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The amount of

appointments or call to cancel.104 If the NHS

tests. Access to preventive care--which is

often costly in itself--is tacitly discouraged by

did nothing more than charge patients the full

preventive care

cash-strapped health care bureaucracies.

costs of missed appointments, it would free

people get under

If anything, the amount of preventive care

up enough money to treat thousands of addi-

single-payer

people get under single-payer systems seems to be

tional cancer patients each year. Yet such

options are not seriously considered.105

based more on socioeconomic status and educa-

systems seems to

tion than on whether medical care is "free" or not.

be based more on

Studies comparing women in Ontario and in two

Myth No. 11: A Single-Payer

areas of the United States found that their

socioeconomic

National Health Care System

chances of receiving a Pap smear or clinical breast

status and

cancer screening increased with education and

Would Lower Health Care

education than

income regardless of whether a woman had

Costs because Preventive

health insurance.110

on whether

Health Services Would Be

medical care is

More Widely Available

Myth No. 12: The Defects of

"free" or not.

National Health Insurance

Proponents of national health insurance

often argue that because care is "free" at the

Schemes in Other Countries

point of service, people will be more likely to

Could Be Remedied by a

seek preventive services. Thus, money will be

Few Reforms

saved when doctors catch conditions in their

early stages before they develop into expen-

sive-to-treat diseases. Yet the evidence shows

The characteristics described above are not

that patients in government-run health care

accidental byproducts of government-run health

systems do not get more preventive care than

care systems. They are the natural and inevitable

Americans do, and even if they did, such care

consequences of placing the market for health

care under the control of politicians.111 Health

would not save the government money.

Preventive care may even be less available

care delivery in countries with national health

under a single-payer system because care is

insurance does not just happen to be as it is. In

free. A comparison of American and British

many respects, it could not be otherwise.

physicians in the 1990s found that the

Why are low-income patients so frequent-

British saw a physician almost as often as

ly discriminated against under national

Americans (roughly six times a year).106 Yet

health insurance? Because such insurance is

almost always a middle-class phenomenon.

when Americans did see a doctor, the consul-

Prior to its introduction, every country had

tation was six times as likely to last more

than 20 minutes.107 A recent survey of 200

some government-funded program to meet

the health care needs of the poor. The mid-

British GPs and more than 2,000 consumers

dle-class working population not only paid

found that 87 percent of smokers want more

for its own health care but also paid taxes to

advice and help in quitting from their GPs,

fund health care for the poor. National

but 93 percent of GPs say they lack the time

to give such advice.108 Moreover, British

health insurance extends the "free ride" to

those who pay taxes to support it. Such sys-

physicians have much less access to diagnos-

tems respond to the political demands of the

tic equipment and must send their patients

middle-class population, and they serve the

to hospitals for chest X-rays and simple

blood tests.109 In Canada, fee structures are

interests of this population.

Why do national health insurance schemes

designed to discourage physicians from pro-

skimp on expensive services to the seriously ill

viding office-based procedures. Doctors can

while providing so many inexpensive services to

only bill for the time they spend examining

those who are only marginally ill? Because the lat-

and evaluating patients, not for diagnostic

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