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The Great Wait
Californians should know what single-payer health care really looks like.


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Michael Tanner

Governor Schwarzenegger plans to veto legislation creating a government-run, single-payer health-care system in California. It’s the right decision.

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Californians are understandably frustrated with the current health-care system. Costs are rising rapidly, straining both businesses and workers. Doctors are burdened with paperwork and the limitations of managed care. Roughly 19 percent of Californians lack health insurance. That’s 6.5 million people. While many of the uninsured are covered by Medicaid and other government programs, California still has the nation’s fifth-highest number of uninsured in the country.

But simply saying that you are going to give every Californian “free” health insurance will do nothing to fix those problems. In fact, it may well make things much worse.

The one common characteristic of all single-payer health-care systems is that they ration care. Sometimes they ration it explicitly, denying certain types of treatment altogether. More often, they ration it indirectly, imposing global budgets or other cost constraints that limit the availability of high-tech medical equipment or imposes long waits on patients seeking treatment. For example, at any given time, one million Britons are waiting for admission to National Health Service hospitals and shortages force the NHS to cancel as many as 100,000 operations each year. Roughly 90,000 New Zealanders are facing similar waits. In Sweden, the wait for heart surgery can be as long as 25 weeks, while the average wait for hip-replacement surgery is more than a year.

In Canada more than 800,000 patients are currently on waiting lists for medical procedures. As the Canadian supreme court noted in striking down the part of Canada’s single-payer law that prohibited private payment for health care, “Access to a waiting list is not access to health care.” The court went on to note that “in some cases patients die as a result of waiting lists for public health care” and “many patients on non-urgent waiting lists are in pain and cannot fully enjoy any real quality of life.”

Not only would a single-payer system limit the availability of quality health care, it would add enormously to California’s tax burden. “Free” health care is anything but free. The plan would be paid for by a three-percent increase in the state income tax as well as a job-killing eight-percent payroll-tax hike. For an already overtaxed state like California, these enormous hikes would be the kiss of death.

The first rule of health-care reform should be taken from the Hippocratic Oath: First do no harm. We should not forget that for all its flaws, America offers the highest quality health care in the world. Many of the world’s top doctors, hospitals, and research facilities are located in California. The University of California’s San Francisco Medical Center, for example, is widely respected and attracts thousands of patients from around the world every year. The same is true of the Stanford University and UCLA medical centers, among others.

Eighteen of the last 25 winners of the Nobel Prize in medicine are either citizens or residents of the United States — five in California. U.S. companies have developed half of all the major new medicines introduced worldwide over the past 20 years. In fact, Americans have played a key role in 80 percent of the most important medical advances of the past 30 years. By almost any measure, if you are diagnosed with a serious illness, the United States is the place you want to be. Do Californians really want to exchange all this for a centrally planned health-care system run by the state equivalent of FEMA?

We can make our health-care system better, and we can lower costs and improve quality by giving health care consumers more choices. Health Savings Accounts, deregulation, and reforms to Medicare and Medicaid would be a good start toward making health care more accessible and affordable.

Health care is literally a matter of life and death, so Californians should be very wary of entrusting it to a costly, government-run single-payer system.

– Michael Tanner is director of health and welfare studies at the Cato Institute.



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