We have entered the twilight zone. Bernie Sanders is pushing for a greater federal role in U.S. healthcare even as we watch the collapse of government-run healthcare in Great Britain and Canada 

While single payer, socialized medicine, Beveridge model, Medicare-for-All, Medicare Extra For All, universal healthcare, and National Health Service (NHS, Great Britain) have minor technical differences, fundamentally they are all government healthcare, where bureaucrats – not patients – make medical as well as spending decisions. 

Great Britain

Three weeks ago, the Guardian confirmed a growing exodus of senior physicians and surgeons from Great Britain relocating to other countries. The on-going British doctor shortage comes as no surprise. British doctors went out on strike in 2016, and since then, their dissatisfaction with the NHS has only gotten worse. 

Wait times for NHS care have been medically dangerous for years and are getting longer. Delays in diagnosis and treatment of cancer and heart disease result in avoidable, unnecessary deaths. 

In January 2018, the NHS announced cancellation of “50,000 scheduled surgeries” due to insufficient staff and/or facilities. There is no evidence these insufficiencies have been addressed. 

Patients can’t get care without doctors.

Bureaucracies defend themselves. The NHS is no exception. For years, death rates for children undergoing heart surgery at the Bristol Royal Infirmary were unacceptable. Yet NHS officials suppressed the information, altered reports of results, and continued to allow the low-quality surgeons to operate. When this scandal finally broke, an investigation ensued. Two Bristol surgeons were fired. The institution was placed on probation. Changes in the NHS recommended by the Bristol Report were not implemented. 

British government (NHS) decides life and death, like Sarah Palin’s infamous “death panels.” The NHS forced a mentally impaired woman to have an abortion against her will. The British High Court mandated withdrawal of life support in two babies – Charlie Gard and Alfie Evans – against the parents’ wishes. The government pays bonuses to doctors and nurses who put patients on lists for euthanasia.

In a 2020 opinion piece defending government rationing of medical care, journalist Ezra Klein claimed, “UK has one of the most equitable health care systems in the world.” If he means people are dying equally while waiting in line for care, then he is accurate. Such misguided sentiments call to mind Winston Churchill’s famous 1945 comparison. “The inherent vice of capitalism is the unequal sharing of blessings. The inherent virtue of socialism is the equal sharing of its miseries.”

Canada

Canada suffers from similar systemic problems. 

Recent data reveal that Canadians with known heart disease wait a median of four months before starting treatment. Those needing neurosurgery have to wait more than a year, many immobilized by severe back pain. 

Because of the excessively long waits for care in Canada, many cancer patients come to the U.S. where care for them is more timely, not what it should be but better than Canada. 

Just as in Great Britain, medically dangerous wait times in Canada are nothing new. There were “crisis” reports in 2007 and in 2017. Nothing changed except wait times got longer. 

Like the NHS, Canadian federal healthcare defends itself against charges of poor quality. When senior surgeon Ciaran McNamee offered data on medically unacceptable surgical wait times and resulting deaths, his charges were ignored, and he became the problem. Dr. McNamee was forced out of his job as Chief of Thoracic Surgery and eventually had to leave Canada, moving to a prestigious position in the Harvard system. 

There was no public investigation of McNamee’s claims. 

Just as with Great Britain, Canada’s healthcare system can override a patient’s wishes. “Canada's Supreme Court has ruled that ... a government board, not the family or doctors, has the ultimate power to pull the plug on a patient.” 

USA

National healthcare in Great Britain and in Canada spend within sustainable limits. The same is not true of the proposed American version of federal healthcare, Medicare-for-All. Senator Sanders admitted that M-4-All would cost $30-40 trillion over ten years. The combined GDP of all nations on planet earth was $104 trillion in 2022. 

If the U.S. moves to greater federal control of healthcare, patients will suffer as BARRCOME expands even further (bureaucracy, administration, rules, regulations, compliance, oversight, mandates, and enforcement). BARRCOME wastes trillions of “healthcare” dollars taking them away from patient care to pay bureaucrats. Such “bureaucratic diversion” can turn wait times, currently in months, into years, resulting in more death-by-queue. 

It is ironic that the phrase death-by-queue – dying while waiting for care – was based on experience from Great Britain’s single payer. 

Federal BARRCOME imposes a huge drain on providers’ time and resources. Time filling out forms and complying with administrative mandates is time doctors cannot spend with patients. 

Expansion of the role of Washington in healthcare will shrink the already dangerously low number of care providers, especially those who currently willing to accept government insured (Medicaid) patients. A recent poll found that 20 percent of senior U.S. physicians are planning to leave clinical medicine. When asked why, three answers are given: the regulatory burden, responsibility without authority (bureaucrats telling doctors what they can and cannot do), and low valuation of their work, demonstrated by ever shrinking “allowable reimbursements.”  

Conclusion

Federal healthcare makes a mockery of medical freedom. Bureaucrats decide what drugs patients can have; when, where, what, and if a patient will have a procedure; how to spend your care dollars; and, they choose your doctor, you don’t. 

Based on extensive outcomes data, direct experience, and abrogation of legally and constitutionally protected medical autonomy, Americans should reject any form of federal healthcare, starting with what we have now. 

The U.S. needs patient-controlled healthcare, not Washington mandated death-by-queue. 

Deane Waldman, M.D., MBA is Professor Emeritus of Pediatrics, Pathology, and Decision Science; former Director of the Center for Healthcare Policy at Texas Public Policy Foundation; and author of the multi-award winning book Curing the Cancer in U.S. Healthcare: StatesCare and Market-Based Medicine.

Public domain image by Creazilla