The Pain of Single Payer

Expect the next Democratic presidential nominee to run strongly on single-payer (ie socialized) medicine.  Vodkapundit reminds us what this is like, with the latest from England:

Hospitals across the country are imposing minimum waiting times -
delaying the treatment of thousands of patients.

After years of Government targets pushing them to cut waiting lists, staff
are now being warned against "over-performing" by treating patients too quickly.
The Sunday Telegraph has learned that at least six trusts have imposed the
minimum times.

In March, Patricia Hewitt, the Secretary of State for Health, offered her
apparent blessing for the minimum waiting times by announcing they would be
"appropriate" in some cases. Amid fears about £1.27 billion of NHS debts, she
expressed concern that some hospitals were so productive "they actually got
ahead of what the NHS could afford".

The Sunday Telegraph has learned of five further minimum-waiting-time
directives. In May, Staffordshire Moorlands PCT, which funds services at two
hospitals and is more than £5 million in the red, introduced a 19-week minimum
wait for in-patients and 10 weeks for out-patients. A spokesman said: "These
were the least worst cuts we could make." In March, Eastbourne Downs PCT,
expected to overspend by £7 million this year, ordered a six-month minimum wait
for non-urgent operations. Also in March, it was revealed that Medway PCT, with
a deficit of £12.4 million, brought in a nine-week wait for out-patient
appointments and 20 weeks for non-urgent operations.

Doctors are also resigning. One gynæcologist said that he spent more time
doing sudoku puzzles than treating patients because of the measures. Since
January, West Hertfordshire NHS Trust, with a deficit of £41 million, has used a
10-week minimum wait for routine GP referrals to hospital. Watford and Three
Rivers PCT, £13.2 million in the red, has introduced "demand management": no
in-patient or day case is admitted before five months.

Note that this is not a bug with single-payer systems, it is a feature.  Any 3rd party payer system has to impose some sort of artificial rationing or bankruptcy will ensue.  Would you drive more if your gasoline costs were all covered by a single-payer system, such that you did not pay directly for gas.  Would your choice of cars be affected?

Along the same lines, from Marginal Revolution comes this story of new scholarship showing the enormous spike that occurs in health care demand under third party payer (e.g. insurance) systems.


  1. Matt:

    The irony is that the reason we have a crisis in the first place is that this seperation of control and cost is already present. It's present to a lesser degree, of course, but it's still present. My health care insurance costs are utterly unaffected by the number of times I do things that health insurance pays for, and hence my only incentive not to overconsume health care is the fact that hanging out in hospitals all the time is boring and depressing. (And no, my choice of vehicles would not be affected by someone else paying for the gas, because I'd still have to be responsible for actually getting that "free" gas into my car, which would still be a PITA. But I'm weirdly focused on the marginal return to leisure time.)

    If people paid for their own health care, it would be cheaper. But as it is, most people already have effectively zero incentive to economize, and hence costs are allowed to grow out of control.

  2. Matthew Brown:

    I think it's more complicated than that, though. Another aspect of the socialisation of medicine, of course, is that it's made even MORE inefficient by being run by the government - hard job though that is. Furthermore, it's open to stupid political grandstanding rather than sensible decisions - bad enough when the government can only make dumb decisions for healthcare at one remove, and by passing laws, even worse when a government department can make decisions at the drop of a hat.

  3. dearieme:

    Don't copy the NHS, chaps, or you'll live to regret it. Or not, as the case may be.

  4. Matt:

    The problem with arguing from "efficiency" is that it's a term our enemies get to define to their advantage. Whatever result their system-of-choice produces, ends up getting called "efficiency".

    Does it manage to reduce total healthcare costs, by rationing care so tightly that every day dozens-to-hundreds of people die waiting for care that, in the system we have today, they would have received in a timely fashion? Well, then...the proponents of socialized medicine will simply declare that "efficiency" means lower cost, and so they win.

    Does it provide current-best-practice care for everyone, by locking out possible future improvements as well as taxing us into destitution? Then proponents of socialized medicine will declare that "efficiency" means that, and so they win.

    Will people who eat meat and smoke cigarettes be hunted down and murdered in their sleep by the police? That actually might be a reasonable definition of "efficiency", but it doesn't sound much like liberty to me.

    We've already almost completely lost this battle. Right now, in the public mind, the state of our healthcare system is measured by the percentage of the population that has health insurance. As long as this stays the statistic we measure, the proponents of socialized medicine can declare victory by fiat as soon as they get enough legislative muscle to enact their agenda. If people think the problem is that some folks are uninsured, they'll be receptive to proposals which simply hand out insurance to everyone (or, as in Massachussetts, compels them by law to buy it with their own money, whether they want it or not), as if that actually solves anything.

    Many problems can be avoided by making sure one is paying attention to the _correct_ statistics.

  5. Robert:

    "Expect the next Democratic presidential nominee to run strongly on single-payer (ie socialized) medicine."

    Do you have any evidence to support this claim?

  6. asg:

    I dunno, maybe the fact that the DNC is constantly trying to get elections to focus on issues where the Democrats are allegedly strong, such as health care, and that the DNC is not known for its enthusiasm for free market health care reform? Or the fact that the Democratic frontrunner right now is Hillary Clinton, whose primary policy achievement during her husband's presidency was her effort to nationalize health care?

  7. Howie DoDat:

    Ask a veteran how he likes the VA medical system - now imagine the same thing for everyone in the US