Hearing Description: The U.S. Senate Committee on Health, Education, Labor, and Pensions, Subcommittee on Primary Care and Aging examined single payer systems from around the world. The witnesses had varying views of single payer systems: some felt it’s too reliant on government and problematic, while others felt a single payer system allows for universal coverage and quality care.
Hearing Date: March 11, 2014
Hearing Summary: Prepared for AAPS by the Market Institute
The Senate Primary Health and Aging subcommittee recently met to examine what other countries are doing in terms of providing and innovating healthcare. Senator Bernie Sanders (I-VT) said in his opening statement the United States is the only industrialized country in the world that does not guarantee health care as a right, but that debate needs to happen. The U.S. is playing from behind when it comes to healthcare efficiency, outcomes, and cost.
The first witness, Tsung-Mei Cheng, Health Policy Research Analyst at Princeton University testified in her opening statement that single payer systems are not the same as socialized medicine or a socialist system. Single payer systems are typically social insurance like the social security system. The delivery of healthcare remains private, while the system is set up and financed by the government. Single payer systems have shown themselves to be effective in achieving universal access to health care without breaking either the nation’s treasury or those of individual households.
The second witness, Victor G. Rodwin, Professor of Health Policy and Management at Robert F. Wagner School of Public Service testified in his opening statement that the French healthcare system is a model of national health insurance that provides healthcare to all of it’s legal residents, but it is not a socialist system. It is a combination of public, social security combined with private financing. The French are outdoing the United States in many indicators of healthcare, most notably, life expectancy. Comparisons across Europe place France among those nations with the highest rates of consumer satisfaction.
The third witness, Ching-Chuan Yeh, MD , former Minister of Health for Taiwan; Professor, School of Public Health, College of Medicine at Tzu-Chi University testified in his opening statement Taiwan has been one of the most egalitarian health systems in the industrialized world. Access to health care is an inalienable right in the constitution. Having a single-payer system is the main reason for efficient services and also the low prices for health care they can achieve. Private delivery and highly competitive providers enable them to have efficient health services.
The fourth witness, Sally Pipes, President and CEO at Pacific Research Institute testified in her opening statement that many healthcare reform advocates, political pundits, and policymakers point to Canada as a shining example of the advantages of a state-run, single-payer healthcare system. State officials set the budget on what can be spent every year. Private insurance is outlawed in many provinces. Canada is forced to ration care; the average patient has to wait 18 weeks to see a specialist. The cost is even higher, about 68 cents out of every dollar in government revenue goes to covering healthcare costs. She urged the committee to resist calls to bring America closer to a single-payer system. Canada shows us what’s in store if we follow its lead: rationing, long waits, poor quality of care, dangerous scarcities of vital medical technologies, and unsustainable costs.
The fifth witness, Danielle Martin, Vice-President Medical Affairs & Health System Solutions at Women’s College Hospital in Toronto, Canada testified in her opening statement that the challenges facing the Canadian health system do not stem from the single payer model. Canadians enjoy the same health outcomes as Americans, but the % of Canada’s GDP is significantly lower. Canadians are not waiting for healthcare longer than their counterparts, including the United States. Almost all health care delivery is private with very few doctors and other providers working directly for the government.
The sixth witness, David Hogberg, PhD, Health Care Policy Analyst, National Center for Public Policy Research, Washington, D.C testified in his opening statement that the most important lesson is that the country should not put health care decisions in the hands of politicians. In the case of Denmark, a single payer system, uses wait times as a way of rationing care as limit costs. In France, while healthcare is heavily financed by the government, over 90% of the population has private insurance. The United States should look at other markets for guidance on how to improve the health care system.
The last witness, Jakob Kjellberg, Professor and Program Director for Health, KORA-Danish Institute for Local and Regional Government Research in Copenhagen, Denmark testified in his opening statement the Danish system provides easily accessible, comprehensive and universal coverage for all it’s citizens. The public sector finances 85% of health care costs. Almost half the population has private insurance to cover out-of-pocket costs. Life expectancy and consumer satisfaction are both ranked very high.
In response to questioning, Danielle Martin said:
- There is a net influx of doctors into the Canadian health care system
- There is a perception, fueled by media discourse, that high payments leads to better care, which is false
In response to questioning David Hogberg said:
- A single payer system would lead to a decline in innovation and thus quality outcomes
Hearing Website:
http://www.help.senate.gov/hearings/hearing/?id=8acab996-5056-a032-522e-e39ca45fcfbe
Links to Testimony:
Tsung-Mei Cheng, LLB, MA
Health Policy Research Analyst
Woodrow Wilson School of Public and International Affairs
Princeton University, Princeton, NJ
Ching-Chuan Yeh, MD
former Minister of Health for Taiwan
Professor, School of Public Health
College of Medicine
Tzu-Chi University, Hualien City, Taiwan
Sally C. Pipes
President and CEO
Pacific Research Institute
San Francisco, CA
Danielle Martin, MD, MPP
Vice-President Medical Affairs & Health System Solutions
Women’s College Hospital, Toronto, Canada
Jakob Kjellberg, MSc
Professor
Program Director for Health
KORA-Danish Institute for Local and Regional Government Research
Copenhagen, Denmark
David Hogberg, PhD
Health Care Policy Analyst
National Center for Public Policy Research
Washington, D.C
Victor G. Rodwin, PhD, MPH
Professor of Health Policy and Management
Robert F. Wagner School of Public Service
New York University, New York, NY
