The Madness of "Single-Payer" Medical Care...

So many people appear to desire government benefits that we must look at what makes them so desirable. The most desired of these is health care, so we have to look at the benefits of government health care, as provided in other countries.

In Canada, the Province of Ontario enacted their health care plan (OHIP) in 1972, so this is a mature system to consider. OHIP is managed by the Ontario Ministry of Health and Long-Term Care. Every citizen of Ontario, as well as every legal immigrant, is covered by OHIP. In daily life, this means that you can walk into a hospital ER, or your doctor's office, and receive care without receiving a bill.

We all know that medical care is expensive, so we can all appreciate how nice it would be to receive free medical care. But of course, nothing is free. OHIP pays for the medical care provided by disbursing tax dollars, so the taxpayers are paying for medical care, as might be expected. Now, since there are many who could not afford to pay for such care on their own, nor to pay for medical insurance that would cover such care, we can easily imagine that the cost to each taxpayer might be higher than in a private health care system. Yet many -- perhaps most -- Canadians seem to believe that the system is essential, and would not wish to do without it.

Now let's look a bit behind the scenes. In order to manage the cost of delivery, OHIP must in some way limit what will be spent. This is accomplished in a variety of ways. Definite monetary values are assigned for each and every action a doctor may take. So much for a prescription, so much for an appendectomy, and so on. Hospitals are managed differently; each hospital is given an annual lump sum, and is required to provide care to all who enter.

Doctors maximize their revenues by maximizing the number of bodies per hour through their offices. Hospitals, however, must do what they can to minimize the care provided. If they do not, they will exhaust their funding, and be unable to provide care to anyone. It's not quite as simple as turning people away, but each doctor in a hospital must be mindful of the relative worth of providing any particular care. And elective procedures, of course, are still paid for by individuals -- OHIP will not pay for breast implants (except perhaps, post-mastectomy).

One of the inevitable consequences of socialized medicine, however, is very long waiting times in hospital ERs. Another is the shortage of expensive equipment. In the Toronto Region (Ontario has a regional government scheme, not county governments), when I last lived there, the Ministry had determined that a total of four MRI machines would be sufficient. And they meant it: when a private donor gave a fifth MRI to a hospital in the region, the Ministry confiscated it, and placed it elsewhere. Should you need an MRI, you may find it impossible to obtain, and indeed, there is a stream of people from Ontario traveling to Buffalo or to Detroit to obtain MRIs, among other things.

Perhaps the most damaging effect of socialized medicine, however, is the impact on enrolment in medical schools. Most people realize that a doctor must go through extensive schooling, and then an internship and residency, before being prepared to practice a specialty. For the most part, people undertake this burden because there is the promise of a large income once they begin to practice. Under OHIP, and in fact, all socialized medicine schemes, the income is limited, and the long-term effect is a drop in medical school enrolment. That makes medical care a precious commodity, and one increasingly hard to obtain. Among other things, it also leads to increased enrolment of students from very poor countries, some of whom will return to their native countries after spending a few years in practice in Canada.

What of the claims made regarding better health care under OHIP? Universal health care has some easily identified side effects that heavily impact the statistical performance of the system. First, infant mortality is reduced because all pregnancies are managed with a standard level of care, since the mother is not paying. Second, a similar effect is in play at end of life, thus extending life expectancy. Third, homeless people are entitled to the same care as those living in suburbia who bear the costs of the system. All of these circumstances elevate the perceived performance of the system. What is less apparent is that the bell-shaped curve has a lower crest than would otherwise be found. The quality of health care delivered to the middle classes is lower than if provided under a privately supported health care system.

Finally, in countries with socialized medicine, it is generally illegal to pay for care, so with the exception of elective procedures, those who could afford better care are denied it, unless they travel to another country for treatment.

But there is more. Waiting periods for treatment have become a serious problem, and will always be so, in countries with socialized medicine. A report on the problem in Canada is available.

Another interesting aspect of medical care is medicine. The United States has for decades produced an amazing number of new medicines, as development is encouraged here by the prospect of profits to be made. Other countries ride on our coat-tails, as does Canada, in particular. The Canadian approach has been to negotiate a low price on medicines, with the threat of legislation if the companies do not cooperate. While this benefits the citizens of Canada, it is effectively a tax on Americans, imposed by a foreign government.

Now for the ugliest truth of all. All of what I report here is known to Hillary and her buddies, who have sought for so long to impose such a system on the United States.