Issues

Single-Payer Health Plans Talking Points

Problems for Patients

Proponents of a single-payer health system argue that such a plan would provide all citizens with high-quality comprehensive health coverage. In reality, single-payer systems deny care to those who need it most. Statistics from countries that have implemented single-payer systems underscore this point.

Medical Rationing

• More than 1.3 million Canadians (out of a total population of 26 million) are waiting for medical services, and the latest survey data indicates that 212,990 Canadian patients are waiting for surgical procedures. Source: National Center for Policy Analysis (NCPA) and Fraser Institute.

• 45% of Canadians who are waiting for services describe themselves as "in pain." Source: Statistics Canada.

• Canadian patients wait an average of 6 weeks after referral from a primary care physician to see a specialist, and then wait another 7.3 weeks on average before they receive treatment. Total waiting time has jumped 43% since 1993. Source: Fraser Institute.

Access to Medical Technology

• A danger of single-payer systems is that they tend to delay covering the latest medical technology, often at the expense of patients.

• Studies show that during the 1970s, heart patients in the United States received needed pacemakers four times more frequently than British patients, and 20 times more often than Canadian patients. U.S. patients were able to receive needed CAT scans three times more frequently than Canadian patients, and six times more frequently than British patients during the same time period. Source: NCPA.

• When compared with Canada, on a per capita basis, the U.S. has 10 times as many MRI units, 11 times as many cardiac catheterization units, and three times as many open-heart surgery units. Source: NCPA.

• On a per person basis, the U.S. has three times as many CAT scanners, and three times as many lithotripsy units (which destroy kidney stones and gallstones). Source: NCPA.

Problems for Physicians

• Under single-payer plans, doctors and other health care providers are also often short-changed. Consider some of these facts about the Canadian single-payer health care system, and its treatment of health care providers.

• In Canada, compensation for doctors has not increased significantly since 1983. Source: Business Week.

• In Alberta, Canada, obstetricians are subject to a $185 cap on delivery fees. Source: Business Week.

• In 1998, physicians in British Columbia and Quebec engaged in work stoppages to protest income caps, low fees, and professional shortages. Source: Wall Street Journal.

• For Canadian physicians, net income after expenses, but before taxes, is on average 40-50% less than their gross income. Source: Wall Street Journal.

• In 1995, 30 of 95 individuals who received a degree in family medicine from the University of Toronto moved to the U.S. Source: Wall Street Journal.

• It is estimated that 2,000 Canadian health care providers, including approximately 500 doctors, emigrate to the U.S. each year. Source: Wall Street Journal.

Administrative Cost Myths

• Advocates of a single-payer plan often claim that implementing such a system would drastically reduce administrative costs. However, when calculating administrative savings, these advocates have failed to take into account the many hidden costs associated with a single-payer health system. Examples of hidden costs include:

• Extra costs because of increased doctor visits. For example, in Quebec, following the introduction of universal health insurance, office visits rose by 32%. Source: Health Affairs.

• Extra costs due to service delays. People who are waiting to receive medical treatment often experience decreased productivity. Furthermore, patients who are forced to wait for medical treatment often experience health status deterioration, driving up their overall treatment costs. Source: Health Affairs.

• Income-loss for family members. Family members who have to serve as caregivers for those experiencing service delays also shoulder the cost-burden. Source: Health Affairs.

• Under single-payer plans, health care savings are not achieved through increased efficiency, but instead are achieved through service denials.

• Despite its single-payer system, Canada has been no more successful in reducing health care costs than the U.S. From 1967-1987, real increases in health care spending per capita were almost identical between the two countries, with Canadian spending rising at a slightly faster rate. (Canada-4.58% increase; U.S.-4.38% increase).

Lessons From Other States

Single-payer plans have been implemented in several locations around the U.S. with disastrous results. It would be irresponsible not to carefully examine the experiences of these other states before attempting to implement a single-payer plan elsewhere.

Washington

• In 1993, Washington state legislators enacted a single-payer insurance program to provide coverage for certain uninsured persons that was similar to the universal coverage program proposed by the Clinton Administration.

• The program resulted in increased taxes, increased costs, and increased regulation.

• Consumers were subject to less choice and reduced quality services.

• The number of uninsured increased by 20%.

• Due to premium caps, the number of available health care plans, doctors, and hospitals were reduced, and consumers suffered as a result.

• Washington legislators were forced to repeal their "reforms." The repeal went into effect in 1995.

• Currently, no health insurance carriers offer individual coverage plans in Washington State.

Sources: Heritage Foundation and NAHU

Kentucky

• In 1994, Kentucky state lawmakers adopted reforms similar to the Clinton health care plan. The reforms include a government-sponsored health insurance plan, mandated benefit standardization, and higher taxes on health care providers and hospitals.

• The tax on health care providers and hospitals ranges from 2 to 2.5% of gross revenues.

• 45 insurance carriers have left the Kentucky market.

• Kentucky Kare, the state insurance plan, lost $30 million over a 20 month period.

• Fewer state residents have health insurance coverage today than before the "reforms" were instituted.

Source: Heritage Foundation

Hawaii

• Hawaii is the only state with employer-mandated health insurance coverage. State employers must pay 50% of full-time employees' health insurance premiums.

• Many part-time workers, dependents, unemployed persons, and low-income people are uninsured. Estimates range from 2-11% of the population.

• Between 1980 and 1991, per capita health care expenditures were higher in Hawaii than for the nation as a whole (Hawaii-9.8%; U.S.-9.4%).

• In 1991, per capita health care spending was $1,899 in Hawaii, as compared to $1,877 in the U.S. as a whole.

• Hawaii has some of the highest health care administrative costs in the country. The state ranks #1 nation-wide in hospital costs as a percent of total hospital spending.

• The employer-mandate has caused serious trouble for Hawaii small businesses. In 1997, Hawaii ranked 49th in income growth rate, 43rd in employment growth, 1st in business bankruptcies, and 48th in new business growth.

• Employers have restricted wage increases, reduced benefits, and raised prices in order to offset health care costs. Employers are also hiring more part-time workers.

• Between 1986 and 1993, the number of medically underserved areas (where the physician-patient ratio is considered to be low) grew from 2 to 12.

• Hawaii patients are beginning to feel the effects of health care rationing. The state is short on acute care hospital beds and nursing home beds. Furthermore, in 1997, the state only had one MRI scanner per one million people. The MRI scanner shortage in Hawaii is so severe, physicians encourage patients to fly to the mainland for immediate treatment.

Source: NCPA