Thankfully, the Assembly Speaker has put the brakes on the version of single payer health care that passed the California Senate, but the controversy over single payer is far a from over.  The fact is that “single payer health care” is a fraud; it does not exist in a single industrialized nation.  Perhaps a few facts are in order.

Single payer advocates want a fully government run health care system, and point to government run systems elsewhere as models.  But in fact, American health care is already pretty much paid for by the government. According to the American Journal of Public Health, March 2017, “American tax-funded health expenditures totaled $1.877 trillion in 2013 and are projected to increase to $3.642 trillion in 2024. Government’s share of overall health spending was 64.3% of national health expenditures in 2013 and will rise to 67.1% in 2024.”

This should be no surprise; we have the rapidly growing Medicare and Medicaid programs; veterans health care; federal, state, and local government health care and more – all of which is paid for, at least in large part, by the taxpayer.

With this as the benchmark, let us look at the systems in the other industrialized countries.  The G-7 nations are the world’s richest industrialized nations: USA, Canada, Great Britain, France, Germany, Italy and Japan.

Let’s start with Canada, famed for its “universal” health care system that is the model for many single payer advocates.  Only Canada’s government-run system is not single payer.  In fact, the government only covers about 70 percent of Canadians’ health care needs.

That is in large part because the Canadian system does not cover prescription drugs; you must buy a private policy to pay for your drugs.  As US News recently reported:  “Contrary to popular belief among Americans, health care is not entirely free for Canadians.  Dental, ambulance and many other services as well as prescription medications must be paid for out of pocket or they’re covered through a combination of public programs and private health insurance. About two-thirds of Canadians have such insurance.”

Single payer advocates love to point to Canada as the nirvana of the future, but the most salient fact about Canada’s universal health care system is that it does not work if you get really sick.  For instance, Canadians have nowhere near the number of MRI machines they need to meet the need.  But Canadians have an escape from their socialist health care system: it is called the United States.

As US News reported: “The Fraser Institute, a Canadian public policy think tank, estimates that 52,513 Canadians received non-emergency medical treatment in the U.S. and other countries in 2014, a 25 percent jump from the roughly 41,838 who sought medical care abroad the previous year.  Ontario, the country’s most populous province, provides a good example. The three hospitals that use stem-cell therapy to treat patients with blood disorders and aggressive cancers …  are unable to keep up with the soaring demand. So patients are sent to medical facilities in Buffalo, Cleveland, and Detroit, for the potentially life-saving treatment.”

Now let’s look at Great Britain.  The grand daddy of all the “universal” health care systems, the National Health Service, was enacted by the Labour government right after World War II.   This is supposedly a “socialized” health care system like what American single payer advocates want, but in fact private health care insurance exists in Great Britain and it works much like the American version.  Many private employers provide health insurance plans for their workers, and this is a particularly important perk because waiting time in the NHS can be deadly, as long as  eight weeks for treatments that require admission to a hospital, four weeks for out-patient treatments and two weeks for diagnostic tests.

Recently The Guardian, a left wing newspaper, reported this about the British system: “The number of people in Britain taking out private medical insurance has risen significantly for the first time since 2008.  After falling steeply between 2008 and 2011 and then staying flat, demand for private medical insurance coverage in Britain rose by 2.1% in 2015 with just over 4 million people insured.

The paper quotes Philip Blackburn, an economist, “There has been a clear rise in interest in private healthcare recently as more and more people are dissatisfied with higher waiting on the NHS and increased restrictions on treatment. Private medical cover will benefit from this, and there is a wide choice of policy options at different prices to attract customers.”

Part of the reason for long waits in the NHS is that socialist systems like Britain and Canada never seem to have enough money.  This has been a problem with NHS for decades, and it has led to some absurdities.  In the general election just concluded, the Conservative government came up with something called the Dementia Tax.   If you were an old person who lived at home until you died, your home would be seized by the government to cover costs of your home health care.  The government actually proposed this as a money raiser for the NHS; it was laughed to scorn, especially by older voters, and contributed to the Conservatives losing their majority in parliament.

Health care systems on the continent seem to work somewhat better. Both France and Germany have universal systems in that you must have some sort of health insurance.  France has national health insurance, but only 77 percent of the costs are covered by the government.  You must buy a supplemental insurance policy from a private insurer to cover the rest.

The German health care system, which dates back to the time of Bismarck, is a universal system with public and private payers.  About 11 percent of Germans have private health insurance plans.  The rest receive their insurance from the government and through employer-paid plans.  The German system works well, but it is not so unlike the United States.

Interestingly, Italy may come closer to the single payer than the other major European countries.  It has a national system based on the British National Health Service model, but even with a universal system the government pays only about 77 percent of costs, the rest are borne through private health care.

Like the British system, the Italian public system has long waiting times, often several months.  Patients can opt for a free market option with private hospitals where the waiting time is much shorter.

Japan has a system based on its post-war experience.  Like the others it is universal but with the government paying only 70 percent of the costs; the patient is responsible for the other 30 percent.  As a result most working Japanese have an employer based health care plan to cover those costs.

Other industrialized nations have variations on the G-7 model.  In Switzerland, for example, there is no government run health insurance but all persons are required to buy private health care.  Some health services are subsidized by the government. Australia has a mixed private-public system with the government paying about 67 percent of health care costs.

So what can Americans learn from these various systems?  First, junking our mixed private-public system would be insane, especially when the other nations of the world are increasing their private health care.  The American employer-based system is found in many countries and works reasonably well.

Secondly, every one of these systems has mandatory purchase of health insurance, either from the government or privately.  The modern health insurance market will not work without mandatory coverage, and these mixed systems work well because of it.  The worst failure of Obamacare is its failure to enforce the individual mandate; the worst aspect of the Republican repeal of Obamacare is doing away with the individual mandate.

American health care costs much more per capita than any of these nations.  Partially this is because there are no market mechanisms in American health care, and partially because Americans expect much higher levels of medical care than other countries.  If you are diagnosed with a serious cancer, Americans want and expect the latest treatments despite their costs; this is not the case in most other systems.

There is a final lesson from these health care systems: the closer the system is to single payer, the worst the medical care.  Ask the Dementia Taxed Britons or the Canadians fleeing south for their treatments.  Single payer advocates here in California should begin by explaining exactly which medical services they think people should do without.