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Friday, September 20, 2019

Health Care Delayed Is Health Care Denied

Nationalizing health care into a single-payer format is popular, but how does it work in practice?

Photo credit: Rocco Lucia on Flickr | (

Medicare for All (M4A), or at least some version of it, is supported by the majority of current Democratic primary candidates. The way it’s being pitched, it sounds great. Never worry about medical bills? That sounds amazing! Paying medical bills is one of my most despised Adult Things I Have To Do, and goodness knows I have more to pay than most people. But as Milton Friedman said, “One of the great mistakes is to judge policies and programs by their intentions rather than their results.”

Government-run health care service is not a novel idea. It’s been tried and continues to be tried in many countries around the world, and even, to an extent, here in the United States. And if we look at the results of those programs, it tells a rather stark story of delays and shortages and deaths that could have been prevented.

Supply, Demand, and Prices

Nationalizing health care into a single-payer format is a popular offering since it would mean that Americans could walk into a doctor’s office, clinic, or hospital, receive care, and never worry about getting a bill in the mail. But how does it work in practice?

If we insist on maintaining government control over the price and the supply, we’re down to rationing and waiting as our options.

First, a little basic economics. When the price of something a lot of people want, like medical care, goes down, the demand for it goes up. More people are able to afford consuming more of it, so they do. If a doctor’s visit costs $10 (or $0) instead of $60, people go to the doctor more often and for less severe symptoms. But there are only so many doctors and facilities and hours in the day, so now we have a supply problem.

When people want more of a thing than is available, normally the price for it will rise, indicating that it’s worthwhile (that is, profitable) for more of that thing to be produced, drawing more suppliers—in this case, medical care providers—to the market. But when the price is fixed by government forces, what’s the indication (or motivation) to produce more?

Now, instead of health care just being expensive, there’s simply not enough of it. If we insist on maintaining government control over the price and the supply, we’re down to rationing and waiting as our options. Since telling a population of over 325 million people that each of them may only receive health care X number of times a year is certainly politically impossible, all we really have left is waiting.

Canada and Elsewhere

And wow, do people wait for nationalized health care. In Canada, for example, the Fraser Institute reports the median wait time between getting a general physician’s referral and actually receiving the treatment was a little over four months in 2018 (19.8 weeks, to be exact). The report goes on to say:

There is a great deal of variation in the total waiting time faced by patients across the provinces. Saskatchewan reports the shortest total wait (15.4 weeks), while New Brunswick reports the longest (45.1 weeks). There is also a great deal of variation among specialties. Patients wait longest between a GP referral and orthopaedic surgery (39.0 weeks), while those waiting for medical oncology begin treatment in 3.8 weeks.

Naturally, the severity of cancer meaning a shorter wait time to begin treatment is encouraging to see, and it’s about on par with the US. But every week of delay before treatment begins increases the chances of mortality. Emergent, life-threatening health issues arise and should be treated with urgency. But who, then, gets to decide what qualifies as urgent and necessary? And what happens when they get it wrong?

And it’s not just waiting for actual procedures and treatments, either. There are long waits to even be seen in the first place. In 2017, a Canadian woman reported being told that the wait time for a new-patient appointment with a neurologist was four and a half years. Granted, that’s an outlier, but the trend in Canada (as well as other countries with single-payer systems) has been toward longer and longer wait times for doctor visits, diagnostic tests, and treatments.

That Couldn’t Happen Here

Lest you think these problems wouldn’t plague us here in the United States, we’ve already gone down the road of government-run health care stateside. The Department of Veterans Affairs (the VA) offers full health care coverage to former military members. And it’s been a disaster for the patients who’ve already had their lives at risk in the armed forces.

In 2014, the VA waitlist “scandal first broke around the Phoenix, Arizona, facility when it was reported that 40 veterans had died waiting for care. (I put “scandal” in quotation marks because it’s not a scandal. Getting caught with a mistress is a scandal. People dying while waiting for medical attention their government promised to give them is a gross injustice.)

Just as justice delayed is justice denied, all too often health care delayed is health care denied.

After an internal audit that same year, it was revealed that more than 120,000 veterans were either waiting for or never received their promised care. And that’s people who have no choice but to go through the VA: the kind of government-run care some Democrats want everyone to have (or lack). Those veterans who managed to secure private health insurance or could afford to pay out of pocket and went elsewhere for their health care weren’t included in the tally. Nor are the 7,400 veterans who took their own lives that year.

Ostensibly, the VA has cleaned up its act since then, though there’s some indication that might not be true.

And let’s not forget the Indian Health Service (IHS) that is supposed to provide health care for Native Americans here in the US. It’s the only option for those living on reservations, and it has long been plagued by shortages and long waits. And yet, in 2008 when a proposed reform would have allowed tribe members to choose from various options including purchasing private insurance, it was voted down.

We Need More Freedom, Not Less

If the American government can’t even care for the people it’s systematically oppressed and displaced for centuries or the ones who risk their lives at its whim, it calls into question the ability of that same government to effectively expand its coverage to encompass the entire population. As evidenced by its own failings at small scale and the failings of other nationalized health care systems around the world, just as justice delayed is justice denied, all too often health care delayed is health care denied.

If we want to actually improve America’s health care system, what it needs is more freedom and more choice, not less. Markets work, even with health care.

Get rid of the burdensome regulations that limit the supply of providers and facilities, and the price of exams, tests, and procedures will come down. End the monopoly on approval and quality control that is the FDA so that private quality assurance providers can operate, and the price of prescription drugs will come down. Extend the tax breaks that businesses get for offering health insurance to include individuals, allow it to be sold across state lines, and stop mandating what it must cover, and the price of insurance plans will come down in addition to ending the reliance on one’s employer for health coverage.

Just as you shouldn’t have to depend on an employer for health care coverage, you shouldn’t have to depend on a government, either.