What John Oliver Didn’t Mention about Single Payer Health Care

During the first episode of this season of “Last Week Tonight,” HBO host John Oliver used his monologue to make the case for the United States to adopt a single-payer health-care system. While Oliver articulated many of the shortcomings of the current system, much of his arguments in favor of a single-payer system missed the mark.

As Oliver noted in his program, whether to adopt single payer represents a debate between the devil one knows and the devil one doesn’t. Skeptics of single payer have the advantage of inertial bias—that is, people may not want to give up what they currently have.

On the other hand, supporters of single payer can characterize the future however they like—even if it doesn’t always line up with the facts. That dynamic has allowed supporters to frame single-payer health-care as “Medicare for All,” even though the legislation introduced by Sen. Bernie Sanders (I-Vt.) would abolish the current Medicare program.

In his program, Oliver acknowledged some of the trade-offs associated with a move to a government-financed health-care system. But he also minimized others, and failed to explain some of the fundamental flaws in Sanders’ approach.

Cost Explosion

Oliver’s segment attempted to tackle the three primary critiques of a single-payer system: It will cost too much; lead to lines and waiting lists for care; and undermine individual choice. On the cost front, Oliver noted that estimates will vary as to whether the Sanders bill will lead to an increase in overall health-care spending. After admitting that the bill could either reduce health spending or cost “a f-ck of a lot more,” Oliver basically threw up his hands, calling the exact amount of spending under the new system unknowable.

On this front, Oliver didn’t analyze why health costs would likely rise under single payer. He mentioned (correctly) that Sanders’s bill would essentially abolish all premiums, deductibles, and co-payments for health care in the United States, making the new system much more generous than the current Medicare program, and much more generous than single-payer systems in places like Canada and Great Britain.

But Oliver did not mention four critical words that majorly affect costs: “Induced demand for care.” In other words, because Sanders’ legislation would make all health care “free” to patients, they would demand much more of it. According to the Urban Institute, a liberal think-tank, a single-payer system that eliminated cost-sharing would result in nearly $1 trillion more in health spending per year than a single-payer system that retained a system of co-pays and deductibles roughly equivalent to Obamacare’s Gold health insurance plans.

Along with many liberals, Oliver views eliminating cost-sharing as a feature of Sanders’ single-payer proposal. But at containing the costs of such a system, it represents a major bug—one Oliver never acknowledged.

Waiting Lists

Oliver did concede that waiting lists for care exist in other countries’ single-payer systems. However, he contended that patients wait primarily for non-emergency care, using knee replacements as an example. (Many patients wouldn’t call the concept of waiting nearly 10 months for a knee replacement—the average wait in Canada for an orthopedic procedure—a non-urgent matter.) He also didn’t point out that 4.56 million individuals in Britain—roughly 7 percent of that country’s population—were on waiting lists for care as of last fall, an increase of roughly 40 percent in the past five years.

Oliver’s discussion of waiting lists also missed a critical point: Sanders’s legislation would go further than other countries with single-payer systems, because it would prohibit individuals from purchasing private health insurance. Canadian and British patients who object to government waiting lists can purchase private coverage, and obtain care via that route.

Under Sanders’s proposal, American patients would not have that choice: They could only opt-out of the single payer system by paying for their treatment entirely in cash. Because not even a family making several hundred thousand dollars per year could afford the full costs of a heart transplant or chemotherapy, the vast majority of Americans would have no choice but to wait for care until the government system got around to treating them.


That brings up Oliver’s discussion of choice, and whether taking choice away matters. He points out—rightly—that many Americans do not have a substantive choice of either insurers or doctors, because their employers control the former, and by definition the latter.

But it doesn’t require the federal government taking over the entire health-care system to solve this problem, and give Americans a true choice among insurance plans and doctors. I have pointed out on many occasions the ways the Trump administration has acted to make coverage more portable, so that individuals, not employers, and not the federal government, choose the coverage options they prefer.

