- - Wednesday, May 22, 2019

ANALYSIS/OPINION:

The discussion about health care reform has changed dramatically to one of single-payer, government-run care vs. a patient-centered, competition-based, decentralized system. Let’s all first realize this: Today’s silence about the Affordable Care Act (ACA), or Obamacare, exposes consensus acknowledgement of the failure of Obamacare.

In its first four years, Obamacare insurance premiums for individuals doubled and for families increased by 140 percent, even though deductibles increased substantially. Doctor networks accepting Obamacare insurance continue to narrow; now, almost 75 percent of plans are highly restrictive. The ACA also encouraged a record pace of consolidation across the sector, including mergers of doctor practices and hospitals. This is harmful to everyone, because prices are consistently higher when fewer hospitals compete for payers.

The Democrats’ new case for reform to single-payer is based on the allure of a simple concept: The government explicitly “guarantees” medical care. Other nations making that claim further insist that such health care is provided “free.”

For instance, England’s National Health System Constitution explicitly states “You have the right to receive NHS services free of charge” despite taxing citizens about $160 billion per year. Not surprisingly, independent estimates for single-payer health care for California alone would cost about $400 billion per year, more than double the state’s entire annual budget. Massive new taxation would be required.

But the opposition to single-payer care should not be focused solely on cost and new taxes. Advocates of single-payer health care for Americans overtly ignore glaring realities.



The first reality is that single-payer systems in countries with decades of experience are proven inferior to U.S. health care, in terms of both access and quality. Single-payer systems have imposed massive waiting lists and unconscionable delays that are unheard of in the United States as verified by numerous studies.

In England alone, a record-setting 4.2 million patients are on NHS waiting lists; in March 2017, 362,600 patients waited longer than four months for hospital treatment; and as of July, 2018, more than 3,400 patients are waiting more than one full year all after receiving diagnosis and referral. In Canada, the 2017 median wait between seeing a doctor and first treatment was about five months.

In single-payer systems, even patients referred for “urgent treatment” wait months. In England’s NHS, more than 19 percent wait over two months after referral for their first urgent cancer treatment; 17 percent wait more than four months for brain surgery. In Canada, the median wait for neurosurgery after seeing the doctor is 32.9 weeks — about eight months. Canadians with heart disease wait 11.7 weeks for their first treatment. And if you need life-changing orthopedic surgery in Canada, like hip or knee replacement, you would wait a startling 10 months.

Ironically, U.S. media calls for reform were widespread when 2009 data showed time-to-appointment for Americans averaged 20.5 days for five common specialties (after Obamacare, increasing in 2017 by 30 percent from 2014). With the exception of orthopedist appointments for knee pain, those waits were for healthy check-ups in all cases, by definition the lowest medical priority. Even for low-priority check-ups, U.S. wait times are far shorter than for seriously ill patients in countries with single-payer health care.

Single-payer systems also actively restrict access to the newest drugs, sometimes for years, compared to Americans. Before Obamacare, a Health Affairs study showed the U.S. FDA had approved 32 of 35 new cancer drugs from 2000-2011 while the European Medicines Agency approved only 26. All 23 approved by both were available to U.S. patients first.

Two-thirds of novel drugs (29 of 45) were approved in the United States before any other country. Of all newly approved cancer drugs in the United States from 2009 to 2014, the U.K., Australia, France and Canada had only approved 30 to 60 percent of them by June 30, 2014.

Women in single-payer Canada wait far longer and had less access to novel contraceptive drugs, compared to American women, as reported in 2016. Nonetheless, in 2017, NHS England introduced a new “Budget Impact Test” to cap drug prices and further restrict drug availability, even though NHS cancer patients could be forced to wait years for life-saving drugs already available in the United States.

Why does this matter? Long waits for diagnosis, treatments, drugs and technology, have major consequences.

The argument that single-payer systems spend less on health care than the United States is true. But that comes with the cost of enduring explicit restrictions of receiving medical care, including severe waits for doctors and important medical procedures, restricted access to modern drugs and limited availability of safer, more accurate diagnostic technology.

It is no surprise that single-payer systems have worse outcomes from almost all serious diseases than the U.S. system, including cancer; diabetes, high blood pressure, stroke and heart disease. The harmful health consequences of single-payer care — beyond pain, suffering, death and permanent disability — also have tremendous costs to individuals in foregone wages and to the overall economy.

What has also been ignored, even perhaps intentionally hidden from Americans, is that single-payer systems all over the world now turn toward private health care to solve their failures. Sweden has increased its spending on private care by 50 percent over the past decade, and abolished its government’s monopoly over pharmacies.

In one year alone, the U.K. government spent more than $1 billion for care from private and other non-NHS providers, as reported by the Financial Times. Governments with single-payer care all over the world — including Finland, Ireland, Italy, the Netherlands, Norway, Spain, Sweden and Denmark — now spend taxpayer money on facilitating private care, sometimes even outside the country, if the waiting time is too long.

Policy should be based on facts not fantasy. Government-centralized, single-payer systems hold down costs mainly by strictly limiting the availability of medical care, drugs and technology, causing more patients to die and suffer. And remember — low- and middle-income Americans will suffer the most if the U.S. system turns to single-payer, because only they will be unable to circumvent that system. Let’s instead empower individuals with control of the money, where doctors compete for patients. This lowers the cost of medical care itself. That’s the best way to bring high quality health care to everyone.

• Scott W. Atlas, a physician, is a senior fellow at Stanford University’s Hoover Institution and the author of “Restoring Quality Health Care: A Six Point Plan for Comprehensive Reform” (Hoover Press).

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