Single Payer Health Care

Single Payer Health Care

© David Burton 2017

Single Payer Health Care

     As the debate over Obamacare and the issue of modification, repeal, replacement, or whatever rages, there are those who are advocating for something called “single payer health care”. Government-run, single-payer health care is the left’s favored fallback as Obamacare waits to be replaced or gutted by the Republican administration now in power. Following President Trump’s initial failed effort to repeal and replace Obamacare, Democratic and Socialist Senator Bernie Sanders from Vermont proposed a single payer health care system funded entirely by taxpayers.

     In late March of 2017, Sanders told CNN that he intended “to introduce legislation outlining a ‘Medicare-for-all, single-payer’ health care plan . . .
     " ‘Ideally, where we should be going is to join the rest of the industrialized world and guarantee health care to all people as a right,’ Sanders said. ‘That's why I'm going to introduce a Medicare-for-all, single-payer program.’ “ (Ref. 1)

     A single payer health care systems has both apparent benefits along with drawbacks. Single payer health care provider systems are basically socialized medicine. Socialized health care systems exist in several countries, including Canada, England and Sweden. Socialized health care systems have proven to be a mixed bag. The big benefit is that everyone gets covered. On the negative side are numerous horror stories of unbearably long wait times and mediocre quality. In some countries, citizens have found their socialized health care to be bad enough to cause them to seek medical care at their own expense, either within their own countries or by seeking medical services outside their own countries, frequently here in the United States.

     Many advocates of a single payer health care system point to foreign universal publicly funded health systems as models to be followed. But, when one takes a deeper look into these socialized health care systems, one discovers that all is not roses. One such example is that in place with our neighbor to the north, Canada.

     There are reportedly some positives with Canada’s system. But, wait times are not among these positives. “Canadians wait longer in hospital emergency departments than people in other countries with publicly funded health-care systems, according to a new report.
     “The Wait Times Alliance’s annual report card, called ‘Time to close the gap,’ said 27 per cent of Canadians reported waiting more than four hours in the emergency department . . . “ (Ref. 2)

     Some more detailed information relative to wait times under Canada’s universal health care system is abstracted from Reference 3 and presented below.

  • 42% of Canadians waited 2 hours or more in the emergency room, vs. 29% in the U.S.
  • 43% waited 4 weeks or more to see a specialist, vs. 10% in the U.S.
  • 37% of Canadians say it is difficult to access care after hours (evenings, weekends or holidays) without going to the emergency department vs. 34% of Americans.
  • 21% of Canadian hospital administrators, vs. less than 1% of American administrators, said that it would take over three weeks to do a biopsy for possible breast cancer on a 50-year-old woman.
  • 50% of Canadian administrators vs 0% of their American counterparts said that it would take over six months for a 65-year-old to undergo a routine hip replacement surgery.
     In reference to the longer wait times in Canada than in the U.S., "the President and CEO of University Health Network, Toronto, reported that there is 'no question' that the lower cost has come at the cost of 'restriction of supply with sub-optimal access to services'" [Emphasis mine] (Ref. 3)

     “Wait times in Canada’s health care system increased between 2012 and 2013 . . . and they are sky high in comparison to 1990s levels. The Classical Liberal Policy Institute, based in Vancouver, British Columbia, asserts that the increase is greatest for elective treatments. However, general levels for all practices are historically high, and physicians consider these times longer than what is clinically reasonable.” (Ref. 4)

