Heritage Foundation Panel Takes ‘Long Look’ At Single Payer Health Care System

Responding to the joint proposal from the American Hospital Association, the Health Insurance Association of American and Families USA to expand health insurance the Heritage Foundation on Feb. 13 convened a panel to discuss health reform "take a long look" at single payer health systems and the problems with access and costs that are associated with them (Darryl Drevna, Kiaser Daily Health Policy Report, 2/14). While the AHA/Families USA/HIAA proposal does not advocate a single payer system, it takes a three-pronged approach, calling for expanding Medicaid to people under 65 earning up to 133% of the federal poverty level; allowing states to expand CHIP program coverage to certain adults; and establishing tax credits for businesses to encourage them to provide coverage to workers (Kaiser Daily Health Policy Report, 11/21). The panel featured three speakers:

• Dr. David Gratzer, author of "Code Blue: Reviving Canada's Health Care System," a book that chronicles the pitfalls of the Canadian health care system;
• Dr. Tim Evans, director of public affairs at the United Kingdom's Independent Healthcare Association, an organization calling itself the "UK's leading representative of the independent health and social care sector"; and
• Richard Teske, who served almost eight years in the Reagan administration as the HHS liaison to the White House and as associate administrator for the Health Care Financing Administration.

Lessons from the North
Saying that the Canadian system of single payer health care is "cruel" and "insane," Gratzer noted that public support for the program has waned in recent years. By providing services at no cost to the consumer, the government created a "free for all" run on health care services, which could only be controlled by rationing care, he said. But rationed care, Gratzer said, has produced waiting lists for treatments. In addition to access problems, Gratzer said the single payer system has been stripped of innovation, since it is difficult to get state approval and funding for "cutting edge therapies." Gratzer said, "When the government finances something, the government ends up managing it. This leads to poor accountability and a lack of information [about] the system."

Jolly Old England
After giving a detailed history of the British health care system starting from the 1850s, Evans then echoed Gratzer's concerns about rationed care, saying that such systems misappropriate resources and politicize health care. Because of the high costs and access difficulties with the single payer system, Evans said the British health system, which once promised to provide "all ... medical, dental, and nursing care," is moving away from its "Sovietized past." He said that single payer systems are ultimately unsustainable and "will not work in a society that cherishes individual freedoms."

Impact on America
Calling the HIAA/Families USA proposal "snobbery" and an "unconscionable" attempt by insurers to avoid covering low-income patients, Teske said, "Single payer systems always end in either rationed care or price controls," which adversely affects patient care and stifle innovation. Instead, he said the American health system should move towards a "defined contribution system," much like a 401(k) retirement fund, where consumers pay into insurance plans and are matched by employers or on a sliding income scale by the government. In reforming any system, he said problems occur during a transition period, where patients may "fall through the cracks." Eventually, however, he said health care reform in America will be consumer-driven and will use the tax code to provide incentives for patients to purchase their own health insurance plan. Gratzer agreed with this sentiment concluding that American "[b]aby boomers, the generation that made the 30 minute pizza, will not wait more than a year for an MRI" (Darryl Drevna, Kaiser Daily Health Policy Report, 2/14).

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