Oliver talks about the choices some patients currently face: whether to seek treatment they cannot pay for, or rationing medicines based on cost grounds. But patients would face similar choices under a government-run system—just for different reasons.

Oliver acknowledged the likelihood of waiting lists under a single-payer system, as have other supporters. For instance, the head of the People’s Policy Project has argued that costs won’t rise under single payer because “there is still a hard limit to just how much health care can be performed because there are only so many doctors and only so many facilities.” In other words, people will seek care, but not be able to obtain it.

In such circumstances, people won’t have a “choice” at all. Because they cannot purchase private insurance to cover treatments the government plan does not, they can either wait for care or they can…wait for care. That’s not just not giving patients choices, it’s harming patients by prohibiting them from buying the insurance they want to buy with their own money.

Towards the end of the segment, Oliver revealed his own bias against giving American patients any choices. After a clip of former South Bend Mayor Pete Buttigieg’s claim that “I trust Americans to make that right choice” on health care, Oliver responded to laughs: “Okay, well, hold on there. You trust Americans to make the right choice? You know Americans choose to drink Bud Light, right?”

Even as he tries to rebut conservative claims that single-payer would undermine Americans’ choices, Oliver admits that he doesn’t really want to give Americans a choice at all. He would rather use government to impose his beliefs on others, and force them to comply.

At minimum, Oliver’s program acknowledged the very real trade-offs associated with a single-payer health-care system. But had he explained those trade-offs fully, the American people would understand why single payer would result in adverse consequences to both our health-care system and our economy as a whole.

This post was originally published at The Federalist.

Unanswered Questions on Single Payer

This month’s Democratic presidential debate will likely see a continued focus on the single-payer health care proposal endorsed by Sens. Bernie Sanders of Vermont and Elizabeth Warren of Massachusetts. But for all the general discussion — and pointed controversy — over single payer at prior debates, many unanswered questions remain. The moderators should ask Sanders and Warren about the specific details of their legislation, such as:

►Section 901(A) of the bill states that “no benefits shall be available under Title XVIII of the Social Security Act” — i.e., Medicare. And an analyst with the liberal Urban Institute has said that “you can call (the bill) many things — from ambitious to unrealistic. But please don’t call it Medicare.” Why do you insist on calling your proposal “Medicare for All” when it would bear little resemblance to the Medicare program and, in fact, would abolish it outright?

►You have claimed that single payer will make health care a human right. But the bill itself does not guarantee access to a doctor — it only guarantees that patients will have their care paid for if they can find a doctor or hospital willing to treat them. In fact, in 2005, the Canadian Supreme Court ruled that “access to a waiting list is not access to health care,” because patients in that country’s single-payer system could not access care in a timely fashion. Why are you promising the American people access to care when your bill falls short of that promise?

►The Urban Institute estimated that a similar single-payer plan would raise national health care spending by $719.7 billion a year, because abolishing cost-sharing (e.g., deductibles, copayments, etc.) will increase demand for care. But the People’s Policy Project called Urban’s estimates “ridiculous,” because “there is still a hard limit to just how much health care can be performed because there are only so many doctors.” Which position do you agree with — the Urban Institute’s belief that individuals consuming more “free” health care will cause spending to rise, or the position that spending will not increase because at least some people who demand care will not be able to obtain it?

►Countries like Canada and Great Britain, both of which have single-payer health care systems, permit individuals to purchase private insurance if they wish — and many Canadians and Brits choose to do so. Why would you go beyond Canada, Britain and other countries to make private health insurance “unlawful” — and do you believe taking away individuals’ private insurance can pass constitutional muster with the Supreme Court?

►Four years ago, your Senate colleague Robert Menendez, D-N.J., was indicted for accepting nearly $1 million in gifts and favors from a Florida ophthalmologist. Menendez had tried to help that ophthalmologist — who was eventually convicted on 67 counts of defrauding Medicare — in a billing dispute with federal officials. Given this ethically questionable conduct by one of your own colleagues regarding the Medicare program, why does your legislation include no new provisions fighting fraud or corruption, even as it vastly expands the federal government’s power and scope?