     “Single-payer’s cheerleaders cite Canada as proof of the system’s superiority. It’s a foolish fetish: Our northern neighbor’s health-care system is plagued by rationing, long waits, poor-quality care, scarcities of vital medical technologies and unsustainable costs. That’s exactly what’s in store for America if we follow Canada’s lead. [Emphasis mine]
     “. . . To keep a lid on costs, Canadian officials ration care. As a result, the average Canadian has to wait 4½ months between getting a referral from his primary-care physician to a specialist for elective medical treatment — and actually receiving it.
     “Mind you, ‘elective treatment’ in Canada doesn’t mean Botox or a tummy tuck. We’re talking about life-or-death procedures like neurosurgery, orthopedic surgery or cardiovascular surgery.
      - - -
     “. . . Canada’s wait times are . . . growing: That average 18-week delay for ‘elective’ referrals is 91 percent longer than in 1993.
     “There’s also a severe shortage of essential medical equipment. Canada ranks 14th among 22 OECD countries in MRI machines per million people, with an average wait time to use one at just over eight weeks. Canada ranks a dismal 16th in CT scanners per million people, with an average wait time of over 3.6 weeks.
      - - -
     “Every Canadian is technically ‘guaranteed” access to health care. But long waits and the scarce resources leave many untreated.
      - - -
     “Nor is Canadians’ treatment close to ‘free’: Patients may only have to pay a nominal fee when they get treatment. But the typical Canadian family pays about $11,300 in taxes every year to finance the public-insurance system.
      - - -
     “Because of the low quality of care and long waits in their home country, many Canadians come to the United States for medical attention — over 42,000 in 2012.
      - - -
     “{A} former head of the Canadian Medical Association has called the system ‘sick’ and ‘imploding.’ {A}n orthopedic surgeon in Vancouver who runs {a} private {clinic}, has quipped that Canada is a country where a dog can get a hip replacement in less than a week — but his owner would have to wait two years.
     Canada’s single-payer system isn’t one America should long for — it’s one we should strenuously avoid.” [Emphasis mine] (Ref. 5)

     What many Americans fail to understand is that there's a big difference between universal health care coverage and actual access to medical care.

     And Canada is not the only country where government provided single payer health care has proven to be very much less than the glowing success some would have you believe that it is. “Simply saying that people have health insurance is meaningless. Many countries provide universal insurance but deny critical procedures to patients who need them. Britain's Department of Health reported in 2006 that at any given time, nearly 900,000 Britons are waiting for admission to National Health Service hospitals, and shortages force the cancellation of more than 50,000 operations each year. In Sweden, the wait for heart surgery can be as long as 25 weeks, and the average wait for hip replacement surgery is more than a year. Many of these individuals suffer chronic pain, and judging by the numbers, some will probably die awaiting treatment. In a 2005 ruling of the Canadian Supreme Court, {the} Chief Justice . . . wrote that ‘access to a waiting list is not access to healthcare.’
      - - -
     “As H. L. Mencken said: ‘For every problem, there is a solution that is simple, elegant, and wrong.’ Universal healthcare is a textbook case.” (Ref. 6)

     What about that other great experiment in universal government-funded health care, Britain’s National Health Service (NHS), now in the middle of its 6th decade? “Emotionally feted by UK citizens and political leaders, the NHS is typically celebrated as a magnificent badge of honor and even as a symbol of national identity in Britain.
      - - -
     “Despite its much heralded presence in Britain’s health care, the problems of the NHS are severe, notorious, and increasingly scandalous in the most fundamental attributes of any health care system: access and quality.
     “Waits for care are shocking in the NHS . . . For instance, in 2010, about one-third of England’s NHS patients deemed ill enough by their GP waited more than one additional month for a specialist appointment. In 2008-2009, the average wait for CABG (coronary artery bypass) in the UK was 57 days. And the impact of this delayed access was obvious. For example, twice as many bypass procedures and four times as many angioplasties are performed in patients needing surgery for heart disease per capita in the U.S. as in the UK. Another study showed that more UK residents die (per capita) than Americans from heart attack despite the far higher burden of risk factors in Americans for these fatal events. In fact, the heart disease mortality rate in England was 36 percent higher than that in the U.S.
     “Access to medical care is so poor in the NHS that the government was compelled to issue England’s 2010 ‘NHS Constitution’ in which it was declared that no patient should wait beyond 18 weeks for treatment – four months – after GP referral. Defined as acceptable by bureaucrats who set them, such targets propagate the illusion of meeting quality standards despite seriously endangering their citizens, all of whom share an equally poor access to health care. Even given this extraordinarily long leash, the number of patients not being treated within that time soared by 43% to almost 30,000 last January. BBC subsequently discovered that many patients initially assessed as needing surgery were later re-categorized by the hospital so that they could be removed from waiting lists to distort the already unconscionable delays. . . .
      - - -
     “{Note that} the breast cancer mortality rate is 88 percent higher in the United Kingdom than in the U.S.; prostate cancer mortality rates are strikingly worse in the UK than in the U.S.; mortality rate for colorectal cancer among British men and women is about 40 percent higher than in the U.S.
      - - -
     “{Isn’t it} odd that people of means in Britain consistently look elsewhere for medical care{?} About six million Brits now buy private health insurance, including almost two-thirds of Brits earning more than $78,700. . . {T}he number of people paying for their own private care is up 20 percent year-to-year, with about 250,000 now choosing to pay for private treatment out-of-pocket each year. Isn’t it notable that more than 50,000 Britons travel out of the country per year and spend £161 million to receive medical care due to lack of access, even though they are hemorrhaging money for their national pride? When given the choice, Brits shun the NHS, and rightfully so.
     “Sadly, just as in America, many in the {government and} media attempt to spin the facts and control public opinion. . . .
      - - -
     “{T}he essence of medical care {should be} preventing, diagnosing, and treating disease for patients, not setting up a massive government bureaucracy. Even the Prime Minister’s 2010 white paper admitted that ‘the NHS is admired for the equity in access to healthcare it achieves’ but not for excellence – as if equally poor access is an achievement. Even though the UK’s mandatory retirement age at 65 was officially eliminated in 2011, perhaps the greatest gift of all to the Brits, and a true celebration of independence, would be to forcibly retire their falsely venerated NHS.” (Ref. 7)

