Debunking Friday the 13th: 13 Myths about Health Care Reform

June 12, 2003
Conrad F. Meier

If you cross the path of a black cat this Friday the 13th, you’re about as likely to experience bad luck as you are likely to win the lottery. That’s a fact.

But facts often give way to myth. While many of those myths are relatively harmless, others can be downright dangerous to our life, liberty, prosperity, and health.

The single-payer health care plans touted by former Vice President Al Gore, Congressman Richard Gephardt (D-Missouri) and other Democrats offer a truly frightening case in point. Consider these 13 myths about single-payer health care.



Myth #1 Single-payer systems are not socialized medicine. Single-payer means government is the insurance company. It doesn’t charge “premiums,” but instead raises taxes. It controls not only the financing, but who gets what services, the quality of what they get, when they get it, and if they get it. You don’t get much more socialized than that. A single-payer system is one big HMO, without the discipline and accountability achieved by competition.

Myth #2 Single-payer systems are efficient. A study by the Institute for Global Health at the University of California concluded the Kaiser-Permanente HMO in the United States and Britain’s National Health Service (NHS) have similar resources, but the HMO offers better care more quickly. The difference is explained by better management, better use of integrated systems, greater investment in technology, and free-market competition.

Myth #3 Single-payer systems are compassionate. If you think HMOs and insurance companies lack compassion, wait until you experience a health care system run by politicians and government bureaucrats. Single-payer health care systems depend on coercion and intrusion into the private affairs of persons subjected to them. Paperwork and red tape--not compassion or respect for the doctor-patient relationship--rule.

Myth #4 Single-payer systems are not expensive for governments. Gephardt’s proposal would cost $247 billion--every year. A proposal to implement single-payer health care in Maryland alone would have cost $40 million a year ... plus lost payroll tax receipts of nearly $5 billion. As many as 117,000 jobs would have been lost.

Myth #5 Single-payer systems are “free” for individuals. Single-payer health care plans are not free: They are paid for by tax dollars. Billions of them. The Maryland proposal would have required a 33 percent increase in the state’s personal income tax. Canadians pay extraordinarily high income taxes for their “free” care ... only to have to pay again when they come to the United States for care they can’t get in Canada.

Myth #6 Single-payer systems do not ration care. In a single-payer health care system like Britain’s, patients have every incentive to demand care, and lots of it. Since no system can satisfy unlimited demand, the central authorities must resort to the only strategy open to them: rationing. In single-payer systems, you get rationing by waiting list; rationing by price controls; and rationing by restricting access to specialists, technology, and new drugs.

Myth #7 Single-payer systems offer high-quality care. To get access to the least-invasive, most effective health care technology, citizens living under single-payer health care schemes come to the United States. The Canadian Fraser Institute reported in August 2002, “with regard to access to high-tech machinery, Canada performs dismally by comparison with other OECD countries. While ranking number one as a health care spender, Canada ranks 18th in access to MRIs, 17th in access to CT scanners, [and] eighth in access to radiation machines ...”

Myth #8 Single-payer systems offer timely care. On any given day, one in 60 British citizens are waiting for medical treatment. Of those who are sick and actually need care, one in six must wait. After meeting with a senior doctor, one million people in Britain are on a waiting list for in-patient hospital admission at any given time. Just 155,000 of those are seen within four weeks. For 250,000 of them, it takes more than 26 weeks to be admitted for care.

Myth #9 Single-payer systems improve access to prescription drugs.
In Britain, the government determines how much profit a pharmaceutical firm is allowed to make--a sure way to arrest research and development. In addition, they ration access to drugs with a lottery based on a consumer's zip code. The prize is your eligibility to receive free medication. The “lucky” zip cod can change at any time, apparently on the basis of political expediency rather than medical necessity. Price controls and rigid drug formularies--hallmarks of a single-payer health care system--limit access to drugs and violate doctors’ and patients’ freedom of choice.

Myth #10 Single-payer systems allow you to see any doctor you choose. Many doctors already refuse to accept Medicare patients. A recent study by the American Medical Association found nearly half of all U.S. physicians would have limited their Medicare practices further if the federal government had carried out a plan to cut physician fees. How many more doctors would “opt out”--or quit the professional altogether--if the entire U.S. were one big Medicare program?

Myth #11 Single-payer systems are popular with doctors. Five hundred physicians leave Canada every year to practice in something other than a single-payer health care system. Zosia Kmietowicz wrote in the October 20, 2001 issue of the British Medical Journal, “one in four general practitioners (GPs) in Britain's National Health Service is seriously considering leaving general practice.” The British Medical Association surveyed all 36,000 General Practitioners in Britain, asking them if they would be prepared to resign from the NHS. There was a 66 percent response rate ... and 86 percent voted in favor of resignation.

Myth #12 Single-payer systems are popular with patients. In 2002, seventy-nine percent of Oregon voters rejected a plan to have government officials run a health care system for the state’s 3.5 million residents. Measure 23, touted by supporters as “health care for all Oregon,” attracted just 204,082 votes, 21 percent of the total, while 786,768 voters--79 percent--rejected the plan.

Myth #13 Single-payer systems are preferred by “forward-looking” countries. Nobody outside Britain--and apparently the United States--praises the NHS anymore. The country is out of step, clinging to central government control and management of health care while other countries move away from a single-payer model towards some mixture of free enterprise and government health care. Canada, Russia, Sweden, Germany ... and even Britain itself ... are moving toward greater reliance on the free-market.



Friday the 13th myths are harmless enough. But single-payer health care? I would just as soon cross paths with a black cat while walking under a ladder.


Conrad F. Meier is senior fellow in health policy at The Heartland Institute and managing editor of Health Care News.


For further information, contact Heartland Public Affairs Director Greg Lackner at 312/377-4000, 773/489-6447, email lackner@heartland.org