Serious Talk

Is there any reason to take talk of a single-payer, government-run health system seriously in the United States?

Yes! The California legislature passed a single-payer bill this fall, which was blessedly vetoed by Gov. Schwarzenegger. And many states, including Massachusetts and Vermont, are imposing much more centralized control over their health systems. That’s just how Canada adopted its single-payer system — province by province.

Further, public anxiety over health care is increasing, with opinion polls showing that a large majority thinks that average Americans should be paying less for health care — and the government should be spending more. Even some otherwise conservatives are ready to give up on our hybrid system and call in the government.

To bring some reality to the debate, the Galen Institute and the Institute for Policy Innovation organized a series of conferences and meetings this week for five European health policy experts to tell U.S. policy makers and opinion leaders what life is like under their government-dominated health systems.

Critics of the U.S. system “tend to go misty-eyed when thinking about the merits of European health care systems,” Helen Disney, director of the Stockholm Network, told a Senate briefing.

Stephen Pollard of the Centre for the New Europe warns Americans, “Do not listen to the perennial siren voices which call for a single-payer system in the U.S.” He says that Americans would never tolerate the rationing involved.

Pollard explained that access to cancer treatment became a major national crisis in Britain when patients were having to wait a year or more after being diagnosed to begin treatment. The government now is spending billions of pounds in an effort to reduce that waiting time to three months by 2010 – but is unlikely to meet that goal, Pollard said.

Johan Hjertqvist offered details of his Health Consumer Powerhouse study that show how poorly European systems respond to consumer needs.

“The most important lessons from Europe are that monopolies serve consumers badly; that top-down reform is inefficient and difficult; that government action can conflict with priorities of the consumer?and that lack of health care information and communication always is harmful,” Hjertqvist said.

But, whatever the flaws of European systems, the U.S. is seen as far worse and is strongly criticized both from within and outside. The latest Commonwealth Fund study, for example, says “America’s health system falls far short ? of what is achievable on all major dimensions of health system performance.”

In Europe, Americans are seen as barbarians, and market-based health care as nothing short of immoral, especially with 47 million uninsured. “Europeans just won’t listen when we explain that nearly half of all health spending in America is through government programs for the poor, the elderly, and children and that no one actually is denied health care when they need it. They just don’t believe it,” Disney said.

This criticism sours the public debate over market-based options.

“Rather than following [a] bottom-up approach of empowering the consumer and letting him make choices, German health reforms have favored the top-down, interventionist approach,” said Wilfried Prewo of Hanover, Germany, with the Centre for the New Europe. “The failure of top-down, interventionist policies has been followed by an ever-higher degree of command-and-control.”

“It would be the ultimate irony if?the U.S. were to embrace such a fundamentally flawed model” as a single-payer system, Pollard said, “at the very time when Europeans are discovering competition and choice.”

One of the most refreshing insights came from the physician in the group: “We all have single-payer health care systems,” Dr. Alphonse Crespo of the Institut Constant de Rebecque in Switzerland observed. “Citizens always wind up paying for health care, either through taxes, insurance premiums, or out-of-pocket costs.

“The real question is whether they have single-decider systems. In many European countries, there are single-decider systems in which governments and their agents control what medical services its citizens will or will not receive.”

Dr. Crespo says that Switzerland’s experiment with its form of managed competition is souring: “Deep public dissatisfaction with sickness funds and current polls reflect a readiness to accept a single insurance provider as a lesser evil.” He says the real cure is genuine competition to enhance consumer autonomy and personal responsibility.

The good news is that political leaders in many parts of Europe are being forced as a last resort to consider market options and to move away from centralization (even though they would never dare call it an American solution).

The Senate briefing was webcast, and you can view it anytime at And our colleagues produced excellent papers summarizing their talks, available at

Our thanks to the International Policy Network for sponsoring these visits. And special thanks to our European colleagues for sharing their insights and expertise to better inform our debate.