►You have criticized President Donald Trump for his supposed attempts to “sabotage” the exchanges created under President Barack Obama’s health care law. How, then, would you stop a future Republican president from sabotaging a single-payer system when your legislation would vest more authority in the federal government than President Trump has?

Once Warren and Sanders finish answering these questions, the American people will likely recognize that, the senators’ claims to the contrary notwithstanding, single payer doesn’t represent a good answer for our health care system at all.

This post was originally published at USA Today.

How Socialized Medicine Will Lead to Waits for Care

Recently, a liberal think-tank, the Center for American Progress (CAP), issued a policy paper that promised “the truth” on waiting times in government-run health systems. If you want the truth about the issue, however, you’ll have to wait a long time for it if you choose to rely on CAP’s disingenuous analysis.

The CAP report cherry-picks facts to try to make an argument that a single-payer health-care system won’t result in rationing of health care. Unfortunately, however, even supporters of single payer have admitted that government-run care will increase waiting times for care.

Misleading Analysis

CAP’s paper starts out by criticizing President Trump and other conservative groups, who have asserted that a single-payer system would lead to “massive wait times for treatments and destroy access to quality care,” as Trump stated in his recent executive order on Medicare. CAP calls these assertions “false,” and then claims:

Patients in peer nations generally have similar or shorter wait times than patients in the United States for a variety of services, refuting the argument that universal coverage would necessarily result in longer wait times in the future. [Emphasis added.]

The above sentence, like the rest of the paper, uses clever semantic wordplay to obscure the issue. CAP claims that universal coverage wouldn’t necessarily result in longer wait times, but Trump and the right-leaning groups have criticized one specific form of universal coverage—single payer, in which the government serves as the sole funder of health care. (CAP repeats those misleading tactics by referencing the impact of prior coverage expansions in the United States, many of which used private insurers and none of which directly equate to a universal, government-funded health system.)

Of the paper’s four “peer nations” with universal coverage systems—Australia, France, Germany, and Sweden—only Australia and Sweden have government-run insurance plans. By contrast, France and Germany rely on private insurers to implement their universal coverage systems.

While it includes other systems without single-payer coverage in its analysis, CAP specifically excludes Britain’s National Health Service, known for its waiting times and rationed access to care. CAP claimed to omit the NHS in its analysis because “no candidate currently running for president is proposing nationalizing health care providers” a la the British model—a true enough statement, but a self-serving one.

If CAP included non-government-funded systems in its analysis, it certainly should have included the government-funded NHS. That it did not suggests the analysts wanted to “rig” the paper’s outcomes by relying solely on favorable examples.

Biggest Waiting Times to the North

The CAP paper’s most deliberate omission comes in the form of our neighbor to the north: Canada. The paper examined four metrics of access to care, based on data from an analysis by the (liberal) Commonwealth Fund of 11 countries’ health systems. Given the shabby results Canada’s health system showed on health care access, it seems little wonder that the leftists at CAP failed to disclose these poor outcomes in their paper:

  • Patients who reported they saw a doctor or nurse on the same or next day the last time they needed care: Canada ranked in a tie for last, with 43% agreeing. (The United States had 51% who agreed.)
  • Doctors who reported that patients often experience difficulty getting specialized tests like CT or MRI scans: Canada ranked third from last, with 40% agreeing. (The United States had 29% who agreed.)
  • Patients who reported they waited two months or longer for a specialist appointment: Canada ranked last, with 30% agreeing. (The United States had only 6% who agreed.)
  • Patients who reported they waited four months or longer for elective surgery: Canada ranked last, with 18% agreeing. (The United States had only 4% who agreed.)

