Health care reform affects many aspects of a nation: social, economic, scientific, and cultural. Prior to implementing a new health care system, it can be difficult to predict what its effects will be. One of the best ways to envision life with government-run health care system in the U.S. is to look at Britain and Canada. Both countries are similar to the U.S. in many ways. And they rely on government-run health care systems: Britain created the National Health Service (NHS) in 1948, and Canada began implementing a single-payer system in 1966. In this section, scholars examine the systems in both countries and explain the negative consequences their citizens have experienced. Americans would be wise to look at their neighbors before implementing an irreversible single-payer system.
Though Britons are proud of the NHS, they are also aware of its shortcomings. British patients suffer from long waiting lists and difficulty scheduling an appointment. In 2011, there were 2.6 million patients waiting for treatment; by 2019 that number had ballooned to more than 4 million, including patients in pain or with life-threatening conditions. The NHS is below average internationally when it comes to preventing deaths from heart attacks, strokes, cancer, and lung diseases. The system has also stifled innovation and delayed the adoption of new drugs. For example, Herceptin, a breast cancer drug that was available in the U.S. in 1998 was not available in Britain until 2002. Meanwhile, the improvement that the NHS has seen comes largely from cooperation with private sector. Unfortunately, even a government system riddled with problems is not cheap—the NHS is projected to receive 38 percent of all government spending by 2024.
Likewise, the Canadian single-payer system should serve as a warning to the American public. International comparisons indicate that Canada achieves only mediocre, and even poor, performance scores for access to, and timeliness of, health care. Like the British, Canadians suffer from long waiting lists, outdated drugs, and understaffed hospitals. While it claims to be universal, Canada’s government-run health care fails to cover many medical needs, and a third of health care spending ends up being covered privately. Of course, Canada’s public health system is not cheap, either: Canadians pay up to 51 percent more in taxes than Americans, yet out-of-pocket health costs are close to what Americans pay, even though Canada covers only marginally more than the U.S. Ultimately, the Canadian system should serve as a lesson in over-bureaucratization at a very high cost.
In Section 4, scholars residing in Britain and Canada examine the problems and tradeoffs of their health systems. Close examination of Britain’s and Canada’s health care approaches is warranted given that some leading American politicians and analysts who favor single-payer health care point to them as models. A realistic look at the systems of their Canadian neighbors and British friends will cause Americans to pause before adopting such a sweeping government takeover of health care.