Grace-Marie Turner is President of Galen Institute, dedicated to informing the public on issues concerning our healthcare system. On her website at galen.org, she recently spoke about the attitudes of students today in medical school, or in public health policy.  She says these young people are convinced that single-payer, government-run healthcare is the answer for the future healthcare of our country. They reject the idea of a market-based system that provides physician autonomy and patient choice.

Where are they going wrong?

It is said that “ignorance is bliss.” But what you don’t know can hurt you! These young people are clearly ignorant of the track record of single-payer healthcare systems that currently exist in the world. This would mean countries like Canada, United Kingdom, and Sweden.

Since it is clear that many people, especially these young students, need more information on the evils of single-payer systems, I have determined now is a good time to re-publish some of my previous posts that address this subject in depth. Therefore, today begins a series of posts re-published from the past, beginning with Single-Payer v. Market-Oriented Healthcare: Which is Better?, first published on June 12, 2017:

It has been their goal from the beginning. Progressives have been pushing for socialized medicine since the days of Teddy Roosevelt. In the politically correct world of healthcare terminology it is referred to as “single-payer” healthcare. There is no real debate happening in Congress right now between Democrats and Republicans on how to stop the collapse of ObamaCare. While Republicans favor a market-oriented system to correct the ObamaCare problems, Democrats deny the problems exist and demagogue the issue, trying to frighten the public. Their real goal is to let ObamaCare implode and then push for its replacement with a single-payer system. Which system is best for America’s future?

The Lancet Study

Chris Conover, writing in Forbes, reports a new study from the British medical journal Lancet that compares the two systems. This study adds to the growing mountain of evidence that market-oriented health care systems outperform the single-payer systems that so enamor progressives. This study compared healthcare outcomes in the single-payer systems of Canada and the United Kingdom (UK) with those of market-oriented systems in the Netherlands, Switzerland, Singapore, and the United States.

Single-payer systems rely on a command-and-control approach to healthcare that depends on price controls and government determined capacity constraints that predictably lead to long waiting lines and lower quality care. Market-oriented systems rely on markets to ensure universal access to high quality care at an affordable price. Switzerland uses private health insurance for all of its citizens, even the poor and the elderly, providing subsidies to purchase the insurance for those in most need.

The Lancet researchers, led by Christopher Murray, uses a measure called the Healthcare Access and Quality Index (HAQ Index) to focus on mortality related to adverse effects of medical treatment. This index measures the ability of countries to avoid “amenable mortality”; i.e., deaths that hypothetically would not occur with timely and effective medical care.

Conover says amenable mortality in the U.S. accounts for about one-fifth of mortality under age seventy-five in men and nearly one-third in women. Since there are over one million deaths a year in the U.S. among those under age 75, this implies there are more than one quarter million avoidable deaths annually.

This figure shows a comparison between single-payer systems in Canada and the UK on the left with market-oriented systems in Switzerland, Netherlands and Singapore on the right. The United States is depicted in the middle. Higher HAQ indexes are seen in green. To be sure, the numbers suggest that single-payer would be an improvement over the status quo (ObamaCare) but not nearly as good as the market-oriented systems in the countries on the right.

Conover has also isolated the “adverse effects of medical treatment” scores, which demonstrate that market-oriented health systems do even better at avoiding medical mistakes than single-payer countries. Contrary to intuition that might suggest more regulation by the government reduces mistakes, this study shows that greater reliance on market forces actually produces greater incentives to avoid errors. It is interesting that Singapore – which relies heavily on health savings accounts – performs the best of all on this measure.

Achieving Potential

The Lancet authors recognize that resources vary from country to country which may limit what can be achieved in avoiding preventable deaths. By these measures alone you could not expect the UK to have a HAQ Index as high as Switzerland, which has a GDP per capita twice as high as the UK. Yet despite these differences the market-oriented systems come closer to achieving their hypothetically attainable HAQ index scores than the single-payer systems. This is depicted in the graph below.

