Analysis: Comparison of U.S., Canadian Systems Shows Single-Payer Is a Bad Deal
Widespread reports this spring that elderly patients in the United Kingdom were facing significant delays getting routine cataract operations coincided with the news that British rock music legend Mick Jagger
underwent successful, highly delicate heart surgery in a New York hospital.
The two developments cast a revealing light on the supposed advantages of the UK’s vaunted single-payer National Health Service (NHS).
In what one medical observer called a “miracle procedure,” the 75-year-old Jagger underwent a transcatheter aortic valve replacement (TAVR). Jagger hasn’t said why he chose to have the risky operation in New York instead of in London. But if cataract operations are hard to come by in the UK, he may have concluded a procedure as complicated as a TAVR had best be undertaken where it is readily available.
Distinctive Access to Quality Care
Access to high quality health care distinguishes the pluralistic public-private U.S. system from traditional singer-payer systems such as those in the UK or Canada. Brett J. Skinner, founder and CEO of the Canadian Health Policy Institute (CHPI) and editor of CHPI’s online journal Canadian Health Policy, writes in a Fraser Institute blog post, “Single-payer Health Care Warning for theU.S.,”Americans spend more money on health care on average “but get faster access to more and better medical resources in return for the money spent.”
Health care only appears to cost less in Canada than in the United States “partly because Canadian government health insurance does not cover any advanced medical treatments and technologies that are commonly available to Americans,” writes Skinner. “If Canadians had the same access to the quality and quantity of health care resources that American patients enjoy, the government health insurance monopoly in Canada would cost a lot more than it currently does.”
Americans spend 55 percent more than Canadians do on health care as a percentage of their national income, Skinner says. Yet the United States has 327 percent more MRI units and 183 percent more CT scanners per capita than Canada does. The United States also produces 100 percent more inpatient surgical procedures per capita than Canada.
“Plus, American patients do not wait as long as Canadians for medical care,” said Skinner. “The U.S. has 14 percent more physicians and 19 percent more nurses per population than Canada; U.S. hospitals are newer and better equipped than Canadian hospitals; and Americans have access to more new medicines than Canadians,” Skinner said.
Universal in Name Only
A standard criticism of the U.S. system is that it doesn’t provide universal health insurance coverage. Skinner says the definition of “universal” may be in the eye of the beholder. He cites data from Statistics Canada showing an estimated 1.7 million Canadians aged 12 or older had no access to a regular family physician in 2007.
“Without access to a family doctor, a person can’t obtain regular primary care or referrals for elective specialty medical services,” said Skinner.
“When Canadians can’t get access to health care because they can’t find a physician or wait so long that they are effectively uninsured, they are no better off than uninsured Americans,” writes Skinner. “Access to a waiting list is not the same thing as access to health care.”
Research shows the actual number of “effectively” uninsured Americans is significantly less than the 47 million reported and that being uninsured is only a temporary condition, says Skinner.
“The point of this comparison is not to advocate for an American-style health care system,” said Skinner. “The point is to show that all of the costs of a single-payer health care system are not as obvious as the dollars spent.”
Tightly Controlling Access
“If you look around the world, single-payer systems all suffer from rationing, bureaucracy, shortages, and excess demand,” said Devon Herrick, Ph.D., a health care policy advisor for The Heartland Institute.
“In tax-funded systems, medicine becomes political,” Herrick said. “There are more votes to be gained by pleasing the majority of the people who are not sick. Thus, systems like those in Canada and the UK ration by placing emphasis on primary care but tightly controlling access to specialty care.”
Bonner R. Cohen, Ph.D., (firstname.lastname@example.org)is a senior fellow at the National Center for Public Policy Research and a senior policy analyst with the Committee for a Constructive Tomorrow (CFACT).