Let's leave aside for a moment the simple fact that "single payer" is synonym for "you've gotta pay for everybody's drug rehab," and focus on what happens when government runs the health care financing system.
Below is an interesting story from Turkey that just caught my eye.
Many people I know there think it's obvious that health care ought to be paid for by the government. And, as far as I know, with the recent changes, most people's health care expenses really are paid for by the government.
I do not follow this very closely, but there are now things like government appointed family doctors (yes, you must tell the most intimate aspects of your life to a government appointed bureaucrat, cause only the very rich can afford to be outside the system), apartment buildings being required to employ health care professionals etc.
The crucial difference between a good being provided by private individuals in the marketplace versus it being provided by a central government is in information requirements.
In the private marketplace, you only need to know if the next cup of coffee you're going to buy is worth the price. The coffee-shop owner only needs to know if she's selling enough coffee at the current price.
Through tens of millions of people's independent decisions, a particular price for a certain amount of hot, freshly made coffee dominates the marketplace. No one involved in this market needs to know your entire preferences over not just amounts of coffee during the entire day, but also your preferences of combinations over both substitutes and complements for coffee.
the "right" price of coffee is when every person who wants to buy a cup of coffee at the prevailing price can get it, and everyone who wants to sell at that price can sell. Free people's interactions in the marketplace brings about this price. If a central government had to decide on the "right" price of a cup of coffee, it would need to collect and process a lot of information.
Not only would the government need to know how much coffee you like in combination with all sorts of foods, but it would also need to know your preferences for all other stimulants, ranging from tea to cocaine.
So, it's no wonder, when the government decides the right price for health services, it needs to collect increasingly intimate details from citizens in a centralized database. Ayşe Arman's column titled
This is how we're being tracked (Google translation) shows an incredible form which collects the following information about a woman in a single place:
- National ID number
- Date of birth
- Blood type
- Social insurance type
- Age at first menstruation
- Periodicity and regularity of menstruation
- Is menstruation painful?
- Age at menopause
- Number of pregnancies
- Number of live births
- Number of still births
- Habits, including, smoking, alcohol use, drug use, medications
- Emigration/immigration/internal migration details
- Name and other details about the spouse
- Information on various diseases, including mental
- Detailed history on pregnancies
Now, I can understand, when you go to a doctor with a specific complaint, that doctor may want to know about some or all of this information.
However, apparently, the practice in Turkey now is to require that you provide this information as a condition of being able to visit a doctor. Your "family doctor" (government appointed) passes the information along to the Ministry of Health, who then puts it in a central database. It becomes part of your permanently held government file.
I usually hesitate to give examples from my experience under central planning in Turkey during my formative years, because people invariably assume that the fact that there was no coffee, no tea, no sugar, no gasoline, no butter, no lightbulbs, no Matchbox cars on store shelves (only in the black market, only if you knew the right people) was due to Turks being stupid or some such inane interpretation.
But that's wrong: People are fundamentally similar. They respond to incentives. Central planning ruins the best incentive mechanism in which humanity has ever participated: A free and open marketplace.
If a central government were to control the entire marketplace for coffee, the it would, necessarily, require you to fill updated forms in triplicate regarding your stimulant preferences every month. You'd pay 10% of your income to ensure that the government provided adequate morning stimulants to everyone. There would not be enough coffee, and whatever coffee you could find after bribing the right people would still taste like crap.
If a central government were to control the entire marketplace for your healthcare, the government would require you to fill updated forms regarding your most intimate details every chance they got, and there would not be enough pills, operating rooms, sterile this, that, and the other for everyone.
Today, most progress in medications and treatments happens because of the rewards these companies expect to be able earn in the U.S. Every other country with a centralized health care industry free rides on the existence of this one market with somewhat private incentives.
Once that is gone, we will have ceded control over our lives to a bunch of bureaucrats. We know there will be less innovation, fewer breakthroughs, but we will never know what could have been.
It took the USSR about 70 years to collapse. Europe is getting there much faster, mainly owing to the fact that they were able to free-ride on U.S. contributions to their economies in the post-World War II world, ensuring they had no resiliency.
There is no reason to take their paths now.