As I discuss in my book, Canada’s health system suffers from myriad access problems, based on other metrics from Commonwealth Fund studies that CAP chose not to mention in their paper:

  • The second-lowest percentage of patients (34%) who said it was easy to receive after-hours care without going to the emergency room;
  • The lowest percentage of patients (59%) who said they often or always receive an answer the same day when calling the doctor’s office about a medical issue;
  • The highest percentage of patients (41%) using the emergency room; and
  • The highest percentage of patients (29%) waiting four or more hours in the emergency room.

With results like that, little wonder that the liberals at CAP didn’t want to highlight what single-payer health care would do to our health system.

Socialists Admit Care Rationing Ahead

That said, some socialist supporters of single payer have conceded that the new system will limit access to care. As I noted last year, the socialist magazine Jacobin said the following about one analysis of single payer:

[The study] assumes utilization of health services will increase by 11 percent, but aggregate health service utilization is ultimately dependent on the capacity to provide services, meaning utilization could hit a hard limit below the level [the study] projects.

Translation: People will demand additional care under single payer, but there won’t be enough doctors and hospitals to meet the demand, therefore resulting in waiting times and rationed access to care.

Lest one consider this admission an anomaly, the People’s Policy Project called a recent Urban Institute study estimating the costs of single payer “ridiculous” and “unserious,” in large part because of its “comical assumption” about increased demand for care: “There is still a hard limit to just how much health care can be performed because there are only so many doctors and only so many facilities.” Again, socialists claim that single payer won’t bust the budget, in large part because people who seek care will not be able to obtain it.

With analysts from the right and the socialist left both admitting that single payer will lead to rationed health care, CAP can continue to claim that waiting times won’t increase. But the best response to their cherry-picked and misleading analysis comes in the form of an old phrase: Who are you going to believe—me, or your lying eyes?

This post was originally published at The Federalist.

Single Payer Wouldn’t Make Health Care a “Right”

In talking about his single-payer bill, which he reintroduced in the Senate on Wednesday, Sen. Bernie Sanders often claims that “I want to end the international embarrassment of the United States of America being the only major country on earth that doesn’t guarantee health care to all people as a right and not a privilege.”

But his legislation would do no such thing. Understanding why demonstrates the inherent drawbacks of his government-centered approach to health policy.

In our own country, low reimbursement rates in many state Medicaid programs can make finding doctors difficult. One 2011 study found that two-thirds of specialist physicians would not accept Medicaid patients, whereas only 11 percent of patients with private insurance could not obtain appointments. Patients with Medicaid also had to wait an average of three weeks longer for an appointment for the few doctors who would see them.

Medicaid suffers from so many access problems that one former director of a state program called a Medicaid card a “hunting license,” because it “gave you a chance to go find a doctor.” That’s the only “guarantee” the Sanders bill actually provides—the guarantee you can try to go find care, not a guarantee you can receive it.

But “access to a waiting list is not access to care.” So ruled four Canadian justices in a landmark 2005 ruling, Chaoulli v. Quebec. In that case, Canada’s Supreme Court overturned Quebec’s ban on private health insurance, finding that it “interfere[d] with life and security,” because “the government is failing to deliver health care in a reasonable manner.”

Indeed, delays and long waits for care plague Canada’s single-payer health system. One study found that approximately 3 percent of the nation’s population remained on waiting lists for care in 2018. From physician referral to the start of treatment, waiting times averaged five months—double that for orthopedic surgery cases.

Government-run health care systems traditionally attempt to contain costs by limiting the available supply of care. Britain’s National Health Service (NHS) follows the same approach as Canada’s single payer system. So patients wait for care there, also.

Consider what happened just last year, when the winter flu outbreak created a national “crisis”: The NHS had to cancel tens of thousands of operations, emergency rooms resembled “Third World” conditions, and ambulances waited for hours to unload patients—because hospitals had no place to put them.

The language in Sanders’ legislation demonstrates how, instead of making health care a “right,” single payer would instead increase demand for care—demand the system could not fulfill. To add insult to injury, the Sanders bill would ban private health insurance—the same type of ban Canada’s Supreme Court struck down—here to the United States, giving patients little way out of a clogged government health system.

