Imagine waiting an hour and a half for an ambulance to take you to the emergency room, then waiting an additional 12 hours before being seen. Or waiting nearly seven months to see a medical specialist for a first consultation. Or being denied life-changing, cost-effective surgeries. These are some of the consequences of single-payer healthcare, and California lawmakers just passed new legislation that is the first step toward creating such a system for our state.
Senate Bill 770, signed by Gavin Newsom earlier this month, directs California’s Health and Human Services Agency to work with the federal government to create one health financing system that would manage healthcare for all Californians. This is the first step to implementing a single-payer plan, because California receives large federal contributions for healthcare, including Medicare, all of which would need to be folded into one single-payer system. Existing private insurance programs, as well as Medicare, would no longer exist. The federal government may be a very willing partner, as Xavier Becerra, the US secretary of health and human services, is a longstanding advocate of single-payer healthcare.
In signing SB 770, Newsom is returning to his 2018 campaign promise of single-payer healthcare: “I’m tired of politicians saying they support single-payer but that it’s too soon, too expensive or someone else’s problem. . . . I think that the ideal system is a single-payer system. I’ve been consistent with that for well over a decade.”
The empirical record for single-payer healthcare is clear. Single-payer systems limit access to healthcare providers and treatment and suppress the use of technologies and medications. This means patients suffer, particularly those who don’t have the financial means to pay out-of-pocket for private healthcare provided outside of the single-payer system. Gavin Newsom, who is wealthy, will be able to afford private care. Many others will not.
Single-payer systems must ration healthcare because they flout the most basic economic laws of supply and demand. Such plans severely limit spending on healthcare, which in turn reduces healthcare supply, including providers, technologies, and treatment. Single payer systems also increase demand, since patient copays are minimal, and in some cases, are zero. So single-payer healthcare administrators, not patients and their providers, decide what services are offered, and how much.
It is not just new, expensive technologies or treatments that are rationed under single-payer systems. Magnetic resonance imaging (MRI) is hardly a new technology, yet there are more MRI machines on Wilshire Boulevard in Los Angeles than in the Canadian province of British Columbia, whose population exceeds five million.
Because of the scarcity of MRI in British Columbia, the wait time for a scan is sufficiently long, even for suspected cancer patients, that tumor size might double before a patient receives imaging. This is unconscionable, but the unconscionable becomes the everyday in single-payer.
In the UK’s National Health Service (NHS), the oldest continuously operating single-payer system in the world, cataract surgeries are often denied because the NHS claims the surgery is of “limited clinical value.” But in reality, cataract surgery is one of the most promising surgical procedures, with a success rate of nearly 99 percent and with very few complications. The NHS denies cataract surgeries because of budgetary issues, even though the surgery only costs about $4,000.
California’s decision to pursue single-payer healthcare is not a matter of coverage; nearly all Californians are covered by public healthcare programs or by private insurance. Rather, California policymakers have the very mistaken view that they can create better healthcare outcomes at a lower cost. But there is another, even more worrisome, motive behind the push for single-payer healthcare. Policymakers believe they have the right to dictate more and more of your key life choices—issues that just 10 years ago would have been considered to be so far off the table as to not even merit serious discussion. But today, this discussion includes providing everyone in the state with the same medical services, regardless of income or other characteristics. In other words, socialized medicine.
California already has a significant primary-care physician shortage because the average physician’s salary in California, which is just 15 percent higher than in the rest of the country, doesn’t come close to offsetting California’s much higher cost of living. This shortage will worsen over time as more existing physicians retire and new doctors choose to practice in more affordable states.
Single-payer healthcare will exacerbate this shortage, because it will limit reimbursements to providers. In the UK’s NHS, it is expected that one in four primary-care positions will be vacant by 2030 as British doctors move to other countries to receive higher compensation and escape what they call “battlefield medical conditions.” And as providers leave, patients wait to be seen. Over 10 percent of the UK’s population—more than seven million individuals—are on waiting lists for routine care.
Lack of access and enormous wait times, as long as two years, are already endemic within California’s existing single-payer MediCal (Medicaid) program, which serves the state’s low-income households. This reflects extremely low reimbursement rates, some of which are only $18 per patient, despite an overall program budget of $139 billion, more than $9,000 per patient per year. And when Medicaid care is provided, its quality is typically inferior to that provided through private insurance.
Healthcare is perhaps the most important good we consume, so why are voters letting policymakers make these choices for them? Perhaps the single-payer train will be stopped, but only if California voters make different choices in those they elect.