THERE IS A BUMPER STICKER on the car ahead of me as I drive down Interstate 93. In white letters on a navy background, it proclaims: "Single-Payer Health Care!" That's it. There is no argument, no attempt at logic or emotion or humor -- just an impatient demand for the drastic transformation of one-seventh of the US economy. And note the exclamation point. That is to communicate earnestness, certitude, and indignation -- classic elements of the liberal approach to policymaking: When promoting radical change, passion and good intentions are what matter most. Real-world consequences count for far less.
As it happens, the real-world consequences of single-payer healthcare -- also known as socialized medicine or national health insurance -- are well-documented. Single-payer care exists in Canada, New Zealand, Great Britain, and much of Western Europe. And wherever it has been tried, writes John C. Goodman, president of the National Center for Policy Analysis, "rationing by waiting is pervasive, putting patients at risk and keeping them in pain."
In "Lives at Risk," a book published last summer, Goodman and co-authors Gerald Musgrave and Devon Herrick showed that a single-payer system, far from proving a panacea, would make American healthcare much worse than it is. (Some of the book has now been adapted into a monograph for the Cato Institute, "Health Care in a Free Society.") The claims endlessly repeated by proponents of socialized medicine -- that it is more efficient, more equitable, and more affordable than American healthcare -- are belied by decades of data from countries that have gone the single-payer route.
There is no denying the grass-is-greener appeal that the idea of nationalized health coverage holds for many Americans. Just recently, town meeting members in 21 Vermont communities, including Burlington and Montpelier, the state's two leading cities, voted to endorse a statewide single-payer system. Some of those town meetings might well have voted the other way if members had first read "Lives at Risk." The facts of socialized medicine aren't nearly as pretty as the myths.
It is routinely claimed, for example, that single-payer systems "guarantee" every citizen the right to healthcare. In reality, countries with nationalized systems invariably limit healthcare to control costs. The ineluctable result is ever-lengthening wait lists.
Thus, around 25 percent of patients undergoing elective surgery in Canada, Australia, and New Zealand -- and around 36 percent in Britain -- have to wait more than four months for a turn in the OR (The figure in the United States: 5 percent). According to the Fraser Institute, a Vancouver think tank, the average Canadian patient waited 8.3 weeks for an appointment with a specialist in 2003 -- and another 9.5 weeks before getting treated.
Lengthy waits are not trivial. Delays in Britain for colon cancer treatment are so protracted that 20 percent of cases considered curable at the time of diagnosis are incurable by the time of treatment. Last year a lawsuit was filed against 12 Quebec hospitals on behalf of 10,000 breast-cancer patients who had to wait more than eight weeks to begin radiation therapy. A "right to healthcare?" Socialized medicine guarantees only the right to stand in line -- and often to get sicker while you wait.
But when you finally do get to the head of the line in a single-payer country, at least the quality of the care you receive will be top-notch, right?
During your last medical appointment, did the doctor have more than 20 minutes for you? The answer is yes for 30 percent of Americans -- but for only 20 percent of Canadians, 12 percent of Australians, and 5 percent of Britons. Because the number of doctors in Canada is artificially restricted, the country suffers from overstressed physicians and undertreated patients. Thus, while the average US doctor sees 2,222 patients annually, the average Canadian doctor must somehow make time for 3,143.
Consider another measure of medical quality: access to lifesaving technology. British scientists helped develop kidney dialysis in the 1960s, yet today Britons use dialysis at one-third the rate Americans do. If you need a coronary bypass, you are five times more likely to get it in the United States than in Canada (and eight times more likely than in Britain). Access to CT scanners? MRI machines? Lithotripsy units for treating kidney stones? Angioplasty? When it comes to one kind of high-tech medical procedure after another, the average American patient is far likelier to get treatment than his single-payer counterpart. That is why Americans often have a better chance at beating a condition -- such as prostate cancer, renal failure, or heart disease -- that would kill them elsewhere.
The Spectator, a British journal, summed up the issue in the headline of its Feb. 12 cover story: "Die in Britain, survive in the US."
The American healthcare system is far from perfect, as Goodman and his co-authors make amply clear. But more government control of that system -- and less private-sector choice -- will not make it better. As our friends in Canada, Britain, and other countries with national health insurance can attest, single-payer healthcare looks better on a bumper sticker than it does in real life.
(Jeff Jacoby is a columnist for The Boston Globe.)
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