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 Almost everyone agrees that the U.S. healthcare system is in dire need of reform. But thereare differing opinions on what kind of reformwould be best. Some on the political left wouldlike to see us copy one of the government-run“single-payer” systems that exist in WesternEurope, Canada, and New Zealand, among otherplaces. Proponents of socialized medicine pointto other countries as examples of health care sys-tems that are superior to our own. They insistthat government will make health care availableon the basis of need rather than ability to pay.The rich and poor will have equal access to care. And more serious medical needs will be given pri-ority over less serious needs.Unfortunately, those promises have not beenborne out by decades of studies and statisticsfrom nations with single-payer health care.Reports from those governments contradictmany of the common misperceptions held by supporters of national health insurance in theUnited States. Wherever national health insur-ance has been tried, rationing by waiting is per- vasive, putting patients at risk and keeping themin pain. Single-payer systems tend to leaverationing choices up to local bureaucracies that,for example, fill hospital beds with chronicpatients, while acute patients wait for care. Access to health care in single-payer systems isfar from equitable; in fact, it often correlates withincome—with rich and well-connected citizens jumping the queue for treatment. Democraticpolitical pressures (i.e., the need for votes) dictatethe redistribution of health care dollars from thefew to the many. In particular, the elderly, racialminorities, and those in rural areas are discrimi-nated against when it comes to expensive treat-ments. And patients in countries with nationalhealth insurance usually have less access to criti-cal medical procedures, modern medical tech-nology, and lifesaving drugs than patients in theUnited States.Far from being accidental byproducts of gov-ernment-run health care systems that could besolved with the right reforms, these are the nat-ural and inevitable consequences of placing themarket for health care under the control of politicians. The best remedy for all countries’health care crises is not increasing governmentpower, but increasing patient power instead.
 Health Care in a Free Society
 Rebutting the Myths of National Health Insurance
by John C. Goodman
_____________________________________________________________________________________________________
 John C. Goodman is president of the National Center for Policy Analysis in Dallas, Texas. This paper is adapted from his book
Lives at Risk: Single-Payer National Health Insurance around the World
(Rowman &  Littlefield, 2004), coauthored by Gerald L. Musgrave and Devon M. Herrick.
Executive Summary 
No. 532January 27, 2005
Routing 
 
Introduction
Despite overwhelming evidence that single-payer health care systems do not provide high-quality care to all citizens regardless of ability topay, proponents of socialized medicine toutsuch systems as models for the United States toemulate. Ironically, over the course of the pastdecade almost every European country with a national health care system has introducedmarket-oriented reforms and turned to the pri- vate sector to reduce health costs and increasethe value, availability, and effectiveness of treat-ments.
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In making such changes, more oftenthan not those countries looked to the UnitedStates for guidance. About seven million peoplein Britain now have private health insurance,and since the Labor government assumedpower, the number of patients paying out of pocket for medical treatment has increased by 40 percent.
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To reduce its waiting lists, the BritishNational Health Service recently announcedthat it will treat some patients in private hos-pitals, reversing a long-standing policy of using only public hospitals;
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the NHS haseven contracted with HCA International, America’s largest health care provider, totreat 10,000 NHS cancer patients at HCAfacilities in Britain. Australia has turned tothe private sector to reform its public healthcare system to such an extent that it is now second only to the United States amongindustrialized nations in the share of healthcare spending that is private.
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Since 1993, the German government hasexperimented with American-style managedcompetition by giving Germans the right tochoose among the country’s competing sick-ness funds (insurers).
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The Netherlands alsohas American-style managed competition,with an extensive network of private healthcare providers, and slightly more than one-third of the population is insured privately.
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Sweden is introducing reforms that will allow private providers to deliver more than 40 per-cent of all health care services and about 80percent of primary care in Stockholm.
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EvenCanada has changed, using the United Statesas a partial safety valve for its overtaxed healthcare system; provincial governments andpatients spend more than $1 billion a year onU.S. medical care.
