Popularity of Single Payer

In my recent post criticizing the single payer model of health care, I left out an important component of the affirmative argument for single payer: the popularity of such systems where in place. There are two questions to ask here:

1.) Are single payer systems actually popular where in place?

2.) Does this mean that single payer is a successful model?

To the first question, the answer is complicated. I was able to find some data from the Commonwealth Fund that does shed some light. They asked people in various if they thought their respective health care systems needed minor changes, fundamental changes, or total rebuilding.

In Canada, which sports the model of single payer that advocates in the USA often want to emulate, the results indicate that only 10% of Canadians are willing to say they want to completely rebuild their system. Only 38%, however, said only minor changes are needed. That leaves a majority (51%) of Canadians saying that their system needs "fundamental change". That isn't terrible, but it is hardly the picture of a popular health care system.

It only looks popular in comparison to the USA. Here, 27% say complete rebuilding is necessary, 42% say fundamental changes are needed, and 29% say only minor changes are needed. Canada's numbers look a good deal better when put into this context.

However, a study that I linked to in my last post on single payer provides data regarding a different but closely related question: how people feel about the care they personally receive. Here, the numbers are quite different. 51% of Americans aged 18-64 report being very satisfied with the health care services they receive. For Canadians, only 42% of those aged 18-64 report being very satisfied with their health care services. For people over 65, the results are closer but even here the USA comes out on top.

In other words, Canadians like their system more than Americans like their system, but Canadians are less positive about the care that they personally receive than are Americans about the care that they receive.

This moves to the second question I posed above. The popularity of a given system is, in my view, shaped more by perception than reality.

I've been to countries with single payer health care, and there is a sort of "health care nationalism". Criticism of the NHS or Canadian Medicare are seen as unpatriotic. The medias in these countries lavish praise upon these systems constantly. By contrast, within America, criticism of the system is universal. Indeed, defenders of the USA status quo in health care are often seen as contrarians.

The people in countries with single payer generally know that these systems have great flaws which is why, at least in Canada, they aren't keen on the service they personally receive. Despite this, they still tend to believe that their system is pretty good. Another reason for this is that most people never encounter any other health care systems other than their own. So, most people really don't know what other health care models are actually like.

Another simple reality is that in systems of single payer, care is free at the point of delivery. Care still costs money, but most of it is paid through taxes. From the point of view of many people in these systems, I would imagine, the care simply seems "free". There is so little direct connection between the costs of health care and benefits of health care that people in these systems only see the benefits. They still bare the costs through taxation, but the connection is often not made. People are more willing to look past the flaws of a system that they think is "free" than a system that they do see the costs for.

This also explains the popularity of Medicare (USA Medicare). People see the benefits, but they don't see the costs. The costs are there, but they are harder to see for the average American.

Single payer health care systems only seem more popular than other models because of perception among the public and how far removed users of the systems are from the costs of the systems. The argument for single payer from popular opinion can be added to the long list of bad arguments for single payer.