you, moving to a single-payer system will not magically cure all that ails the American health care system. Rather, it would exacerbate those problems.

Canada’s Fraser Institute estimates that 63,459 people may have received treatment outside Canada in 2016, a substantial increase from the 2015 level of 45,619. The authors of that report point to the wait times, 10.6 weeks for medically necessary treatment after seeing a specialist, as a major reason the rolls are growing.

Perhaps due to its single-payer system, Canada has a limited number of health care professionals. Compared to 29 OECD counties, on a per-1,000-population basis the country is 26th in terms of physicians and 15th for nurses. The country also has fewer physical resources, with fewer acute care beds and psychiatric beds per capita than the average OECD country.

Even with these forms of rationing, the burden for Canadians has increased. Health care is free at the point of service and the public health system is financed out of general revenue instead of a dedicated tax, making it more difficult to estimate this burden. However, in another report the Fraser Institute estimates that the amount of taxes paid by an average Canadian family going towards public health insurance has increased almost 174 percent from 1997 to 2017.

Sanders has not mentioned the United Kingdom, and its single-payer system, the National Health Service (NHS). His silence about the NHS is likely due to its serious problems and controversies.  The problems in the U.K. would be worse if British doctors were prohibited from accepting private payments for services also covered by public reimbursement, as they are in Canada.

A tracker from the BBC found that for 18 months hospitals across England, Wales, and Northern Ireland have failed to meet any of their three key targets, namely four-hour waits at the emergency department, cancer care within 62 days, and treating at least 92 percent of patients for planned hospital care or surgery within 18 weeks.

 Waiting lists have ballooned. As of August 2017, the most recent month of data available, 409,000 had been waiting longer than 18 weeks for hospital treatment, an increase of almost 73,000 from the previous August. The median wait now stands at 7.1 weeks. Earlier this year the NHS decided to abandon the target of 92 percent treatment within 18 weeks for non-urgent operations, which prompted the Royal College of Surgeons of England to accuse NHS of “waving the white flag” on that metric.

In response to budget squeezes and demand outpacing capacity, local government authorities are turning to increasingly inventive and invasive ways to ration care. In one area, under new rules, smokers would be denied non-urgent surgery unless they pass a test confirming they have not smoked for eight weeks. Obese patients would also be denied non-urgent surgery until they lose weight. Rules already in placed added delays for surgery for up to nine months for obese patients, but surgery could now be delayed indefinitely.

Other localities are using pain threshold scales to ration non-urgent surgeries based on pain, limiting them only to people reporting debilitating or incapacitating pain. Health commissioners in Kent suspended all non-urgent care from February until the start of their new fiscal year in April.

Citizens dissatisfied with rationing and wait times are turning to alternative options, forbidden in Canada. About 10 percent of people purchase supplemental private insurance for more timely treatment, many through company offerings. The recent increase comes even though the insurance premium tax doubled from 6 percent in October 2015 to 12 percent today. Profit-driven hospital firms have seen a 15-25 percent year-on-year increase in the number of patients paying for their treatment themselves. 

People are also venturing abroad in their quest to get needed medical care. According to the Office of National Statistics, the total number of people leaving the U.K. for medical care surged from 48,000 in 2014 to almost 144,000 in 2016. Analysis from The Daily Telegraph finds the number of medical visits for some countries is rising. For example, the number of people visiting Spain for medical treatment increased from 1,112 in 2015 to 10,741 in 2016.

Source:  Data from Laura Donnelly and Katie Morley, “Soaring Numbers Flying Abroad for Medical Care as NHS Lists Lengthen,” The Daily Telegraph, October 22, 2017.

Proposals to bring some form of single-payer to the United States would suffer from the same struggles to provide access to timely, quality health care. Further, American voters have shown little appetite for the substantial tax increases that would be needed to finances such an effort, voting down proposals at the state level once they got a sense of the price tag. The American health care system has much room for improvement, but single-payer would be far from a panacea and would exacerbate many of the current problems.

Charles Hughes is a policy analyst at the Manhattan Institute. Follow him on Twitter @CharlesHHughes

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