Promises aside, Sanders’ “guarantee” of coverage would quickly turn into a guarantee that patients would wait, and wait, for care. The American people deserve better.

This post was originally published at The Federalist.

Vitter Amendment (#769, as Modified) on FDA Reimportation

Senator Vitter has offered an amendment (#769) regarding prescription drug reimportation.  The amendment is pending, and a vote on the amendment may occur later this evening.  
  • The amendment would prohibit the use of funds for the Food and Drug Administration “to prevent an individual…from importing a prescription drug from Canada that complies with the Federal Food, Drug, and Cosmetic Act.”
  • The amendment further provides that drugs reimported may not be controlled substances or a biological products.
  • The amendment prohibits the use of funds for the Food and Drug Administration “to change the practices and policies…in effect on October 1, 2011, with respect to the reimportation of prescription drugs into the United States…with respect to such importation by individuals from countries other than Canada.”
  • The Senate last considered prescription drug reimportation in 2009, during debate on the health care bill (H.R. 3590, 111th Congress).  At that time, a Dorgan amendment (#2793) regarding remportation failed on a 51-48 vote (60 votes were required for adoption).  Press reports from that time indicated that some Senate Democrats considered the amendment a “threat” because it would jeopardize the “rock-solid deal” Democrats made with the pharmaceutical industry.
  • In May 2007, the Senate considered reimportation in the context of FDA reauthorization (S. 1082, 110th Congress).  At that time, a Dorgan amendment (#990) regarding reimportation was adopted by unanimous consent, following a 63-28 vote to invoke cloture.  However, according to the Congressional Research Service, the Dorgan amendment was “effectively negated” by a second-degree Cochran amendment (#1010), which required the Secretary of HHS to certify that reimportation would 1) pose no additional public health risk and 2) “result in a significant reduction of cost” to consumers.  That second-degree Cochran amendment was adopted on a 49-40 vote.
  • In May 2006, the Senate considered a reimportation amendment as part of the Homeland Security appropriations measure (H.R. 5441, 109th Congress).  The Vitter amendment (#4548), which blocked Customs and Border Protection from enforcing prescription drug reimportation from Canada, passed on a 68-32 vote, and was ultimately included as Section 535 of the appropriations conference report (P.L. 109-295).
  • This amendment is a limitation-of-funds provision.  Under Rule XVI, any additional provisions would not be germane to the underlying appropriations measure.  In other words, this amendment differs from stand-alone reimportation legislation (S. 319) introduced earlier this year.
  • The amendment would only prohibit FDA from enforcing reimportation regulations regarding drugs from Canada, and not pharmaceuticals reimported from other countries.
  • Supporters of reimportation argue that the measure would result in drug price reductions for American seniors, while opponents of reimportation argue that other countries’ pharmaceutical supplies would raise concerns about drug safety.

UPDATE: Three additional points of note regarding this amendment:

  • A vote on the Vitter amendment (as modified) on reimportation is now scheduled for the noon vote series, and will be subject to a 60-vote threshold for adoption.
  • In my background section above, I neglected to mention a second reimportation vote in the 111th Congress, one that was NOT tied into the broader health care debate.  In July 2009, a Vitter reimportation amendment (#1467) was agreed to on a 55-36 vote.
  • Finally, the amendment omits language included in several prior reimportation amendments – including that in Section 535 of P.L. 109-295 – that prohibited reimportation enforcement “only to individuals transporting on their person a personal use quantity” of pharmaceuticals, “not to exceed a 90-day supply.”  Because the Vitter amendment excludes the preceding language, it has the effect of also permitting reimportation via mail order and Internet pharmacies based in Canada – which is a change from several of the prior reimportation amendments that were adopted.

