People who are concerned with the issue of health care / health insurance tend to align themselves with either of two major philosophical schools of thought. The first maintains that only the federal government can adequately address a nation’s health care needs; that because the issue of health care itself is massive and complex, an equally massive and complex solution is required. With sufficient taxpayer funding, the argument goes, the government – with its size, infrastructure, and power – is best equipped to deliver such a solution on a national scale. Advocates of this perspective favor the implementation of what is termed the “single-payer” model, where one entity—a government-run organization—collects all health care fees and pays all health care-related costs. Countries that have a single-payer system include, among others, the United Kingdom, Sweden, Canada, Cuba, Australia, and New Zealand.
The second school of thought believes that government involvement in the administration of health care is actually part of the problem; that excessive government regulation causes health care systems to become sluggish, overpriced, and unresponsive to consumer demands. Rather than expand the government’s role in health care, proponents of this view seek to diminish that role and to inject greater measures of free-market competition into the system. They note, for example, the observations of Dr. Donald M. Berwick, who was appointed by President Obama to serve a stint as head of the Centers of Medicare & Medicaid Services. According to Berwick, there is an “extremely high level of waste” in federal health spending, ranging between 20 and 30 percent. Much is done that does not help patients at all,” said Berwick in December 2011. “And many physicians know it.” Berwick listed five reasons for the waste, as reported by the New York Times: “overtreatment of patients, the failure to coordinate care, the administrative complexity of the health care system, burdensome rules, and fraud.”
Because single-payer systems have been tried in a number of nations in recent decades, there is a good deal of data about their efficacy. Evidence suggests that single payer systems are consistently beset by a constellation of problems. Because it is “free,” people tend to overuse the system. Because they overuse it, government must, to contain costs, ration care for diagnostic procedures, rehabilitation services, surgery, etc. Patients in single-payer systems invariably face long waiting lines for treatments of all types. Nor is it uncommon for people on waiting lists to eventually become too feeble to undergo the surgical procedures that were initially recommended for them; in some cases, they die before they are able to access the treatments they need.
Another hallmark of most single-payer systems is a shortage of doctors. Between 1998 and 2008, for instance, approximately 11 percent of all physicians who had been trained in Canadian medical schools relocated to the United States – mainly as a result of government controls and capped compensation. Because doctors’ salaries in Canada are negotiated, set, and paid for by provincial governments and are held down by cost-conscious budget analysts, the average Canadian doctor earns only 42 percent as much as his or her American counterpart. Today many Canadians cannot even find a doctor who has time to examine or consult with them. Some provinces actually hold lotteries where only the winners are granted access to medical care.
The bureaucracies of single-payer systems inevitably interfere with, and hold ultimate authority over, the treatment decisions of every patient. Britain’s National Health Service, for example, bases its funding decisions on the recommendations of the quasi-governmental National Institute for Clinical Evaluation and Excellence (NICE), a panel that determines which patients are preferred in terms of the treatments for which they are eligible, the medications they may be given, and how soon they may have access to a doctor. Because of cost-effectiveness considerations, NICE generally gives preference to young people over older people, and to healthy people over those with chronic disease or destructive habits such as smoking or alcoholism. NICE is also explicitly tasked with limiting people’s access to the latest and most effective drugs, again basing its decisions on what it considers to be most “cost-effective.”
Moreover, evidence shows that in terms of caring for people who are seriously ill, government-run health care systems are significantly inferior to free-market systems. For example, the five-year survival rate for American women with breast cancer is 83.9 percent; for women in Britain, the corresponding figure is just 69.7 percent. For men with prostate cancer, the five-year survival rate is 91.9 percent in the United States, 73.7 percent in France, and 51.1 percent in Great Britain. Similarly, American men and women with colon cancer are more than 35 percent likelier to survive the disease than are their British counterparts.