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Sunday, January 13, 2019

Democrats Going For Single Payer Health Care

Back in August I explained how Europeans manage to undercut the United States in health care costs. Reporting a large amount of data on health care accessibility, I concluded:
Plain and simple: the reason why we have a more expensive health care system is that we actually provide health care. 

In other industrialized countries, access to health care is tightly restricted, leading to - among many other examples - higher mortality from cancer. For breast cancer, e.g., we have the highest survival rate, beating every country with single-payer health care. Other examples are nurse-to-bed ratios, where we beat almost every single-payer system, and access to various technology, such as CT scanners where every other country except Australia makes people wait longer than we do.

In Sweden, patients have to first see a General Practitioner (GP) before they can see a medical specialist. Once they have seen their GP and obtained a referral to a specialist (by no means guaranteed), they have to wait in line. As of November 2018, in eleven of the country's 21 health care districts at least one third the patients waiting for a specialist appointment had to wait more than 60 days. 

After seeing the specialist, patients had to wait for treatment, which in some cases meant surgery. In 14 of the 21 health care districts, at least one third of the patients had to wait more than 60 days for treatment. In one district, more than half the patients had to wait more than 60 days. 

Despite a national law that guarantees patients treatment within 90 days, one in four patients have to wait longer than that. 

The Canadian system is a bit better, but not exactly something to write home about. According to the Fraser Institute's annual Waiting Your Turn review of waiting times in specialized medicine, 

--The median waiting time between referral from a general practitioner to receipt of treatment has increased by 113 percent in the past 25 years;
--The waiting time from referral to consultation with a specialist had increased by 136 percent, to a national average of 8.7 weeks;
--The waiting time from consultation to treatment had increased by 97 percent, averaging eleven weeks.

In five of Canada's ten provinces, patients on average had to wait a total of six months or more from a specialist referral by a general practitioner to treatment. Nationally, Canadians had to wait on average four weeks for radiation oncology, ten weeks for elective cardiovascular surgery, 26 weeks for neurosurgery and 39 weeks for orthopedic surgery.

As for diagnostic technologies, the Fraser Institute reports:
Canadians could expect to wait 4.3 weeks for a computed tomography (CT) scan, 10.6 weeks for a magnetic resonance imaging (MRI) scan, and 3.9 weeks for an ultrasound.
They also explain that waiting times exceed what is deemed to be clinically reasonable:
Specialists are also surveyed as to what they regard as clinically “reasonable” waiting times in the second segment covering the time spent from specialist consultation to delivery of treatment. Out of the 96 categories (some comparisons were precluded by missing data), actual waiting time exceeds reasonable waiting time in 72% of the comparisons.
Despite all these bad experiences with single-payer health care, there are still those here in America who manically continue to pursue it. Recently, their voices have grown louder. For example, reports that New York Mayor
de Blasio is set to roll out an ambitious $100 million plan to provide a “public option” to provide healthcare to serve New York City’s 600,000 uninsured — including undocumented immigrants. “This has never been done before in this country in this kind of comprehensive way — it’s going to be for the first time a guarantee of healthcare,” de Blasio said Tuesday morning on MSNBC’s Morning Joe. “We’re going to guarantee healthcare for New Yorkers who need it.” 
To my point about rationing under government-run health care systems: the money that Mayor de Blasio wants to appropriate is enough to give each of the 600,000 enrollees a whopping $167 worth of health care per year. Given the going rates for anything in New York, plus taxes and other fees on health care, this amount will probably give each one of them an annual fifteen minute chat with the receptionist at the local public hospital.

Perhaps sensing the arithmetic problem with his plan, MSN reports that the mayor
said the city would be expanding an already existing public option. Though he did not specify which program, on Monday DocumentedNY reported he was poised to expand ActionHealthNYC, a pilot that provided reduced health costs in a managed care framework at public hospital facilities. 
If managed care is what de Blasio refers to as guaranteeing health care "for New Yorkers who need it", then those "New Yorkers who need it" are in for a rude surprise. Managed care is a good Stateside simulation of run-of-the-mill European single-payer systems. Currently, 65 percent of all people enrolled in Medicaid are on managed-care plans, yet those plans only represent 43 percent of total costs of the program. This is not surprising, given how even the federal government admits that cost management is the first goal of managed care in Medicaid.

I am sure a rationed version of Medicaid is exactly what Mayor de Blasio considers to be the perfect health insurance system for New Yorkers. 

The delusion over single-payer health care has also taken California by storm (and we are all very surprised). The Daily Wire has the story about what the new governor in Sacramento has in mind:
Gavin Newsom doubled down on claims he made earlier this month that he'd turn California into a single-payer healthcare state, telling the Pod Save America podcast that he plans on expanding Medicare to cover every Californian — even illegal immigrants.
There is just one problem. Medicare is an entirely federal program. Governor Newsom has no jurisdiction over it. None. Zero. Zilch. Nada.

Maybe someone should call him and let him know. 

Back to the Daily Wire:
“I’d like to see if we can control our own destiny,” Newsom, the former mayor of San Francisco, said. “I’m not naive about it. I did universal health care when I was mayor, fully implemented regardless of pre-existing conditions, ability to pay, and regardless of your immigration status." “San Francisco is the only universal health care system for all undocumented residents in America, very proud of that. We proved it could be done without bankrupting the city. I’d like to see that we can extend that to the rest of the state,” he continued. 
He is right. San Francisco did not file for bankruptcy under his mayorship. He only left the city with a $576 million deficit for his successor to deal with. 

How much is he going to increase the hole in the La La State's budget?

Incidentally, the Daily Wire observes that health care professionals in California are not exactly enthusiastic about Governor Newsom's plans:
doctors and California's healthcare administrators are against the prospect of a fully single-payer system, largely because it will tank their salaries, and they're planning on opposing any legislation designed to make big changes. 

As if to really drive home the point that America's left really doesn't care about facts, the Fiscal Times reports:
Democrats are making it clear that they’re serious about moving forward on universal health care. Speaker Nancy Pelosi (D-CA) said last week that she supports holding hearings on Medicare-for-All legislation, and on Tuesday House Budget Committee chair Rep. John Yarmuth (D-KY) sent a letter to the Congressional Budget Office requesting a comprehensive analysis of how a single-payer health system would work in the U.S. Yarmuth said that although the Affordable Care Act significantly reduced the number of people without health care coverage, “millions of Americans remain uninsured, and millions more – even though they have insurance – struggle to afford their health care costs.” 
And as always, the Democrats make promises to one group of people and send the bill to another group of people. The problem with a single-payer health care system is that it would require about $2 trillion in new taxes. That is approximately $13,000 per year, per working American. In addition to all other taxes we pay today. 

Health care statists will counter that an average, unsubsidized private health insurance plan for a family costs about $14,000 per year, so that's a win for everyone, right?

No. Please note that the extra taxes applies to all working Americans, meaning that for most families this adds $26,000 per year in taxes. Even if we assume that their private plan costs them $14,000 per year and thus deduct that from the new taxes, we are still left with a substantial $12,000 annual extra tax.

For sure, this is a stylized example, but it is at least an attempt at illustrating the costs associated with single-payer health care. And that is before we even get to the costs associated with the inevitable Swedish or Canadian style health care rationing. 

Again, these are points that health care statists faithfully ignore. The Fiscal Times again:
While many countries successfully provide “near-universal coverage through single-payer systems,” there are different paths the U.S. could take to build such a system.
The success is limited to giving every person the right to health care. Whether or not they ever get health care is a different story. A story, in fact, that is easy to answer: they will get health care when government can afford to deliver - not when the patient needs it.

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