Politics & Policy

The Many Failures of Single Payer

From Vermont to Britain, it’s not working out.

Vermont’s incumbent governor, Peter Shumlin, wants his state to become the first to launch a government takeover of its health-care system. But the results of last month’s election could give him pause. He was unable to secure a majority of votes this November — after winning 58 percent of the vote two years ago. Now the state legislature will determine whether to send Shumlin back for another term.

What happened in between? Vermont botched the launch of its state-run insurance exchange. By 2017, the exchange is supposed to serve as the “infrastructure” for a single-payer system, with the state picking up the tab for just about every resident’s health care. That exchange hasn’t even gotten off the ground, and state officials have no idea how to raise the $2 billion a year they’ll need to operate a single-payer system.

Vermont’s struggle to implement single-payer health care shouldn’t be a surprise. Such systems are failing to deliver affordable, quality care all over the world. And ordinary citizens are starting to notice.

Shumlin’s administration announced last month that it would shut down the state’s Green Mountain Care exchange for repairs that could take weeks. One state senator said its rollout “has been pretty much a disaster” and “has shaken a lot of people’s faith in the ability of state government to put together something that would work.”

Even if the state could figure out how to operate a single-payer system, it wouldn’t be able to afford it. A 2013 University of Massachusetts study commissioned by the state concluded that Vermont would have to come up with $1.6 billion in new revenue every year to pay for the plan. Now the state estimates that single payer will take $1.7 billion to $2.2 billion in additional annual revenue.

Vermont collects $2.7 billion a year in taxes. How does it expect to boost its tax take by 80 percent to pay for single payer?

Vermonters should be thrilled that single payer has false-started in their state. For evidence that single payer doesn’t work, look no further than the United Kingdom and Canada.

Britain’s National Health Service is projected to face budget shortfalls of 30 billion pounds — nearly $47 billion — annually by 2020. The government is responding to this fiscal squeeze by effectively rationing care. Last year, the number of family-practice doctors who appealed to the National Health Service to stop accepting new patients doubled. Between April and June, nearly 16,000 scheduled operations were canceled for non-medical reasons. That’s the highest such figure in nine years.

As care has become scarce, British patients have taken matters into their own hands. The number of patients paying for treatment on their own has increased tenfold in the past two years. That’s because paying out of pocket allows patients to jump ahead of the interminable waiting lists for care.

This winter, the NHS is actually calling on the Red Cross to “stave off an NHS winter crisis as waiting lists reach a record high,” as British newspaper The Telegraph put it. More than 3 million people are on waiting lists for treatment — the most since January 2008. In June, more than 32,000 patients had waited at least 18 weeks for treatment. If Britain’s health-care system has to be rescued by the same folks who deliver emergency care in war zones, perhaps it’s a sign that single payer doesn’t work.

Confidence in single-payer health care is also eroding in Canada. An August poll commissioned by the Canadian Medical Association found that 78 percent of Canadians over 45 are worried that they won’t be able to access care when they need it. Eighty-one percent of older Canadians say they are worried about the quality of care they will receive.

Countries without single-payer systems are doing their best to keep things that way. Last month, Swiss voters rejected a plan to scrap their private insurance system for single payer. Nearly two-thirds of the country opposed the measure — significantly more than polls conducted before the vote predicted.

Vermonters would be wise to note the failures of single payer abroad — if the Green Mountain State completes its journey toward single payer, waiting lists, budget-busting costs, and rationing await. And to avoid this single-payer outcome for all Americans, Obamacare must be repealed and replaced.

— Sally C. Pipes is president, CEO, and Taube Fellow in Health Care Studies at the Pacific Research Institute. Her latest book is The Cure for Obamacare (Encounter 2013).

Sally C. Pipes is the president, CEO, and Thomas W. Smith Fellow in Health Care Policy at the Pacific Research Institute. Her latest book is The False Promise of Single-Payer Health Care (Encounter). Follow her on Twitter @sallypipes.

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