Critics Take ‘Long Look’ at Single Payer Systems
Responding to the joint proposal from the American Hospital Association, the Health Insurance Association of America and Families USA to expand health insurance, the Heritage Foundation yesterday convened a panel to "take a long look" at single payer health systems and the problems with access and costs that are associated with them. The panel featured three speakers:
- Dr. David Gratzer, author of "Code Blue: Reviving Canada's Health Care System," a book that chronicles the pitfalls of the Canadian health care system;
- Dr. Tim Evans, director of public affairs at the United Kingdom's Independent Healthcare Association, an organization calling itself the "UK's leading representative of the independent health and social care sector"; and
- Richard Teske, who served almost eight years in the Reagan administration as the HHS liaison to the White House and as associate administrator for the Health Care Financing Administration.
While Gratzer and Evans highlighted problems with the Canadian and British forms of single payer systems, Teske spoke about how costs and patient care would be affected if the United States moved towards a single payer system.
Saying that the Canadian system of single payer health care is "cruel" and "insane," Gratzer noted that public support for the program has waned in recent years. By providing services at no cost to the consumer, the government created a "free for all" run on health care services, which could only be controlled by rationing care, he said. But rationed care, Gratzer said, has produced waiting lists for treatments. In addition to access problems, Gratzer said the single payer system has been stripped of innovation, since it is difficult to get state approval and funding for "cutting edge therapies." Gratzer said, "When the government finances something, the government ends up managing it. This leads to poor accountability."
After giving a detailed history of the British health care system starting from 1858, Evans then echoed Gratzer's concerns about rationed care, saying that such systems misappropriate resources and politicize health care. Because of the high costs and access difficulties with the single payer system, Evans said the British health system, which once promised to provide "all ... medical, dental, and nursing care," is moving away from its "Sovietized past." He said that single payer systems are ultimately unsustainable and "will not work in a society that cherishes individual freedoms."
Calling the HIAA/Families USA proposal "snobbery" and an "unconscionable" attempt by insurers to avoid covering low-income patients, Teske said, "Single payer systems always end in either rationed care or price controls," which adversely affect patient care and stifle innovation. Instead, he said the American health system should move towards a "defined-contribution system," much like a 401(k) retirement fund, where consumers pay into insurance plans and are matched by employers or on a sliding income scale by the government. In reforming any system, he said problems occur during a transition period, where patients may "fall through the cracks." Eventually, however, he said health care reform in America will be consumer-driven and will use the tax code to provide incentives for patients to purchase their own health insurance plan. Gratzer agreed with this sentiment, concluding that American "[b]aby boomers, the generation that made the 30-minute pizza, will not wait more than a year for an MRI" (Darryl Drevna, California Healthline, 2/14).This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.