Democrat Plans Rationing with Open Eyes

From Montana this week comes word that its Governor, Brian Schweitzer, wants to establish a government-run health care plan in his state.  The governor said he “has completely different plans for the Medicare and Medicaid money the federal government gives the state,” and that he wants to “create a state-run system that borrows from the program used in Saskatchewan.”  He then went on to explain how his government-run system might keep taxpayer spending on health care low:

[Schweitzer] said the Canadian province [i.e., Saskatchewan] controls cost by negotiating drug prices and limiting non-emergency procedures such as MRIs.

A simple web search about waiting times in Saskatchewan yields information about the types of “non-emergency procedures” subject to rationing in the province; for instance, the list of “Wait List FAQs” from the Saskatchewan Cancer Agency includes this helpful guidance for cancer patients:

What are you doing to ensure that I get an appointment in a timely way?

Currently we have a shortage of medical oncologists that is impacting our wait times.  We are also actively recruiting to fill our vacant positions throughout our facilities and are working to bring in locums to help address wait times….

Can I get care sooner if I go somewhere else?

You will find that wait times exist in the healthcare system throughout Canada and in other countries as well….

And when it comes to the MRI example Governor Schweitzer referenced, rationing occurs there as well – unless you’re politically connected.  Saskatchewan Rough Riders – i.e., players in the Canadian Football League – have been able to jump the long queues for MRIs in the province by paying for their own treatment; other people can wait for as long as three months.

Details on how Governor Schweitzer intends to turn Montana into a Canadian-style health care system are not yet known.  However, given that Schweitzer’s application will be reviewed by the Centers for Medicare and Medicaid Services – whose head, Donald Berwick, has spoken of rationing with our eyes open – it’s quite possible the application will be approved.  In that scenario, those who can afford to get to the head of the queue – millionaires and billionaires who can fund the entire cost of their treatment, and pro athletes like Michael Vick – will receive in a prompt fashion the MRIs and cancer care they need to maintain or regain their health.  Everyone else, perhaps not.

Waiver Wire: Why Top-Down Washington Solutions Don’t Work

Leading the news this morning are two stories about waivers granted by Washington bureaucrats from mandates in the health care law.  The New York Times reports on a House hearing held yesterday regarding the more than 900 waivers granted to various states, employers, and insurance companies from several of the law’s new insurance mandates.  However, the story also notes that the waivers are temporary in nature, and are only intended to last until the new insurance Exchanges kick in.  In other words, the Administration’s new position appears to be that “If you like your current coverage, you MAY be able to keep it – but only until 2014, and only if you’re politically savvy enough to apply for and obtain a waiver from Washington bureaucrats.”

On another waiver-related story, both Kaiser Health News and the Washington Post report on Arizona’s application for a waiver of the Medicaid maintenance of effort requirements included in the health care law.  A letter sent by Secretary Sebelius to Arizona’s governor on Tuesday indicated that HHS believes Arizona’s current demonstration waiver can expire as scheduled later this year without violating the maintenance of effort requirements.  However, as both stories clearly indicate, it’s far from clear that the circumstances unique to Arizona’s situation occur in other states, meaning that at a time when they face acute fiscal stress, dozens of other states could still be left “holding the bag” for the onerous maintenance of effort mandates included in the health care law – mandates that prevent state flexibility in managing their Medicaid programs.

And a federal study released yesterday demonstrated exactly why states need MORE flexibility, not less, in running their Medicaid programs.  The Centers for Disease Control’s survey on Americans’ health* found that Medicaid patients visit the emergency room at nearly twice the rate of uninsured patients.  Tables 88 and 89 (pages 321 through 326) tell the tale:

  • Nearly one-third (33%) of children on Medicaid visited the emergency room at least once in 2009, compared to 20.9% of privately insured children and 23% of uninsured children.
  • More than one in ten children on Medicaid (10.6%) visited the emergency room more than once in 2009, compared to 5.7% of uninsured children and only 4.2% of privately insured children.
  • Among adults, more than four in ten patients on Medicaid (41.5%) visited the emergency room at least once in 2009, nearly double the rate of uninsured adults (21.2%) and more than double the rate of privately insured adults (16.7%).

