Government Health Care and Efficiency

I am always absolutely amazed when advocates of some form of national or single-payer health care argue that such a system would be more efficient.  For example, Kevin Drum argued:

A few days ago, during an email exchange with a
friend, I mentioned that I don't usually tout cost savings as a big
argument in favor of universal healthcare. It's true that a national
healthcare plan would almost certainly save money compared to our
current Rube Goldberg system, but I suspect the savings would be
modest. Rather, the real advantages of national healthcare are related
to things like access (getting everyone covered), efficiency (cutting down on useless -- or even deliberately counterproductive -- administrative bureaucracies), choice
(allowing people to choose and keep a family doctor instead of being
jerked around everytime their employer decides to switch health
providers), and social justice (providing decent, hassle-free healthcare for the poor).

I don't think any of these are true.  For example, let's take access.  Yes, everyone in a universal health care system would have a piece of paper that says they have health care, and the left seems really focused on that piece of paper.  But that paper has about as much value as my piece of paper that says I own a hundred shares of Enron.  Because someone has to redeem that piece of paper and actually provide the care, and there is the rub, is it not?  Canadian David Gratzer writes (vis Q&O):

My book's thesis was simple: to contain rising
costs, government-run health-care systems invariably restrict the
health-care supply. Thus, at a time when Canada's population was aging
and needed more care, not less, cost-crunching bureaucrats had reduced
the size of medical school classes, shuttered hospitals, and capped
physician fees, resulting in hundreds of thousands of patients waiting
for needed treatment"”patients who suffered and, in some cases, died
from the delays....

Nor were the problems I identified unique to
Canada"”they characterized all government-run health-care systems.
Consider the recent British controversy over a cancer patient who tried
to get an appointment with a specialist, only to have it canceled"”48
times. More than 1 million Britons must wait for some type of care,
with 200,000 in line for longer than six months. A while back, I toured
a public hospital in Washington, D.C., with Tim Evans, a senior fellow
at the Centre for the New Europe. The hospital was dark and dingy, but
Evans observed that it was cleaner than anything in his native England.
In France, the supply of doctors is so limited that during an August
2003 heat wave"”when many doctors were on vacation and hospitals were
stretched beyond capacity"”15,000 elderly citizens died. Across Europe,
state-of-the-art drugs aren't available. And so on.

I had forgotten about the heat wave.  Could you imagine backwards old America having 15,000 people die when the temperature got into the 90's?

As to efficiency, which Drum defines as "cutting down on useless -- or even deliberately counterproductive -- administrative bureaucracies," does anyone really ascribe these characteristics to the government?  Really?  Even European health care bureaucrats would not agree with this statement:

This privatizing trend is reaching Europe, too.
Britain's government-run health care dates back to the 1940s. Yet the
Labour Party"”which originally created the National Health Service and
used to bristle at the suggestion of private medicine, dismissing it as
"Americanization""”now openly favors privatization. Sir William Wells, a
senior British health official, recently said: "The big trouble with a
state monopoly is that it builds in massive inefficiencies and
inward-looking culture."

I won't get much into the last two, except to say that we actually have a ton of health care choice in the US today, far more than any other country.  And even if we did not, what does doctor choice mean if the best people are driven away from being doctors, as they are in socialized medicine.  And social justice?  Well, the poor get care in the US, the key is the "hassle-free" in his statement.  Would you immediately assume that a government-run service is going to involve less hassle than a private service?  Have you renewed your drivers license lately?  It may well be that the poorest 10% have such an awful health care experience that they will see things better.  But almost assuredly the other 90% are going to be worse off.

Remember this -- Universal health care is NOT a system in which the majority of us who are satisfied with our care can keep our current system, while the poor get a better one.  It is a system where all of us are thrown out of our current system and given the same care the poor get.  It is roughly equivalent to a Great Society housing program in which not just the homeless get housing, but everyone in the country are forced to give up their current house and live in public housing.

Postscript:  There is great improvement to be had in the health care system.  It revolves, though, around making the payer for health care the same person who receives the service, as it is for every other product and service we buy in this country.  We already have too much single-payer.  We need multi-payer.  I won't go there today, but I explained here.

Another Thought:
A huge pillar of the women's movement was that the government should not make decisions for a woman and her body (e.g. by banning abortion).   All well and good.  But I have never understood how this was consistent with support, say, for the FDA, which tells women exactly what they can and can't put in their body.  And now women's groups are all for universal health care, where government will make all the medical decisions about what procedures one can and can't have, and when.  Consistency please?


  1. Robert Recht:

    Which insurance co are you tied to? I've experienced private insur then went to Medicare. Not perfect but far, far better than what you tout. And it has actually improved thru the years and become more cost effective. If it insured those under 65,( it insures those over 65 who are the "sickest" and cost the most, ) it would be even more viable because of the increased size of the pool and a far healthier one at that.
    Republicans and health insurors are intent on destroying Medicare, a successful single payer plan, and will say and do anything to do this. Your arguments are worn, transparant, inaccurate and full of holes.

  2. Bob Smith:

    Medicare is *not* cost effective. Studies showing it to be so either assume certain costs to be zero or ignore certain costs entirely. Even if it were cost effective, health care with service like the DMV isn't worth it no matter how little it costs.

    Btw, women's groups want universal health care is because (a) women as a class are a lot more liberal and socialist-leaning than men, and (b) they want abortions to be "free". The overarching goal is to subsidize women cradle to grave so they can proclaim themselves independent of men (but not, as a matter of "social justice", of their money).

  3. tk:

    Every year I pay more for my insurance and every year I have my benefits reduced. I'm paying an arm and a leg for my families insurance and still have high deductibles. While my care is efficient and of good quality, I don't know how much long my family can afford this trend of higher prices an lower benefits. I make a pretty good salary and still have this problem. I can't imagine what families with lower incomes must go through. All for the profit of the insurance companies... not that you can blame them. As public companies, it's their responsibility to maximize profits. That's why the system is screwed. They're trying to maximize profits while I'm trying to get affordable health care. It doesn't work.

  4. somebody:

    Honest liberals will admit that universal health care is more inefficient than privatized health care (just like any other service in the market). However, the philosophical basis for the leftists isn't freedom. It's equality. They hate the fact that some people are better off than others. It's always about "social justice."

  5. Anon E. Mouse:

    "It's true that a national Software Company would almost certainly save money compared to our current Rube Goldberg system, but I suspect the savings would be modest. Rather, the real advantages of national Software are related to things like access (getting everyone covered), efficiency (cutting down on useless -- or even deliberately counterproductive -- administrative bureaucracies), choice (allowing people to choose and keep an operating system instead of being jerked around everytime their employer decides to switch software providers), and social justice (providing decent, hassle-free software for the poor)."

    What if Bill Gates started a nationwide push for universal software coverage? Kevin Drum's arguments hold just as well.