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ter services benefit millions of people (read: mil-

Conclusion

lions of voters), while acute and intensive care ser-

vices concentrate large amounts of money on a

handful of patients (read: small numbers of vot-

The realities of national health insurance

ers). Democratic political pressures in this case

documented in this paper--waiting lines,

dictate the redistribution of resources from the

rationing, lack of cutting-edge medical tech-

few to the many.

nology, restricted access to the latest pre-

Why are sensitive rationing decisions and

scription drugs, inequitable distribution of

other issues of hospital management left to

care--are not accidental. Such problems flow

hospital bureaucracies? Because the alterna-

inexorably from the fact that politicians and

tive--to have those decisions made by politi-

bureaucrats--not patients and doctors--are

cians--is politically impossible. As a practical

given the authority to allocate limited health

matter, no government can make it a national

care resources.

policy to let 25,000 of its citizens die from lack

Yet proponents of socialized medicine

of the best cancer treatment every year.112 Nor

insist that a single-payer health care system is

the only way to solve the structural problems

can any government announce that some peo-

of the U.S. health care system. They conve-

ple must wait for surgery so that the elderly can

niently ignore or explain away the flaws of sin-

use hospitals as nursing homes, or that elderly

gle-payer systems, arguing that we could

patients must be moved so that surgery can

design a better system and spend more money

proceed. These decisions are so emotionally

than Britain and Canada, thus getting better

loaded that no elected official could afford to

results. But the failures of socialized medicine

claim responsibility for them. Important deci-

are evident in every country that implements

sions on who will receive care and how that

it, and there is no reason to believe that a sin-

care will be delivered are left to the hospital

gle-payer system in the United States would be

bureaucracy because no other course is politi-

any different. Advocates of national health

cally possible.

insurance would do well to look at how coun-

Why do the rich and the powerful manage

tries like Germany, Sweden, and Australia are

to jump the queues and obtain care that is

choosing free-market reforms to alleviate the

denied to others? Because they are the people

problems of their national health systems.

with the power to change the system. If they

Through painful experience, many of the

had to wait in line for their care like ordinary

countries that once heralded the benefits of

people, the system would not last for a

government control have learned that the best

minute. For example, the president of the

The failures of

remedy for their countries' health care crises is

Canadian Medical Association, Dr. Victor

socialized medi-

not increasing government power, but increas-

Dirnfeld, suggested in 1998 that the

ing patient power instead.115

Canadian system is in fact a two-tiered sys-

cine are evident in

tem, and said that he knew of seven promi-

every country that

nent political figures in British Columbia

Notes

and Ontario who received special treatment.

implements it,

"Instead of waiting three months for an

1. Marshall W. Raffel, Health Care and Reform in

and there is no

MRI," he said, "they will have it done in three

Industrialized Countries (University Park, PA:

reason to believe

or four days."113 More recently, Canada's

University of Pennsylvania Press, 1997). Also see

Monique Jérôme-Forget, Joseph White, and Joshua

Health Minister, Allan Rock, underwent a

that a single-

M. Wiener, Health Care Reform through Internal

successful surgery after he was diagnosed

Markets: Experience and Proposal (Washington:

payer system in

with prostate cancer in January 2001. Rock

Brookings Institution Press, 1995); and Wendy

the United States

Ranade, ed., Markets and Health Care: A Comparative

was sharply criticized by other Canadian

Analysis (New York: Longman, 1998).

prostate cancer patients who waited much

would be any

longer for treatment--often more than a year

2. "Thousands Shun the NHS," BBC News, March

different.

between diagnosis and surgery.114

20, 2002.

20