Medicare for All Is Bad Medicine

A better prescription would be to get government entirely out of health care.

Opponents of choice in medicine are at it again, promoting Medicare for All with the U.S. government as the single payer and private alternatives outlawed. The push comes as health care systems around the world try to catch their breath from the stress test inflicted by the pandemic—and by normal demand for expensive services. While American medicine has its share of problems, single-payer supporters would take all of the flaws in the system and make them universal and mandatory.

"Everybody in! Nobody out!" protesters chanted in Toledo, Ohio, this week in an attempt to pressure Rep. Marcy Kaptur (D-Ohio) to sign on to H.R.1976, the Medicare for All Act of 2021. They should have added "or else," since the bill, with 115 cosponsors at the moment, makes it "unlawful for … a private health insurer to sell health insurance coverage that duplicates the benefits provided under this Act" or for employers to offer alternative coverage.

Providers wouldn't be forced to participate; the proposed law lets Americans pay non-participating physicians out of pocket for services—subject to regulations. Why would Americans pay for services covered by a hypothetical Medicare for All? To answer that question, look north of the border, where Canada's single-payer system, commonly called Medicare, struggles to meet patients' needs.

"With COVID-19 fuelling a surge in hospitalizations, the latest data provided by the Ministry of Health shows that as of December 31, 2020, there were 29,650 people on a waiting list for surgery" in Saskatchewan, the Canadian Broadcasting Corporation (CBC) reported earlier this month. The CBC noted similar delays in other provinces.

"Specialist physicians surveyed report a median waiting time of 22.6 weeks between referral from a general practitioner and receipt of treatment," which is the longest wait recorded, according to the free-market Fraser Institute.

As of 2020 only 62 percent of Canadians told Commonwealth Fund pollsters that they "waited less than 4 months for non-emergency or elective surgery after they were advised they needed it," compared to 92 percent of Americans. Only 38 percent of Canadians were able to see a specialist (who might recommend such surgery) within four weeks, compared to 69 percent of Americans.

Such waits cost more than money—although they cost plenty of that. "[T]wice as many Ontarians with heart ailments passed away waiting for surgery during the pandemic than before COVID-19 hit," according to the National Post.

To relieve the backlog, Canadian provincial governments, which manage the single-payer system, are turning to private clinics. In Quebec, "without the private sector contracts, a region like Laval would have delayed 76 per cent of surgeries instead of 31 per cent," the CBC noted in February.

As the data suggests, though, the public sector in many places had trouble delivering as advertised long before anybody had heard of COVID-19. In Germany, where those making less than €64,350 per year must participate in the government health insurance system which is funded on a quarterly basis, the system runs out of money on a regular basis.  

"State health insurance patients are struggling to see their doctors towards the end of every quarter, while privately insured patients get easy access," Deutsche Welle reported in 2018. "The researchers traced the phenomenon to Germany's 'budget' system, which means that state health insurance companies only reimburse the full cost of certain treatments up to a particular number of patients or a particular monetary value … Once that budget has been exhausted for the quarter, doctors slow down — and sometimes even shut their practices altogether."

The "budget" acts as backdoor rationing, limiting costs by choking off access for publicly insured patients to all but emergency medical care once the magic number is hit. Single-payer advocates often criticize private medicine for being cost-conscious, but government systems put at least as much emphasis on the bottom line as any corporate accountant.

That's especially obvious in the United Kingdom, where the National Health Service has a cult-like status. During the pandemic, this took the form of a "Stay Home. Protect the NHS. Save Lives." campaign. "The NHS is under severe strain and we must take action to protect it, both so our doctors and nurses can continue to save lives and so they can vaccinate as many people as possible as quickly as we can," Prime Minister Boris Johnson scolded the public. 

The campaign worked. Even people with medical concerns stayed home, resulting in a drop in doctor visits and a 90 percent plunge in hospital admissions.

"We are sadly seeing the fallout of people not getting cardiovascular care during this pandemic – with thousands of excess deaths caused by these conditions," Dr. Sonya Babu-Narayan, the associate medical director at the British Heart Foundation, told The Telegraph in October 2020.

Even that wasn't enough. Britons staying at home were advised to refrain from home repairs and gardening that might result in injuries burdensome to the government-run health care system.

"It suggests our treatment of the NHS as a religion has reached such a dizzying level that the government thinks the best way to secure our obedience during this lockdown is by telling us we'll be helping to Save the NHS," objected Brendan O'Neill in The Spectator.

It's difficult to imagine Americans venerating government bureaucracy (although feelings about Social Security come disturbingly close). But it's impossible to pretend that Medicare for All could escape the concerns that plague all tax-paid medicine. "A doubling of all currently projected federal individual and corporate income tax collections would be insufficient to finance the added federal costs of the plan," the Mercatus Center's Charles Blahous pointed out about an earlier Medicare for All proposal.

That's not to say that American medicine couldn't be improved; it suffers from cost and access problems of its own. Much of the problem comes from previous government interference in what is no longer even close to being a free market. Under the Affordable Care Act, federal regulators deliberately pushed previously independent physicians and small clinics to consolidate out of a smug belief that the health care industry would operate better in the hands of fewer operators. 

Those remaining operators are heavily regulated, and at great expense. "Providers are dedicating approximately $39 billion per year to comply with the administrative aspects of regulatory compliance," warned a 2017 American Hospital Association report.

Health care in the United States requires reform, without doubt. But rather than emulate the heavy state involvement that evokes headaches elsewhere in the world, a better prescription would be to get government entirely out of medicine and encourage more competition and choice.