In this graphic we can see that the United States is functioning 11.1% below what it is capable of, which by the earlier calculations results in 250,00 preventable deaths per year. If these measurements are accurate it implies that conversion to a single-payer system like Canada would improve the HAQ Index and potentially save 150,000 lives per year compared to our status quo. However, conversion to a market-oriented system such as Switzerland would save an additional 100,000 lives or 250,000 lives over the status quo.

The status quo is unacceptable. No one wants to go back to the pre-ObamaCare days. America can do better. But the answer is not single-payer healthcare. The answer is a market-oriented health system that preserves freedom of choice to pick your doctor, your insurance coverage, and your treatment – and incentivizes doctors and hospitals to provide high quality care at the lowest possible cost. Such systems in countries like Switzerland, the Netherlands and Singapore are already providing high-quality healthcare at a lower cost to both government and patients than in America today.

(Author’s Note: More on single-payer, government-run healthcare in my next series of blogs.)

“The British are coming! The British are coming!” That was the cry of Paul Revere, warning the citizens of the approaching British army as the Revolutionary War began. Today, the warning to private schools might be “The students are coming! The students are coming!”

The reason for this warning is the growth of school choice legislation in many states. According to The Wall Street Journal, Indiana this year reported an increase of some 20% in its voucher program. More than 53,000 students participated in 2022-23, compared with 44,376 the previous school year, according to the state education department. Thirteen more private schools were included, bringing the total to 343. All of this was before the state made vouchers nearly universal in May by raising the income cap and removing other restrictions.

Florida also made its K-12 scholarships universal this year by removing income limits. Step Up for Students, a nonprofit administering organization, recently said it had awarded 268,221 income-based scholarships, up from 183,925 at the same time a year ago. The group said it also had granted 74,711 special-needs scholarships, an increase of some 15,000.

Arizona beat Florida by a year in making its education savings accounts, or ESAs, universal. The state says it approved 47,667 new student applications in 2023, compared with 5,103 before the expansion. Nearly 700 private schools receive ESA funds. West Virginia’s ESA program, open to any student already in public school, is entering its second year. The program has received 6,323 applications for the coming school term, up from roughly 3,600 last year, per the state Treasurer.

Iowa’s new ESA program received 29,025 applications during a month-long window, according to Gov. Kim Reynolds’s office. In Arkansas nearly 5,000 students and more than 80 schools have applied or begun applying to another new ESA system, the state Education Department says. Applications opened in late June and continue through July. The Iowa and Arkansas programs aren’t universal in the first year, but they’re likely to grow as they phase in broader eligibility.

There may be bumps in the road in some states to implement these new programs. A recent Manhattan Institute report points out that getting ESAs through the political thicket is only the first step. Many parents are unaware of the offerings in their states, and a law does little good if it isn’t implemented well. “We fear a program in which 100,000 families want to participate,” the authors write, “but cannot log in to the payment platform, or cannot track their expenditures, or cannot promptly pay the educational providers helping their children.” The mainstream media reluctance to promote anything the GOP does may hinder parents’ recognition of these programs.

Some states might also find that the demand exceeds the supply of seats in private schools. But in time, states that are generous with ESAs are encouraging a variety of options to expand or open, whether faith-based, classical, Montessori or something new, and with families choosing what works best for them. That’s what a future of school choice looks like.

Although school choice has been solely an issue pushed by GOP lawmakers, the support for these programs crosses the political aisle. Parents of both parties want their children to get the best possible education and school choice makes this realistic for even low economic status families. This issue alone turned Florida into a red state, instead of a purple one, in the first election of Governor Ron DeSantis. Now he has made school choice vouchers available to every Florida student, regardless of economic status. Democrats can’t seem to free themselves from their devotion to teachers unions or they would also jump on the school choice bandwagon.

The students are coming! The students are coming!

If you don’t like history, rewrite it. That seems to be the mantra of Progressives. They didn’t like the history of the founding of our country, so they rewrote it in The 1619 Project, an attempt to claim our country was founded by slave traders rather than those seeking religious freedom. The New York Times colluded with Progressives in that rewriting of history.

