Lies My Mother Never Told Me About Single-Payer Health Care

The nature of a lie is such that if you repeat it often enough it takes on a life of its own, always at the expense of truth.

While some lies--"your hair looks great"--are harmless enough, and lies like "I never had sex with that woman" are laughable, others can be harmful to life, liberty, and the pursuit of health. So it is with lies spoken in defense of single-payer health care. Consider:

Lie #1 Single-payer systems are not socialized medicine.

Single-payer means government is the insurance company. It doesn't charge "premiums," but instead raises taxes. It controls not only the financing, but who gets what care, the quality of the care, when they get the care and even if they get the care. A single-payer system is one big Medicare plan, without the discipline and accountability achieved by competition and consumer choice. Sorry, but that's socialism.

Lie #2 Single-payer systems are efficient.

A study by the Institute for Global Health at the University of California concluded the Kaiser-Permanente HMO in the United States and Britain's National Health Service (NHS) have similar resources, but the Kaiser plan offers better care more quickly. The difference is explained by better management, better use of integrated systems, greater investment in technology, and free-market competition.

Lie #3 Single-payer systems are "free" for individuals.

Single-payer health care plans are not free. They are paid for by tax dollars -- billions of them. The Maryland proposal would have required a 33 percent increase in the state's personal income tax. Canadians pay extraordinarily high income taxes for their "free" care ... only to have to pay again when they come to the United States for care they can't get in Canada.

Lie #4 Single-payer systems do not ration care.

In a single-payer health care system like Britain's, patients have every incentive to demand care, and lots of it. Since no system can satisfy unlimited demand, the central authorities must resort to the only strategy open to them: rationing. In single-payer systems, you get rationing by waiting list; rationing by price controls; rationing by restricting specialists, technology, new drugs and rationing by age.

Lie #5 Single-payer systems offer high-quality care.

To get access to the most effective health care technology, citizens living under single-payer health care schemes come to the United States. The Canadian Fraser Institute reported in August 2002, "with regard to access to high-tech machinery, Canada performs dismally by comparison with other OECD countries. While ranking number one as a health care spender [among OECD countries with publicly funded universal health care systems], Canada ranks 18th in access to MRIs, 17th in access to CT scanners, [and] eighth in access to radiation machines."

Lie #6 Single-payer systems offer timely care.

On any given day, one million people in Britain are on a waiting list for in-patient hospital admission at any given time. While some people actually get better while waiting, others die in during the wait.

Lie #7 Single-payer systems improve access to prescription drugs.

In Britain, the government determines how much profit a pharmaceutical firm is allowed to make--a sure way to arrest research and development. In addition, they ration access to drugs with a lottery based on a consumer's zip code. The prize is your eligibility to receive free medication. The "lucky" zip code can change at any time, often on the basis of political expediency rather than medical necessity. Price controls and rigid drug formularies--hallmarks of a single-payer health care system--limit access to drugs and violate doctors' and patients' freedom of choice.

Lie #8 Single-payer systems allow freedom of choice.

Many doctors already refuse to accept Medicare patients. A recent study by the American Medical Association found nearly half of all U.S. physicians would have limited their Medicare practices further if the federal government had carried out a new plan to cut physician fees even further. How many more doctors would "opt out"--or quit the profession altogether--if the entire U.S. were one big Medicare program?

Lie #9 Single-payer systems are popular with doctors.

Five hundred physicians leave Canada every year to practice in something other than a single-payer health care system. Zosia Kmietowicz wrote in the October 20, 2001 issue of the British Medical Journal, "one in four general practitioners (GPs) in Britain's National Health Service is seriously considering leaving general practice." The British Medical Association surveyed all 36,000 general practitioners in Britain, asking them if they would be prepared to resign from the NHS. There was a 66 percent response rate ... and 86 percent voted in favor of resignation.

Lie #10 Single-payer systems are popular with patients.

In 2002, seventy-nine percent of Oregon voters rejected a plan to have government officials run a health care system for the state's 3.5 million residents. Measure 23, touted by supporters as "health care for all Oregon," attracted just 204,082 votes in favor, 21 percent of the total, while 786,768 voters--79 percent--rejected it.

If we are to make informed choices about what trade-offs we are willing to make in our quest for universal health care, we need the truth. My Mother never told me these lies because she knew the truth. She was an immigrant from a country with a single-payer health care system.

Conrad F. Meier is senior fellow in health policy at The Heartland Institute and managing editor of Health Care News. His email address is meier@heartland.org.