     So, for those pushing for a single payer health care system, be careful what you wish for! It sounds great in theory, but it has not proven to be such a great success in practice. Like all things Utopian, the real world is not Utopia. The Socialist ideal has pretty much failed everywhere it has been tried. Why would one expect socialized medicine to be any different?

     In truth, the United States has had a single payer health care system for over 200 years – that for veterans. In 1811, the federal government authorized the first domiciliary and medical facility for Veterans. The current veterans’ health care provider is known as the Veterans Administration or VA. Today, health care for veterans is provided by the U.S. government through the VA. Modern veterans’ health care came into being in 1946 under Public Law 293 which established the Department of Medicine and Surgery within VA. The law enabled the VA to recruit and retain medical personnel by modifying the civil service system. By 1948, there were 125 VA hospitals throughout the United States.[8]

     The VA disaster is by now well known. In 2014, it was reported that, “At least 40 U.S. veterans died waiting for appointments at the Phoenix Veterans Affairs Health Care system, many of whom were placed on a secret waiting list.

     “The secret list was part of an elaborate scheme designed by Veterans Affairs managers in Phoenix who were trying to hide that 1,400 to 1,600 sick veterans were forced to wait months to see a doctor . . .” (Ref. 9) Other failures, coverups, deaths and bad treatment within the VA medical system were uncovered and it does not appear that the problems of veterans health care have been corrected some 3 years later.

     Some three years after the initial VA scandals came to light, the problems in the VA single payer health care system continue. "A 2015 inspection of the Boston VA Regional Office, the most recent one conducted, found an ‘unacceptable’ error rate in assessing the degree of disability in traumatic brain injury claims — one in six of the cases the VA inspector general reviewed that year — despite a warning four years earlier to add more oversight and safeguards.” (Ref. 10)

     The VA scandal points out the almost universal failure of any socialized governmental effort to serve the public. Based on a vast amount of accumulate experience, who doesn’t believe that a government controlled single payer health care system will create an enormous federal bureaucracy to administer and ultimately control health care. Would such a bureaucracy perform any better than the VA?

