Michael Moore Is Right: Obamacare Is Awful, But Single-Payer Would Be Much Worse

Obamacare is awful,” filmmaker Michael Moore recently wrote in the New York Times. He went on to say that President Obama “knew in his heart that a single-payer, Medicare-for-all model was the true way to go.”

Moore’s been preaching the single-payer gospel for years, most famously in his 2007 “documentary” Sicko, in which I unwittingly had a cameo pointing out the failures under Canada’s single payer system — the system under which I grew up.

Other supporters of the president have begun beating the drum for single-payer — with Obamacare serving as a way station on the path there. In January, The New Republic published an article entitled “How Obamacare Actually Paves the Way Toward Single Payer.” The article was even filed under the header “Trojan Horse.”

This trend should trouble Americans. Single-payer systems in other countries arbitrarily ration care — and yield health outcomes far worse than those in the United States.

That reality hasn’t dissuaded single-payer cheerleaders from trying to use Obamacare to install their preferred model of healthcare delivery.

Vermont’s Democratic governor Peter Shumlin signed a single-payer bill into law in 2011. The law hinges on section 1332 of Obamacare, which allows states to apply for waivers from health care regulations and get federal funding to enact their own plans.

States won’t be able to apply for section 1332 waivers until 2017. But some folks in Hawaii, Oregon, New York, Washington, California, Colorado, Maryland, and Massachusetts are already agitating to get special dispensation to implement single-payer systems.

Then there’s the federally ordered expansion of Medicaid. Twenty-six states are complying; the rest have chosen to take advantage of the U.S. Supreme Court’s ruling that they’re not required to do so.

Between Medicare and Medicaid alone, more than one in three Americans now receives health care through a government-run program. Government already accounts for nearly half of all health care spending in this country.

Those two figures will only grow as states and the feds put more people on the public-insurance rolls — and as the Baby Boomers age.

Obamacare also creates two new bureaucracies — the Patient Centered Outcomes Research Institute (PCORI) and the Independent Payment Advisory Board (IPAB) — that look an awful lot like the rationing bodies other nations use to try to keep their own healthcare costs down.

PCORI is supposed to sponsor research comparing the relative effectiveness of various medical treatments. Of course, the federal government has a strong incentive to “discover” that older, cheaper treatments are just as effective as newer, more expensive ones. Such a finding could save the government — as one of the nation’s largest healthcare payers — a significant amount of money.

That’s exactly what happens in Great Britain. Just last week, the National Institute for Health and Care Excellence (NICE) — which decides whether the British government will pay for drugs — ruled that a new prostate-cancer drug that can extend lives by five months wasn’t worth its price. Cancer patients will have to try a cheaper therapy first. Of course, they may die in the interim.

PCORI’s proponents try to rebut charges that it’ll ration care by citing Obamcare’s text: “The Patient-Centered Outcomes Research Institute shall not develop or employ a dollars-per-quality adjusted life year (or similar measure that discounts the value of a life because of an individual’s disability) as a threshold to establish what type of health care is cost effective or recommended.”

But as University of Michigan law professor Nicholas Bagley has postulated, PCORI could “compile cost information about the treatments that it studies” or “rank the cost-effectiven IPAB, meanwhile, is essentially charged with rationing care. This 15-member, unelected, and yet-to-be-appointed board must come up with cost-cutting recommendations if Medicare spending exceeds certain levels. It’s forbidden from changing the program’s fee-for-service structure or adjusting the level of benefits that seniors receive — but the Board can ratchet down reimbursement rates for doctors and hospitals.

Doctors may respond by limiting the number of Medicare patients they see — or opting out of the program entirely. More seniors competing for fewer doctors’ appointments will result in longer wait times and lower-quality care.
Wait times are facts of life in Canada’s single-payer system. The average wait time from referral by a general practitioner to actual treatment by a specialist is 18.2 weeks. Nearly 700,000 Canadians are on a waiting list for surgery or other procedures. Preventative care is also less available — Canadian women are almost 25 percent less likely to have had a mammogram than American women.
It’s no wonder that almost 40,000 Canadians cross the border and pay out of pocket to get treated in U.S. hospitals every year.

Even as America moves toward single-payer, other nations are doing the opposite. According to the Swedish publication The Local LOCM -1.57%, about one in 10 Swedes now has private insurance. Svensk Försäkring, Sweden’s insurance industry trade group, reports “most of these people have their policy paid by their employer.”
Why are Swedish employers picking up the tab when the government provides free health care?

The Local reports that even cancer patients can wait a year for treatment. “It’s quicker to get a colleague back to work if you have an operation in two weeks’ time rather than having to wait for a year,” privately insured Anna Norlander told a Swedish radio station. “It’s terrible that I, as a young person, don’t feel I can trust the health care system to take care of me.”

Unless Obamacare is repealed and replaced, Americans may soon be saying the same thing.