Presidential hopefuls have begun to put forward proposals that would bring about universal health coverage in America. Foreign systems which seem to offer high quality care at relatively low cost are frequently held up as models to adapt and adopt. These systems are attractive because a larger proportion of these populations have access to “basic” health care. In many of these cases, access to so-called “extended” care—things like dental and vision care—is only starting to open up through co-operation with the private sector.

Canada’s single payer health care system, for example, does not fund dental care, and funding for vision care (determined by the provinces) often excludes the standard vision test. As a result these services are often obtained through employer-based private plans and upon leaving employment, many retirees experience difficulty paying for their extended care needs. Britain’s National Health Service (NHS) claims to fund dental care, but many Britons have an incredibly difficult time obtaining it. In July 2005 the UK Public Accounts Committee reported significant regional variation in the quality of dental healthcare and found that children in some parts of Britain had twice the level of dental decay as elsewhere in Europe, and two million Britons did not have access to a public dentist.

The current vogue for venerating single-payer health care systems is reckless.

On the other hand, the vision care sector of England’s NHS has been deregulated and has partnered with the private opticians. The sight-test fee patients pay to the NHS has been subsidized through the sale of eyeglasses and is now well below the cost of providing the test (The sight test fee is at £18.39 and the cost of providing the fee is £37). The fee is an entitlement which customers can use at any practice (and is not restricted to a particular provider) so opticians must compete to attract customers. Money follows the patient and prices have deflated while access to care has increased. This opportunity has fostered significant growth in firms such as SpecSavers, a joint-venture partnership with opticians and other retailers whose profits have nearly tripled over the past ten years (from £310 million in 1996 to £880 million in 2006).

Democratic hopeful Chris Dodd recently proposed a “Universal HealthMart”, a system of comprehensive plans that would entitle every American to the same benefits and types of plans as Members of Congress. In John Edwards’ March 2007 proposal, he similarly argued that businesses have a responsibility to provide their employees with a “comprehensive health plan”. Mr. Edwards even stated that “over time, the system may evolve toward a single-payer approach”. These proposals incorrectly think that foreign programs for universal care are “comprehensive.” In fact many cannot afford to provide dental and vision care, or claim that these services are covered but then have severe difficulty providing them. Mimic their approach in America, and we will see the same results.

The current vogue for venerating single-payer health care systems is reckless. If the federal government were to force everyone into a public system with comparable per-patient spending to today’s private sector, funding demands would be enormous and quality would have to decline. Fairness would be compromised as patients accustomed to consumer-driven health services would attempt to navigate around “gatekeeper” referral structures and waiting lists, both of which are meant to keep costs down. An American single payer system would not be able to meet expectations for private-style benefits and its existence would reduce employers’ incentive to offer private health care options for their employees. Health care quality for all would be depressed. More people might gain access to preventive care and America’s performance on international health rankings could improve, but right now a majority of Americans enjoy private health insurance that pays for care superior to the public care assigned by the foreign universal access systems. Nationals of these countries make this fact clear when they opt to be treated in America, often entirely at their own expense.

At this time last year the UK House of Commons Health Select Committee reported: “In the future, the NHS may not be able to pay for every possible medical treatment in a country with an ageing population, demographic pressures, rising public expectations and increased possibilities of medical treatment and long-term therapies. Some treatments or procedures may have to be charged for [that is, in addition to tax financing].... The Government should consider this possibility sooner rather than later to ensure that a set of consistent criteria apply to those areas for which a fee is charged, to avoid the development of charges in an ad hoc way, as has been the case until now.” Proponents of centrally planned systems of healthcare argue that “ad hoc” action won’t occur in a centralized system. However a program which encompasses five times as many individuals as does the NHS will be even more unwieldy.

A few universal health care systems do manage to provide high-quality, comprehensive benefits, but these systems are not single payer. They have competing insurance funds and they are more expensive to operate compared to their single payer counterparts, but the results are better. It was recently reported that the survival rates for stomach cancer are twice as poor as in the UK as in Germany.

In Germany, 90 percent of the population is insured publicly, but a 10 percent privately insured “fringe” does exist. The public system is not, as in Britain, financed through general tax revenues, but by a payroll tax. However, those who make more than the contribution limit for the payroll tax can opt out of the public system and contract with a private company. German government workers can opt out of the public system without reaching the contribution limit; they make up approximately half of the 10 percent “fringe.” This privately insured proportion is highly competitive; private insurance finances the introduction of new technology and after a few years the publicly insured demand similar benefits. As a result of this pressure, the German system is more expensive than the British system, but it is also highly regarded because Germans do not wait nearly as long for treatment and employ a higher usage of technology.

In Canada private provision of health care is much less widespread compared to the 10 percent level attained by Germany and the UK. When spokesmen for the Canadian public system discuss the use private contractors they use terms like “independent providers.” It seems like in the USA, one needs to talk about “universal” health care as opposed to public. Yet proposals that call for a single-payer government-led system will be public. Single payer health care systems struggle to compete with the health care paid for by private insurance. They have had to cooperate with the private sector in order to begin to compete with the dental and vision care paid for by private insurance. It is wrong to assume that the implementation of a similar system in America will produce a different result.

Emily Beuhler, a Program Assistant at AcademyHealth, was an intern at the American Enterprise Institute in Fall 2006.

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