Grace-Marie Turner


  • HSAs: An affordable new option for businesses
  • Wal-Mart announces accelerated rollout of $4 generic prescription program in 14 states
  • Medicare prescription drug plan guide: How to choose your 2007 plan
  • Understanding the American public’s health priorities: A 2006 perspective
  • Prescription for change
  • Paying more, getting less 2006: Measuring the sustainability of public health insurance in Canada

Author: Grace-Marie Turner
Source: Agent’s Sales Journal, 10/06

Grace-Marie Turner offers a primer for health insurance agents with highlights and key facts about health savings accounts. In this article, published in Agent’s Sales Journal, Grace-Marie writes that HSAs are one tool in giving individuals and companies a more affordable option for health insurance. She also advises that “companies that have instituted health savings accounts have found that they were most successful if they also implemented an active communications program with their employees to educate them about HSAs.”
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Source: Wal-Mart, 10/19/06

Following a successful test in Florida, Wal-Mart says that “customer demand led the company to accelerate the launch” of its $4 generic prescription drug program into 14 additional states, including Illinois, Texas, and New York. The $4 generics program “includes 314 generic prescriptions available for up to a 30-day supply at commonly prescribed dosages” and “represents nearly 25 percent of prescriptions that [Wal-Mart] currently dispenses in its pharmacies nationwide.” One factor in the early launch, the Wal-Mart announcement said, was to help seniors that may fall into the Medicare Part D doughnut hole before the end of the year.
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Source: America’s Health Insurance Plans, the National Association of Chain Drug Stores, and the National Community Pharmacists Association, 10/12/06

America’s Health Insurance Plans, the National Association of Chain Drug Stores, and the National Community Pharmacists Association have published an online, interactive guide to assist Medicare beneficiaries in evaluating their prescription drug plan choices for 2007. “This comprehensive guide educates seniors about Medicare prescription drug coverage, examines their personal priorities and preferences, and helps them navigate through the different plan options,” according to the news release. The guide covers topics including the top ten things beneficiaries should know about the Medicare prescription drug benefit, choosing a stand-alone plan, choosing a plan with both medical and drug coverage, getting the most from the coverage, and next steps for selecting a plan.
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CMS also announced this week that it will not automatically enroll dual-eligibles in drug plans for 2007, requiring them to pick their own plan. In last year’s launch of the Part D benefit, the automatic enrollment caused a great deal of negative publicity following duals who were switched from Medicaid to private plans for their drug coverage without understanding the changes.
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Authors: Robert J. Blendon, Kelly Hunt, John M. Benson, Channtal Fleischfresser, and Tami Buhr
Source: Health Affairs Web Exclusive, 10/17/06

An examination of 19 national opinion surveys dating back to 1940 shows that, in 2006, health care “is an important but second-tier issue,” ranking higher than terrorism, education, Social Security, and the environment, but behind the war, the economy, and energy issues, according to Harvard’s Robert Blendon et al. The report also highlights a troublesome paradox: A 2006 survey on national spending for health care found that “the majority of respondents (57 percent) thought that the United States as a country was spending too little on health care in the aggregate, and 70 percent said that government health care spending was too low.” At the same time, the survey found that 65 percent of respondents think the average American spends too much on health care, while only 17 percent say too little (i.e., they say the government is not spending enough on their health care?).
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Source: ABC News/USA Today, 10/06

ABC News and USA Today are running a series of features all this week on health care problems in the United States. The series highlights one of the findings in Blendon’s survey (above): People have little concern about how much the country as a whole spends on health care, but they are very concerned about the costs of health care for themselves and their families. They fear that rising costs could cause them to lose their health insurance, creating a strong undercurrent of anxiety about health care.
ABC News:
USA Today:

Authors: Brett Skinner and Mark Rovere
Source: The Fraser Institute, 09/06

Spending on health care by Canadian provincial governments “will consume more than half of total revenue from all sources by the year 2020 and all revenue by 2050 in six out of 10 provinces if current trends continue,” according to a new study from the Vancouver-based Fraser Institute. The authors write that health care spending has increased faster than revenues for many years “despite higher tax burdens in each of the provinces as well as government policies that restrict access to medically necessary goods and services.” They recommend implementing several policies used by other countries that could help control costs, including requiring co-payments for publicly-insured health services, giving patients the option to pay privately for medical services, and allowing both for-profit and non-profit health providers to compete for delivery of publicly insured health services.
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Narrative Matters: The Power of the Personal Essay in Health Policy
Health Affairs Event
Monday, October 23, 2006, 5:30 p.m. – 7:30 p.m.
Washington, DC

For additional details and registration information, contact Health Affairs at 301-347-3940 or

Health Policy Matters is a weekly newsletter containing summaries of timely and informative studies and articles on free-market health reform. It features research and writings by participants in the Health Policy Consensus Group, articles of interest from the health policy world, and announcements of coming events. Health Policy Matters is published by the Galen Institute, a not-for-profit public policy organization specializing in information and education on health policy. For more information about the newsletter and our organization, please visit our website at

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