Single Payer Health Care: Promise and Reality

John McClaughry

John McClaughry

The Vermont legislature is about to take its first decisive step toward imposing a grand single payer health care mega-system on most of the people of the state. The House will vote this week to advance H.202, the “road map” bill to launch “Green Mountain Care”.

The single payer idea springs from at least three arguments. One is ideological – the belief that health care is a “human right”. As such, the advocates believe, government must use its power to force other people to pay for what the government believes to be “appropriate health care at the appropriate time in the appropriate setting.”

Our state and national constitutions affirm that every person has individual rights that governments may not prohibit or infringe. But nowhere can be found a right to enjoy government-mandated health care.

The second argument for single payer flows from dissatisfaction with the operation and financing of what the advocates would call the present chaotic health care “non-system”: a collection of patients, providers, insurers, employers, programs and regulators that, because of continually competing interests and inefficiencies, produces inadequate care and unnecessary costs. To the advocates, one grand government-run, centrally coordinated single payer system will assure superior care, maximize efficiency, and save hundreds of millions of dollars.

When skeptics point to the very apparent failure of the single payer systems of Canada to achieve those standards, the Vermont advocates reply “But we are Vermonters – we can make it work” (an actual quote). Given the malign contributions to the present health care “non-system” inflicted by unwise government policies over the past 50 years, this assertion does not satisfy many of the skeptics.

The third argument for single payer is political and rarely stated.  Even if the single payer System fails to fulfill its lofty promises, it will put the government in control of all employers, medical providers, insurers (if any), and patients. The government’s power and reach will expand dramatically.

That will mean many more jobs for (unionized) government bureaucrats. It will require unionization of doctors and other professionals who will have to bargain with the public body over their compensation and working conditions. It will mean more campaign contributions and votes for politicians who will work to rig the system in favor of their particular group of “stakeholders”.

If the State becomes the final authority over $6 billion worth of health care spending, it will matter a lot who controls the State.  The House bill gives page after page of instructions, and $1.1 million, to administration officials and the Green Mountain Care Board – referred to under the Dome as the “Jedi Council”. According to Dr. William Hsaio, the consultant hired by the legislature, this supposedly “independent” five-person body, appointed by the Governor, is designed to “remove the budgeting decisions from the political process.”

The Board will determine what “high quality, medically necessary” benefits the taxpayers will pay for, and for which patients; how much hospitals can expend; how much the doctors, dentists, hospitals and nurses will be paid for performing which Board-authorized services; how much of the System’s costs will be shifted onto the providers by underpaying them; and what payroll and other tax rates the state will need to levy to raise enough revenues to keep the whole System afloat.

Can such a single payer System be fiscally sustained? In a word, no. Joint Fiscal Office director Steve Klein has already informed the solons that the their single payer plan would produce cost savings for the first two years, but over the longer term “health care costs would rise faster than revenues”. “It’s not going to be a pretty picture”, Klein concluded. What happens when infinite demands run up against finite taxpayer resources? The government must ration the resources. A common technique in Canada is to limit the number of providers. Fewer providers equal fewer billings for fewer services. Costs contained!

That may solve the System’s annual budget problem, but from the patient’s point of view it’s called denial of care.

Is this government monopoly System likely to achieve its ambitious principles? Or will it, as critics have claimed, quickly degenerate into rationing, waiting lines, maddening bureaucracies, demoralized doctors and nurses, shabby facilities, obsolete technology, declining quality of care, and much higher taxation?

The single payer advocates have scoffed at this characterization.  If they would look honestly at the unacceptable (to Americans) outcomes produced by the single payer System just north of the border, they might revise their opinions. Of course, they won’t. They’d rather push the bill through to Gov. Shumlin’s desk and let Vermonters find out the hard way.

John McClaughry is vice president of the Ethan Allen Institute.