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Monday
Mar172014

Single-Payer Without Wait Times? Taiwan Is On Borrowed Time

One other matter I didn’t get a chance to address during my testimony at the recent Subcommittee on Primary Health and Aging hearing was the issue of why Taiwan, a single-payer health care system, does not use wait times to ration care.

Here is an exchange on the subject between Dr. Danielle Martin and Sally Pipes:

Note that Dr. Martin states, “…single-payer does not equal wait times.  We heard our colleagues from Taiwan tell us quite clearly that they have a single-payer system with virtually no wait times…We should avoid over-simplifying the message and equating a single-payer model with wait times.  That simply is not the case.”

Looking at reports from the Organization of Economic Cooperation and Development on wait times, many of the nations that have wait times—Canada, Denmark, England, Finland, Italy, Norway, Portugal, Spain, and Sweden—have single-payer health care systems.  Saying “single-payer leads to wait times” isn’t an oversimplification.  It’s stating a pattern.

As for Taiwan, its single-payer system is less than 20 years old.  Wait times can take decades to develop, as they did in England and Canada.  As I noted a while back in a blog post titled “The Single-Payer ‘Dance Of Nations’,”:

In 1980, Milton and Rose Friedman noticed the beginnings of the single-payer dance in their book Free To Choose (pages 113-114):

Proponents of socialized medicine in the United States—to give their cause its proper name—typically cite Great Britain, and more recently Canada, as examples of its success.  The Canadian experience has been too recent to provide an adequate test—most new brooms sweep pretty clean—but difficulties are already emerging.  The British National Health Service has now been in operation more than three decades and the results are pretty conclusive. That, no doubt, is why Canada has been replacing Britain as the example pointed to.

The Friedmans went on to point out that there was a waiting list for hospital beds about 600,000 long in Britain. In present day Britain about 2.5 million are waiting for treatment in any given month, 677,000 are waiting for diagnostic tests, and just under 20,000 had their elective surgery cancelled in the first quarter of 2013.

However, the single-payer system in Canada wasn’t fully established until 1966, so single-payer advocates could go on for years singing its praises.  Drs. David Himmelstein and Steffie Woolhandler, co-founders of Physicians for a National Health Program, spent the early 1990s arguing against the Clinton health plan and in favor of the Canadian system.  They were especially keen to claim that Canada’s system would save the U.S health care system a ton in administrative costs.

Alas, all good propaganda exhibits must come to an end.  Problems with waiting lists, cancelled surgeries, etc. were beginning to make the Canadian news by the 1990s.  In 1999 a psychiatrist in Canada, Dr. David Gratzer, wrote a spectacular book, Code Blue, that blew the lid off the disaster that was the Canadian health care system. Anyone not wearing ideological blinders now had to admit that Canada’s single-payer system rationed care much the way Britain’s did.

But not to worry.  A few years earlier Taiwan had switched to a single-payer system giving single-payer advocates a new nation, without all those ugly warts and scars, that they could bring to the health-care policy dance. Taiwan’s system is not yet two decades old, so the problems that arise from a single-payer system have not yet fully emerged. 

So give Taiwan a few more years.  Unless the laws of economics do not apply to Taiwan’s health-care system, eventually wait times will emerge.  For now, the Taiwanese system provides single-payer advocates with a convenient example.  But that example is living on borrowed time.

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