     Actually, “{a}dvocacy for a single-payer system in the U.S. is nothing new. In the fall of 1945, just after the end of World War II, recently inaugurated President Harry Truman addressed Congress with a plea for a national healthcare system. The American Medical Association opposed the idea, and it eventually faded away.” (Ref. 11)

     The one apparently incontestable advantage of a government run single payer health care system over other health care systems is that it is cheaper. If cost is the only consideration, a single payer health care system may make sense. Admittedly, health care costs in the United States are among the highest in the world. BUT, if factors like quality, wait time, choice, and other considerations are important factors, then the choice no longer tilts in favor of the single payer health care system. There are those of us who choose to have other priorities in addition to that of cost, such as: freedom to choose health care providers, reasonably short time from referral to time of time of service, quality of health care, number and availability of heath care providers, and, the ability to make informed healthcare decisions without bureaucratic interference. While health care costs may be undeniably high in the United States, there is an old adage that says, “you get what you pay for”. In other words, if you pay little, then you get little. The adage certainly seems to apply to health care as evidenced by the experiences in the U.S., Canada, England and elsewhere.

     Buying the cheapest item is not necessarily a wise choice. “It's unwise to pay too much, but it's worse to pay too little. When you pay too much, you lose a little money - that's all. When you pay too little, you sometimes lose everything, because the thing you bought was incapable of doing the thing it was bought to do. The common law of business balance prohibits paying a little and getting a lot - it can't be done. If you deal with the lowest bidder, it is well to add something for the risk you run, and if you do that you will have enough to pay for something better.(Ref. 12)

     Even our government has come to the conclusion that the cheapest is not necessarily the best. Early in my working days, the winner of competitive bids for government contracts invariably was the low-cost bidder. Later, the government realized they weren’t getting the best deal and the criterion for winning a competitive contract became “the best value” and not “the lowest bid”. As the astronaut, Alan Shepard, was quoted as saying, “It's a very sobering feeling to be up in space and realize that one's safety factor was determined by the lowest bidder on a government contract.” (Ref. 13) With regard to a single payer health care system, Shepard’s remark could be rephrased to read, “It's a very sobering feeling to need open heart surgery and realize that one's life will be determined by the lowest cost health care system.” Consider this: “In 2010, the premier of Newfoundland flew to Florida for heart-valve surgery. Questioned about the decision, he said, ‘This was my heart, my choice and my health.’ Millions of ordinary Canadians would surely love to have that option.” (Ref. 5)

     If cost is the only consideration, a single payer health care system may make sense. Admittedly, health care costs in the United States are among the highest in the world. BUT, if factors like quality, wait time, choice, and other considerations are important factors, then the choice no longer tilts in favor of the single payer health care system.

     The Affordable Care Act has proven to be a failure - it needs to go. Obamacare provided limited choices for patients, drove up costs for consumers, and buried employers and health care providers under thousands of new regulations. Obamacare needs repeal and replacement, but certainly not replacement by a government run single payer health care provider!

  1. In wake of GOP failure on health care, Sanders to push single-payer option, Eleanor Mueller, CNN politics,
    29 March 2017.
  2. Medical wait times up to 3 times longer in Canada, CBC NEWS | Health, 3 June 2014.
  3. Comparison of the health care systems in Canada and the United States, Wikipedia; United_States, Accessed 10 June 2014.
  4. Wait Times Keep on Extending for Canada’s Universal Health Care, Sofia Ramirez Fionda, PanAm Post,
    5 November 2013.
  5. The false promise of single-payer healthcare, Sally C. Pipes, New York Post, 16 April 2014.
  6. Happy Birthday To Great Britain's Increasingly Scandalous National Health Service, Scott W. Atlas, M.D., Forbes, 5 July 2013.
  7. Universal healthcare's dirty little secrets, Michael Tanner and Michael Cannon, Los Angeles Times, 5 April 2007.
  8. History - Department of Veterans Affairs (VA), U.S. Department of Veterans Affairs, Accessed 22 April 2017.
  9. A fatal wait: Veterans languish and die on a VA hospital's secret list, Scott Bronstein and Drew Griffin, CNN,
    23 April 2014.
  10. VA Errors “An Absolute Travesty”, Jack Encarnacao, Boston Herald, Pages 4-5, 1 may 2017.
  11. The Drawbacks Of Single-Payer Healthcare, Greg McFarlane, Investopedia, 27 November 2013.
  12. John Ruskin > Quotes > Quotable Quote,, Accessed 3 May 2017.
  13. Alan Shepard Quotes,, Accessed 3 May 2017.


  11 May 2017 {Article 289; Govt_69}    
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