Tag Archives: Wait Time

What Americans don’t know about Canada’s single-payer health care system

Price of healthcare per Canadian household (Source: Fraser Institute)
Price of healthcare per Canadian household (Source: Fraser Institute)

I post a lot of research from Canada’s Fraser Institute, but they are not the only think tank that publishes research on the efficiency and costs of single payer health care in Canada. This time, I found a report from the Heritage Foundation, where they go over quality of care, taxes, out of pocket costs, coverage, rationing, waiting lists, staff shortages, substandard equipment, and outdated drugs.

Here’s the report from the Heritage Foundation. I’ll focus on the differences.

Canadians pay slightly less in out of pocket costs:

The OECD calculates that Canadians spend 1.6 percent of GDP on out-of-pocket health spending, compared to 1.9 percent in the U.S.

[…]While these numbers are very close, they are actually getting closer. Since 1970, U.S. out-of-pocket spending as a percentage of total medical spending has been falling steadily, from 33 percent in 1970 to about 10 percent in 2017.19

Meanwhile, Canadian out-of-pocket spending has been falling much slower, so that by 2016 it totaled 15 percent of total medical spending—a higher proportion than in the U.S.20

 As a result, Statistics Canada warned in early 2020 that the percentage of Canadians experiencing large out-of-pocket burdens is growing, writing that “[b]etween 1998 and 2009…the percentage of households spending more than 10% of their total after-tax income on health care rose by 56%.”

Canadians pay more in federal and state taxes:

Federal taxation excluding social security contributions, then, comes to 28 percent of GDP in Canada, compared to just 19 percent in the U.S.—meaning 51 percent more.

[…]This excess taxation is largely a result of health spending, which has bloated provincial budgets to nearly three times the taxes of U.S. states.

Provincial taxes have grown to nearly the same level as federal taxation. Meanwhile, provincial health costs have risen to fully 37 percent of provincial budgets in 2016—up from 33 percent in 1993 – —and range as high as 42 percent.

Canada’s Fraser Institute has estimated this excess tax burden from public health costs at roughly $9,000 for a household of two adults with or without children or $750 per month in additional taxes.

When I wanted an MRI I was scheduled the same week
When I wanted an MRI I was scheduled the same week

Canadians wait far longer for treatment than Americans:

Medical waiting times have become a national crisis in Canada, and continue to worsen. The average wait time for medically necessary treatment between referral from a general practitioner and a consultation with a specialist was 8.7 weeks in 2018, 136 percent longer than in 1993. Patients then have to wait again between seeing the specialist and the actual treatment, another 11 weeks on average, 97 percent longer than in 1993.

From referral to treatment, then, it takes an average of 19.8 weeks (see Chart 2) to be treated, in addition to the original wait to see the family doctor in the first place—this for “medically necessary” treatment, not cosmetic surgery.

In contrast, nearly 77 percent of Americans are treated within four weeks of referral, and only 6 percent of Americans report waiting more than two months to see a specialist.

As for appointments, a 2017 survey of American physicians in the 15 largest U.S. cities found that it took just 24 days on average to schedule a new-patient physician appointment, including 11 days for an orthopedic surgeon and 21 days for a cardiologist.

As a result of these long waits, by one recent estimate, at any given moment, over one million Canadians—3 percent of the entire population—are waiting for a medical treatment.

These lists can average six months, and often much longer in rural areas, which tend to suffer from doctor shortages so severe that many do not even have a family doctor. Overall, 15 percent of Canadians did not have a regular health care provider in 2017.

The shortages ripple through the system; one doctor in Ontario called in a referral to the local hospital, only to be told there was a four-and-a-half year wait to see a neurologist.

In Canada, people die or become inoperable on waiting lists:

A Montreal man was finally called for his long-delayed urgent surgery two months after he had died. One 16-year-old boy in British Columbia waited three years for an “urgent” surgery, during which time his condition deteriorated so much that he became a paraplegic.

Canadians have to travel abroad to countries with functioning health care systems in order to be treated:

These cases are, unfortunately, not isolated; a survey of specialists found that average wait times exceed what is deemed clinically “reasonable” for fully 72 percent of conditions in Canada. The situation continues to worsen every year: In 1994, the average gap between clinically reasonable delay and actual delay was only four days, and by 2018 had grown to 23 days.

[…]With one million waiting, many Canadians turn in desperation to U.S. health care—the very system some U.S. policymakers propose to transform. In 2017 alone, Canadians made 217,500 trips to other countries for health care, of which 52,500 were to the U.S., paying out of pocket to skip the waiting.

Outdated equipment, outdated drugs, staff shortages:

 While the average employer-sponsored private insurance plan in Canada covers between 10,000 and 12,000 drugs, most public plans in Canada only cover 4,000. Canada has 35 percent fewer acute care beds than the U.S., and only one-fourth as many magnetic resonance imaging (MRI) units per capita—indeed, it has fewer MRI units per capita than Turkey, Chile, or Latvia.

[…]Some common treatments are simply unavailable to Canadians. For new pharmaceuticals, for example, Canada’s policy of forcing down prices so that American consumers essentially pay for Canada’s research and development has led to years-long delays for Canadian patients.