The fact that Medicaid patients visit the emergency room so much more frequently than even uninsured patients – often because they do not have regular access to physician care – speaks volumes to why states need the additional flexibility to manage their programs without intrusive mandates coming from Washington.  Continued federal dictates to maintain a broken Medicaid system will not only further squeeze states’ budgets – it will perpetuate the poor access and problems obtaining care that many beneficiaries currently receive.


* The CDC survey on Americans’ health also includes other interesting nuggets.  For instance, Table 120 (page 381) demonstrates how the United States leads the world in availability of magnetic resonance imaging equipment, and ranks second to Belgium in the number of CT scanners (both adjusted based on availability per million population).  For the record, Canada’s system of socialized medicine has just over one-quarter the number of MRI units and a little more than a third the number of CT scanners as the United States (again, based on availability per million population).

The Responsiveness of Government-Run Health Care

On a lighter note on the day before Thanksgiving comes this cautionary note from north of the border about the perils of an unresponsive government-run health care system.  When exiting a meeting about long emergency room waiting times, the head of Alberta’s health service was approached by reporters and asked what he was doing to shorten the waiting lists.  The head of the health service responded by saying he couldn’t be disturbed, because he was eating a cookie.  No, seriously; watch the exchange yourself.

This amazing-but-true incident typifies the problems with government-run health care, where bureaucrats can afford to be flippant with the public, because the public has no other choice of health care options. (For the record, in Alberta private health insurance is prohibited to compete with the government-run health system in offering the basic benefit package.)  The same predicament will face the estimated 18 million individuals dumped into the Medicaid program as a result of the health care law – individuals who will NOT have the choice of health care plans, and will instead be forced into a government-run program with significant access difficulties and waiting times (just like those in Canada).

Having seen the responsiveness of the Canadian health care system in full bloom, do you think that American bureaucrats wouldn’t ignore similar questions from reporters about the government restricting patients’ access to care?  Think again…

What Happens When Bureaucrats Make Health Care Decisions

In light of comments by many Democrats—including President Obama—that a government-run health plan may end up controlling the ability to limit access to life-saving treatments, we have compiled anecdotes from other countries showing the effects of government bureaucrats making personalized health decisions on patients’ behalf.

“The chronically ill and those toward the end of their lives are accounting for potentially 80 percent of the total health care bill out here….There is going to have to be a very difficult democratic conversation that takes place.”

