Policy Analysis No. 532

Health Care in a Free Society: Rebutting the Myths of National Health Insurance

By John Goodman
January 27, 2005

Executive Summary

Almost everyone agrees that the U.S. health care system is in dire need of reform. But there are differing opinions on what kind of reform would be best. Some on the political left would like to see us copy one of the government-run “single-payer” systems that exist in Western Europe, Canada, and New Zealand, among other places. Proponents of socialized medicine point to other countries as examples of health care systems that are superior to our own. They insist that government will make health care available on 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 priority over less serious needs.

Unfortunately, those promises have not been borne out by decades of studies and statistics from nations with single-payer health care. Reports from those governments contradict many of the common misperceptions held by supporters of national health insurance in the United States. Wherever national health insurance has been tried, rationing by waiting is pervasive, putting patients at risk and keeping them in pain. Single-payer systems tend to leave rationing choices up to local bureaucracies that, for example, fill hospital beds with chronic patients, while acute patients wait for care. Access to health care in single-payer systems is far from equitable; in fact, it often correlates with income—with rich and well-connected citizens jumping the queue for treatment. Democratic political pressures (i.e., the need for votes) dictate the redistribution of health care dollars from the few to the many. In particular, the elderly, racial minorities, and those in rural areas are discriminated against when it comes to expensive treatments. And patients in countries with national health insurance usually have less access to critical medical procedures, modern medical technology, and lifesaving drugs than patients in the United States.

Far from being accidental byproducts of government-run health care systems that could be solved with the right reforms, these are the natural and inevitable consequences of placing the market for health care under the control of politicians. The best remedy for all countries’ health care crises is not increasing government power, but increasing patient power instead.

Read the Full Policy Analysis

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.