President Donald Trump’s continued focus on immigration may play well to his base but to win the swing voters and cobble together a majority of electoral votes, he must address our broken health care system — it ranks first among issues with voters.
With those same Americans increasingly enamored with socialism — not the Soviet but rather the French variety — that means coming to terms with Berniecare or a very aggressive agenda for reform and regulation — no matter who emerges to win the Democratic nomination.
Affordability is key — Americans pay 75% more for health care through taxes, premiums and out of pocket than do Canadians and Europeans, and often encounter a morass to access services.
Local cartels are common among hospitals, insurers and physician-specialist groups. Pharmaceutical companies block competing new drugs and rig prices for generics. And prices for hospitals, drugs and other services are opaque and vary arbitrarily among purchasers. Filling prescriptions and scheduling procedures can require hours of hassle for patients and physicians with benefits managers and insurers.
Sen. Bernie Sanders promises to sweep that all away with a single-payer system similar to the Canadian and British approaches but that would require about $3 trillion in new taxes annually, likely including a payroll tax with exemptions for families below the poverty line.
His proposal is slim on how he would persuade doctors to accept Medicare reimbursements, which would hardly be enough to keep them in business. Or how he would stop drug companies from soaking Americans to enable discount prices in Europe and Canada. However, the promise of free stuff is a proven winner for Democrats.
Conservative warnings about single-payer systems have data problems too.
Canadians and Europeans run two types of systems — most relevant for Americans are the Canadian, British, German and Netherlands systems that provide universal coverage. The former two have single-payer frameworks, whereas the latter have more comprehensive variants of Obamacare with mandatory enrollment in private or nonprofit insurance that feature less bureaucracy, price controls with teeth, and insurers that follow national health-care policies rather than rationing without much democratic accountability.
Conservatives are fond to tell tales of inadequate access and poor quality north of the 49th parallel and imposed on our British cousins. According to data published by the Fraser Institute, when it comes to prompt access to specialists or elective surgery, Germany is best, Canada worst and the Netherlands and U.K. about on par between them.
On quality of care, on 11 measures such as in-patient hospital mortality and obstetric trauma with vaginal delivery, the Netherlands is best followed by Canada, then Germany and the U.K. finishing last. Germany and the U.K. are not the places to get cancer—they have the lowest overall five-year survival for breast, cervical, colon and rectal malignancies.
As comprehensive measures—years of healthy life expectancy and deaths adjusted for conditions that are not amenable to health care—Canada and the Netherlands were tops followed by the U.K. and then Germany.
The bottom line is neither a single-payer nor an insurance-based approach, which offer consumers many choices, appears superior. All four systems are much less expensive to run than the U.S. system, because national governments set prices and establish frameworks for rationing. In the bargain, patients and doctors suffer much less bureaucracy.
Republicans with their quaint fondness for health-care spending accounts, devolving Medicaid to the states with block grants, and free markets simply have not embraced ideas that address what makes the U.S. system the worst on a value basis—price fixing.
As Americans are so divided—especially between red and blue states—and no single approach appears superior, give the states what the federal government now spends—not just federal allotments for Medicaid. Let them set up Berniecare or reform the present system to their tastes.
However, the federal government—read the Trump administration—must take the leadership to curb Big Pharma, benefit managers, and insurance company anticompetitive practices in national markets. And empower—and require as a condition for access to federal funds—states attorneys general to crack down on regional hospital and physician cartels.
Without those, eventually frustrated voters will deliver to socialists control of the White House and a working majority in Congress, who will impose a single-payer system.