Recently I wrote two blogs about other attempts to rewrite history. Weingarten Rewriting History was about AFT teachers union president Randi Weingarten trying to rewrite the history of her collusion with the Biden Administration to control the re-opening of public schools to suit her political agenda. Fauci Rewriting History was about Dr. Anthony Fauci’s attempts to escape responsibility for his inaccurate and self-serving advice about Covid while serving as the country’s primary advisor for Covid policy.

Now, Progressives are attempting to rewrite the history of Florida’s response to the Covid pandemic in an attempt to discredit Florida Governor Ron DeSantis, who is campaigning for the presidency. They see him as a threat to the re-election of President Joe Biden, their progressive puppet in the White House. Since the strength of DeSantis is his record as governor, they want to rewrite the history of that record. Sadly, former President Trump is joining their efforts because he recognizes DeSantis is the only true threat to his winning the GOP primary.

This is not my opinion alone; it is the opinion of The Wall Street Journal editorial board. They say, “Progressives want Donald Trump to win the GOP nomination, which explains why they’re distorting Ron DeSantis’s Covid record. The press knows the Florida Governor’s opposition to lockdowns is a political selling point, so in Trumpian fashion they are rewriting history.”

They say Democrats have never forgiven Mr. DeSantis for defying the lockdown consensus and reopening his state in spring 2020. DeSantis and some other GOP Governors, notably Brian Kemp in Georgia and South Dakota’s Kristi Noem, broke ranks in early May by easing virus restrictions. Democrats denounced DeSantis for “letting it rip,” but he reopened the state in phases and took into account the healthcare system’s capacity to treat sick patients.

On May 4, restaurants and retail stores were allowed to open at 25% of capacity. Two weeks later Mr. DeSantis announced that theme parks, including Disney World, could submit plans to reopen as early as June if they could keep patrons safe. In June Mr. DeSantis gradually eased other restrictions. That summer Covid swept Florida and southern states that had largely dodged a first wave in the spring. But Mr. DeSantis, having examined the data and consulted scientists such as Stanford University’s Jay Bhattacharya, refused to shut down businesses. Instead, he focused on protecting the elderly who faced immensely higher risk.

Seniors over the age of 75 years were hundreds of times more likely to die of Covid than young adults. And lockdowns disproportionately harmed young people who were more likely to die of drug overdoses than Covid. The public-health clerisy focused narrowly on virus risks, ignoring the social, economic and psychological damage from lockdowns.

Not least of these was learning loss from school closures, which may never be made up. Mr. DeSantis was among the few Governors to reopen schools for in-person learning in autumn 2020 despite opposition from the teachers’ unions. His reopening mitigated learning loss and helped parents return to work.

Mr. DeSantis’s strategy of focused protection was articulated in the Great Barrington Declaration, which progressives still revile despite its vindication. To date, over 937,000 healthcare providers and scientists have signed the declaration in support of its conclusions. In 2020 Florida had the tenth lowest age-adjusted Covid death rate in the country, which was nearly 20% lower than California’s despite the Golden State’s prolonged lockdown.

Florida experienced a lower Covid death rate than most states in late 2021 and early 2022. The press likes to cherry-pick data and focus on discrete periods to present Mr. DeSantis as a grim-reaper. But Florida’s overall age-adjusted Covid death rate during the pandemic is 13% lower than the U.S. average and about the same as California’s. Progressives and Mr. Trump also won’t concede that Mr. DeSantis’s Covid strategy proved to be an economic boon. Between April 2020 and July 2022, 622,476 people moved to Florida from other states, including families who wanted children in school. Employment in Florida has grown by 7.4% since January 2020 versus 2.5% in California and a 1.2% decline in New York.

More people are moving to Florida than any other state. More people are moving out of California than any other state.These facts alone should make people question anything progressives say since California is run by the very progressive Governor Gavin Newsom.

The WSJ editors summarize this history rewriting well: “The lockdown damage continues, but progressives can’t admit they were wrong. Nor can Mr. Trump. So they are trying to take down Mr. DeSantis for being right.”