Recently, a liberal think-tank, the Center for American Progress (CAP), issued a policy paper that promised 'the truth' on waiting times in government-run health systems. That's not what it delivers.

Recently, a liberal think-tank, the Center for American Progress (CAP), issued a policy paper that promised “the truth” on waiting times in government-run health systems. If you want the truth about the issue, however, you’ll have to wait a long time for it if you choose to rely on CAP’s disingenuous analysis.

The CAP report cherry-picks facts to try to make an argument that a single-payer health-care system won’t result in rationing of health care. Unfortunately, however, even supporters of single payer have admitted that government-run care will increase waiting times for care.

Misleading Analysis

CAP’s paper starts out by criticizing President Trump and other conservative groups, who have asserted that a single-payer system would lead to “massive wait times for treatments and destroy access to quality care,” as Trump stated in his recent executive order on Medicare. CAP calls these assertions “false,” and then claims:

Patients in peer nations generally have similar or shorter wait times than patients in the United States for a variety of services, refuting the argument that universal coverage would necessarily result in longer wait times in the future. [Emphasis added.]

The above sentence, like the rest of the paper, uses clever semantic wordplay to obscure the issue. CAP claims that universal coverage wouldn’t necessarily result in longer wait times, but Trump and the right-leaning groups have criticized one specific form of universal coverage—single payer, in which the government serves as the sole funder of health care. (CAP repeats those misleading tactics by referencing the impact of prior coverage expansions in the United States, many of which used private insurers and none of which directly equate to a universal, government-funded health system.)

Of the paper’s four “peer nations” with universal coverage systems—Australia, France, Germany, and Sweden—only Australia and Sweden have government-run insurance plans. By contrast, France and Germany rely on private insurers to implement their universal coverage systems.

While it includes other systems without single-payer coverage in its analysis, CAP specifically excludes Britain’s National Health Service, known for its waiting times and rationed access to care. CAP claimed to omit the NHS in its analysis because “no candidate currently running for president is proposing nationalizing health care providers” a la the British model—a true enough statement, but a self-serving one.

If CAP included non-government-funded systems in its analysis, it certainly should have included the government-funded NHS. That it did not suggests the analysts wanted to “rig” the paper’s outcomes by relying solely on favorable examples.

Biggest Waiting Times to the North

The CAP paper’s most deliberate omission comes in the form of our neighbor to the north: Canada. The paper examined four metrics of access to care, based on data from an analysis by the (liberal) Commonwealth Fund of 11 countries’ health systems. Given the shabby results Canada’s health system showed on health care access, it seems little wonder that the leftists at CAP failed to disclose these poor outcomes in their paper:

Patients who reported they saw a doctor or nurse on the same or next day the last time they needed care: Canada ranked in a tie for last, with 43% agreeing. (The United States had 51% who agreed.)

Doctors who reported that patients often experience difficulty getting specialized tests like CT or MRI scans: Canada ranked third from last, with 40% agreeing. (The United States had 29% who agreed.)

Patients who reported they waited two months or longer for a specialist appointment: Canada ranked last, with 30% agreeing. (The United States had only 6% who agreed.)

Patients who reported they waited four months or longer for elective surgery: Canada ranked last, with 18% agreeing. (The United States had only 4% who agreed.)

As I discuss in my book, Canada’s health system suffers from myriad access problems, based on other metrics from Commonwealth Fund studies that CAP chose not to mention in their paper:

The second-lowest percentage of patients (34%) who said it was easy to receive after-hours care without going to the emergency room;

The lowest percentage of patients (59%) who said they often or always receive an answer the same day when calling the doctor’s office about a medical issue;

The highest percentage of patients (41%) using the emergency room; and

The highest percentage of patients (29%) waiting four or more hours in the emergency room.

With results like that, little wonder that the liberals at CAP didn’t want to highlight what single-payer health care would do to our health system.

Socialists Admit Care Rationing Ahead

That said, some socialist supporters of single payer have conceded that the new system will limit access to care. As I noted last year, the socialist magazine Jacobin said the following about one analysis of single payer:

[The study] assumes utilization of health services will increase by 11 percent, but aggregate health service utilization is ultimately dependent on the capacity to provide services, meaning utilization could hit a hard limit below the level [the study] projects.

Translation: People will demand additional care under single payer, but there won’t be enough doctors and hospitals to meet the demand, therefore resulting in waiting times and rationed access to care.

Lest one consider this admission an anomaly, the People’s Policy Project called a recent Urban Institute study estimating the costs of single payer “ridiculous” and “unserious,” in large part because of its “comical assumption” about increased demand for care: “There is still a hard limit to just how much health care can be performed because there are only so many doctors and only so many facilities.” Again, socialists claim that single payer won’t bust the budget, in large part because people who seek care will not be able to obtain it.

With analysts from the right and the socialist left both admitting that single payer will lead to rationed health care, CAP can continue to claim that waiting times won’t increase. But the best response to their cherry-picked and misleading analysis comes in the form of an old phrase: Who are you going to believe—me, or your lying eyes?