How Single-Payer Healthcare Kills: The Charlie Gard Case Study
If you haven’t heard, Charlie Gard’s parents announced they will no longer fight to have him treated for his illness. They have surrendered because so much time has passed, and in that time his condition has deteriorated. Had they been allowed to take him to the United States for treatment when they first wanted to, or even any time during the months that followed, he would have had a great chance. Many doctors who specialize in Charlie’s condition, including leaders in that field, wanted to treat him and said his case was promising. However, because the courts and the hospital refused to let him go, he is now past the point of no return. Time was of the essence, and the courts wasted time until it was gone.
What does this have to do with single-payer healthcare? That’s the system the U.K. has. Some would like us to follow their lead. Here is how that system has effectively killed Charlie Gard (barring a completely miraculous recovery):
Doctors earn less. Under single-payer healthcare, the government takes over. In order to make the costs manageable, doctors are paid lower salaries. Now, most doctors in America make a lot of money. This isn’t about whether they get paid “enough” to meet their expenses. It’s about whether they are paid enough to keep them in the country.
Doctors leave. The highest-skilled doctors, the leaders of the various fields, the experts. They will leave. Other countries will offer them higher salaries, better conditions. Others may leave the system, choosing to work in private practices and accept only out-of-pocket fees from wealthy patients. Others may leave the profession for something that is less demanding or better paying. Still others may never enter at all, realizing the government-regulated salaries will not make their years of school and massive debt worth it in the long run.
The system overloads. With more patients than ever and fewer doctors, plus the inefficiency of any government-run program, we encounter a shortage of medical care. This results in long wait times for routine procedures, or even just for a check-up. Patients like Charlie with time-sensitive conditions may not see the right specialist until it is too late. Just like we saw with the poor management of the VA hospitals, patients may die waiting for care.
Innovation grinds to a halt. With the leaders of medical innovation moving to countries that offer better working conditions and salaries, and with remaining doctor prioritizing efficiency and standardization in order to see as many patients as possible, medical progress will become stagnant. Hospitals in a country with single-payer healthcare cease to be state-of-the-art. They fall behind on new treatments and procedures.
Patients leave. Or they try to. Those with complex conditions requiring skilled specialists, who can afford it, will head to other countries to find those specialists. They’re not in the local hospitals. They were driven out by bureaucracy and stagnation.
This is where Charlie Gard comes in. His parents knew that doctors in America had treated similar conditions and were willing to treat Charlie. All they asked was for permission to try. They were denied, first by the hospital, then by the courts. Why?
The hospital first said the treatment was futile. Charlie was too far gone. We know this to be false based on the reports of other doctors who examined Charlie and his scans. The treatment had a reasonable chance of working. Then they said he wouldn’t be able to survive the trip. Both of these arguments make no sense, as the alternative was to let him die. Even when doctors in America offered to send the treatment and protocol to the Great Ormond Street Hospital, where Charlie was, they still refused. They went back to claiming it was futile, and was only prolonging Charlie’s suffering. Only all medical evidence said he wasn’t in any pain or suffering in his current condition.
Why, then, did they refuse? A few reasons:
Single-payer systems offer no incentives to save lives. Lengthy hospital stays and complicated treatments are a drain on the system. To the bureaucrats, a patient with a severe condition and a low chance of recovery looks like a waste of resources. Better to say the condition is irreversible and untreatable.
Single-payer systems offer no incentives for patient-centered care. In order to keep up with demand for care with a shortage of doctors, single-payer systems turn to a maximum-efficiency model. Patients receive standardized, one-size-fits-all care, whether or not it’s what they need. Giving Charlie Gard an experimental treatment doesn’t fit in that model.
Losing patients to other countries makes the system look bad. When patients start leaving the country to seek high-quality care, the international community is forced to recognize that the system has failed, and that other systems with less government involvement are leading medical progress. This can exacerbate the problems mentioned earlier, especially the problem of doctors leaving the system. If you are specializing in your field, and you realize that patients in your field are leaving to go elsewhere for care, where will you go? As doctors leave or lower their standards to keep up with demand, wait times increase and patient care suffers.
Once again, patients find themselves in a system where anyone outside the very wealthy receives either substandard care or no care at all. Except now, their incomes have been slashed to pay for this poor or nonexistent care, and they are no longer given the choice to leave. Now, bureaucrats are deciding who gets life-saving treatment and who dies while waiting to see a specialist. Courts drag out appeals until time runs out.
Your rights are gone. The government now controls your life: your income, your health, your freedom.
Charlie Gard is a victim of government-controlled health care. Let him be the last.
So what system do we need instead?