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In each of these countries, growing frus-tration with government health programshas led to a reexamination of the fundamen-tal principles of health care delivery. Throughbitter experience, many of the countries thatonce touted the benefits of government con-trol have learned that the surest remedy fortheir countries’ health care crises is notincreasing government power, but increasingpatient power instead.
9
In this paper, we examine 12 popularmyths about national health insurance. Wehave chosen to focus primarily, though notexclusively, on the health care systems of English-speaking countries whose culturesare similar to our own. Britain, Canada, andNew Zealand in particular are often pointedto by advocates of national health insuranceas models for U.S. health care system reform.In amassing evidence of how these systemsactually work, many of our sources are gov-ernment publications or commentary andanalysis by reporters and scholars who fully support the concept of socialized medicine.
Myth No. 1: In Countries withNational Health InsuranceSystems, People Have aRight to Health Care
In fact, no country with national healthinsurance has established a right to healthcare. Citizens of Canada, for example, haveno right to any particular health care service.They have no right to an MRI scan. They haveno right to heart surgery. They do not evenhave the right to a place in line. The 100thperson waiting for heart surgery is not enti-tled to the 100th surgery. Other people canand do jump the queue.One could even argue that Canadians havefewer rights to health services than their pets.While Canadian pet owners can purchase anMRI scan for their cat or dog, purchasing a 
2
In this paper,we examine 12popular mythsabout nationalhealth insurance.
 
scan for themselves is illegal (although moreand more human patients are finding legalloopholes, as we shall see below).
10
Countries with national health insurancelimit health care spending by limiting supply.They do so primarily by imposing global budg-ets on hospitals and area health authoritiesand skimping on high-tech equipment. Theresult is rationing by waiting (see Figure 1).In Britain, with a population of almost 60million, government statistics show that morethan 1 million are waiting to be admitted tohospitals at any one time.
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In Canada, with a population of more than 31 million, the inde-pendent Fraser Institute found that more than876,584 are waiting for treatment of all types.
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 And in New Zealand, with a population of about 3.6 million, almost 111,000 people are onwaiting lists for surgery and other treatments.
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 Although there may be some waiting inany health care system, in these countriesrationing by waiting is government policy.Patients may wait for months or even yearsfor treatment (see Figure 1).
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For example,Canadian patients waited an average of 8.3weeks in 2003 from the time they werereferred to a specialist until the actual con-sultation, and another 9.5 weeks before treat-ment, including surgery.
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Of the 90,000 peo-ple waiting for surgery or treatment in New Zealand in 1997, more than 20,000 werewaiting for a period of more than two years.
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The London-based Adam Smith Instituteestimates that the people currently on NHSwaiting lists will collectively wait about onemillion years longer to receive treatmentthan doctors deem acceptable.
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 Among the patients waiting, many are wait-ing in pain. Others are risking their lives. Delaysin Britain for colon cancer treatment are so longthat 20 percent of the cases considered curableat time of diagnosis are incurable by the time of treatment.
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During one 12-month period inOntario, Canada, 71 patients died waiting forcoronary bypass surgery while 121 patientswere removed from the list because they hadbecome too sick to undergo surgery with a rea-sonable chance of survival.
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Myth No. 2: Countries withNational Health InsuranceSystems Deliver High-Quality Health Care
In countries with national health insur-ance, governments often attempt to limitdemand for medical services by having fewer
3
During one12-month periodin Ontario,Canada, 71patients diedwaiting forcoronary bypasssurgery.
5%23%26%27%36%United StatesAustraliaNew ZealandCanadaBritain
Figure 1Patients Having to Wait More Than FourMonths forSurgery (as percentage of all adultsurgery patients receiving elective [nonemergency] surgery in last two years)
Source: Cathy Schoen, Robert J. Blendon, Catherine M. DesRoches, and Robin Osborn, “Comparison of HealthCare System Views and Experiences in Five Nations, 2001,” Commonwealth Fund, Issue Brief, May 2002.
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