 — President Obama, interview with The New York Times

Patients Cannot Obtain Life-Saving Treatments

  • Bruce Hardy, a patient living outside London, suffers from kidney and lung cancer, for which his physician prescribed the new drug Sutent.  But as a profile in the New York Times pointed out, “If the Hardys lived in the United States or just about any European country other than Britain, Mr. Hardy would most likely get the drug.”  However, in Britain, Sutent’s $54,000 price means “Mr. Hardy’s life is not worth prolonging.”  As his wife stated, “It’s hard to know that there is something out there that could help but they’re saying you can’t have it because of cost.  What price is life?”
  • Sarah Anderson, an ophthalmologist who works for Britain’s National Health Service (NHS), published an article last spring titled “How the NHS Is Letting My Father Die.”  Her father’s kidney tumor could be treated by a new drug—but while the pharmaceutical has been approved for use in Europe for two years, Britain’s National Institute for Clinical Effectiveness (NICE) delayed its assessment of the drug’s usefulness.  Until NICE renders its judgment, local NHS branches can refuse to provide the drug, leaving Anderson’s family to pay for their father’s treatment on their own, or face the inevitable consequences that will follow if he cannot obtain it.  Anderson’s ultimate verdict on her family’s dilemma is a sobering one: “If Dad should lose his life to cancer, it would be devastating—but to lose his life to bureaucracy would be far, far worse.”
  • Ian Dobbin, a patient in Yorkshire, faced a difficult dilemma—because the NHS wouldn’t pay for his life-saving cancer treatment, he needed to pay £25,000 to obtain the treatment and survive.  He said the NHS’ decision “is a death sentence for me. I feel absolutely gutted because there is no way I can find that sort of money.  My life is dependent on getting this drug and without it I will die. I am totally devastated.  I’ve been paying my national insurance all my life and when it comes to the point that I need it to keep me alive, they are not prepared to help. I don’t really know what to do. My consultant is appealing the decision and I’m just praying that they change their minds.”
  • In 2006, Ann Marie Rogers filed a ground-breaking lawsuit in Britain, seeking to force her local NHS bureaucracy to pay for the breast cancer drug Herceptin—“which has been shown to halt the spread of the cancer.”  In a public interview, she expressed her outrage at the bureaucracy that forced her to file a lawsuit in order to access a life-saving treatment: “It makes me so angry that these trusts are playing God, saying ‘you can’t have this, you can’t have that.’ They’ve got no right to decide who can have this life-saving drug. This is not a poor country, after all. I have worked all my life and paid my taxes. It makes me sick to think a lot of women are in my position.”
  • Pamela Smith, a patient with advanced bowel cancer, had her appeal for treatment denied by her local NHS trust in 2007—the drug (Erbitux) is widely available in the United States, but in Britain, the government refused to pay for the treatment.  As a result, Ms. Smith had to spend her life savings to obtain the drug privately.  Her son expressed anger at the NHS’ decision to deny care: “My mum now has no money left so she will have to rely on the family.  What makes the appeal result a disgrace is that she is responding to the treatment.”
  • In Alberta, Bill Murray was denied hip resurfacing surgery that generates better results than a traditional hip replacement—because the Canadian government said the 57-year-old was “too old” to benefit from the state-of-the-art procedure.

Physicians Cannot Treat their Patients

  • A study released last August found that one quarter of cancer specialists are deliberately keeping their patients “in the dark” about available treatment options—in order to avoid upsetting those patients when they find out the NHS will not pay for their treatments.
  • Warpreet Husan, a colon cancer specialist, stated that bureaucracy compels his colleagues’ silence: “A lot of my colleagues also face pressure from managers not to tell patients about new drugs. There is nothing in writing, but telling patients opens up a Pandora’s box for a health service trying to contain costs.”
  • One cancer patient undergoing treatment confirmed that doctors are keeping their patients uninformed about potentially life-saving—but overly costly—treatments: “My consultant never told me about the latest treatments. I don’t know why he hasn’t said anything. I’m a little concerned.”
  • Another physician, Dr. Sarah Jarvis, wrote an anguished op-ed condemning government-run health bureaucracy entitled “Sentenced to Death by NICE.”  “Recently I was left feeling furious and frustrated after a visit from a patient called Peter. He’d just had a serious heart attack and my job as a GP [general practitioner] was to reduce his very high risk of having another.  I knew what the latest research told me was the best way, but I had just basically been forbidden to use it by an official email from the Department of Health.”

Patients Cannot Use their Own Money to Pay for Care

  • Until last November, patients in Britain who paid for unapproved drugs out-of-pocket had to renounce all future NHS care—an effective prohibition on patients using their own money to pay for care.  The Government reversed its position on “top-up payments” within the NHS, but not before stakeholders called the policy “despicable,” “appalling,” “uncivilised,” “spiteful,” “cruel,” “abhorrent,” “perverse,” “inhuman,” and “unjust”—even though most stakeholders agreed that some form of rationing within the NHS was inevitable.
  • In Canada, Lindsay McCreith filed suit against Ontario’s government-run health care system, claiming that the Canadian government’s ban on patients paying for private care violates his fundamental freedoms.  Mr. McCreith was forced to travel to the United States for an MRI to diagnose a malignant growth in his brain—and then, when the Canadian government offered him a months-long wait to treat his brain tumor, to travel back to Buffalo for life-saving surgery, as patients cannot pay for treatments with their own money in much of Canada.