[…]Cutting corners on facilities and using outdated drugs show up in Canadian mortality rates. Thirty-day in-hospital mortality rates in Canada are 20 percent higher than in the U.S. for heart attacks, and nearly three times the U.S. level for strokes. Cancer age-standardized mortality is 10 percent higher in Canada than in the U.S.—despite far healthier lifestyles.

[…]When it comes to personnel, Canada underspends on medical staff and doctors, ranking 29th out of 33 among high-income countries for doctors per 1,000 population, accounting for a large part of those wait times. Canada has half as many specialist physicians per capita as the U.S.

[…]With such shortages and waiting lists, Canadian emergency rooms are packed. So packed that Canadians sometimes just give up and go home. Of Canadian ER visitors who are seen, 29 percent report wait times of over four hours, three times the U.S. level.

[…]Canadian seniors are 65 percent more likely to have visited the emergency room (ER) four or more times in the past year than American seniors.

Ultimately, nearly 5 percent of Canadian ER visitors end up leaving without ever being treated, giving up on a medical system that is perennially “free” but out of stock at the moment. In one study at two ERs in Alberta, 14 of the 498 walkaways were subsequently hospitalized, and one died within the week.

And keep in mind how things work in a single payer system. You pay up front through your taxes. The harder you work, the more you pay into the system. When you want treatment, you just get in line behind people who never paid one dime into the system – like all those low-skill refugees that Canada imports from Middle Eastern countries to build up the socialist voting bloc.

Canada’s single payer health care: pay up front, take a number and wait until you die

Price of healthcare per Canadian household (Source: Fraser Institute)
Price of healthcare per Canadian household (Source: Fraser Institute)

I post a lot of research from Canada’s Fraser Institute, but they are not the only think tank that publishes research on the efficiency and costs of single payer health care in Canada. This time, I found a report from the Heritage Foundation, where they go over quality of care, taxes, out of pocket costs, coverage, rationing, waiting lists, staff shortages, substandard equipment, and outdated drugs.

Here’s the report from the Heritage Foundation. I’ll focus on the differences.

Canadians pay slightly less in out of pocket costs:

The OECD calculates that Canadians spend 1.6 percent of GDP on out-of-pocket health spending, compared to 1.9 percent in the U.S.

[…]While these numbers are very close, they are actually getting closer. Since 1970, U.S. out-of-pocket spending as a percentage of total medical spending has been falling steadily, from 33 percent in 1970 to about 10 percent in 2017.19

Meanwhile, Canadian out-of-pocket spending has been falling much slower, so that by 2016 it totaled 15 percent of total medical spending—a higher proportion than in the U.S.20

 As a result, Statistics Canada warned in early 2020 that the percentage of Canadians experiencing large out-of-pocket burdens is growing, writing that “[b]etween 1998 and 2009…the percentage of households spending more than 10% of their total after-tax income on health care rose by 56%.”

Canadians pay more in federal and state taxes:

Federal taxation excluding social security contributions, then, comes to 28 percent of GDP in Canada, compared to just 19 percent in the U.S.—meaning 51 percent more.

[…]This excess taxation is largely a result of health spending, which has bloated provincial budgets to nearly three times the taxes of U.S. states.

Provincial taxes have grown to nearly the same level as federal taxation. Meanwhile, provincial health costs have risen to fully 37 percent of provincial budgets in 2016—up from 33 percent in 1993 – —and range as high as 42 percent.

Canada’s Fraser Institute has estimated this excess tax burden from public health costs at roughly $9,000 for a household of two adults with or without children or $750 per month in additional taxes.

When I wanted an MRI I was scheduled the same week
When I wanted an MRI I was scheduled the same week

Canadians wait far longer for treatment than Americans:

Medical waiting times have become a national crisis in Canada, and continue to worsen. The average wait time for medically necessary treatment between referral from a general practitioner and a consultation with a specialist was 8.7 weeks in 2018, 136 percent longer than in 1993. Patients then have to wait again between seeing the specialist and the actual treatment, another 11 weeks on average, 97 percent longer than in 1993.

From referral to treatment, then, it takes an average of 19.8 weeks (see Chart 2) to be treated, in addition to the original wait to see the family doctor in the first place—this for “medically necessary” treatment, not cosmetic surgery.

In contrast, nearly 77 percent of Americans are treated within four weeks of referral, and only 6 percent of Americans report waiting more than two months to see a specialist.

As for appointments, a 2017 survey of American physicians in the 15 largest U.S. cities found that it took just 24 days on average to schedule a new-patient physician appointment, including 11 days for an orthopedic surgeon and 21 days for a cardiologist.

As a result of these long waits, by one recent estimate, at any given moment, over one million Canadians—3 percent of the entire population—are waiting for a medical treatment.

These lists can average six months, and often much longer in rural areas, which tend to suffer from doctor shortages so severe that many do not even have a family doctor. Overall, 15 percent of Canadians did not have a regular health care provider in 2017.

The shortages ripple through the system; one doctor in Ontario called in a referral to the local hospital, only to be told there was a four-and-a-half year wait to see a neurologist.

In Canada, people die or become inoperable on waiting lists:

A Montreal man was finally called for his long-delayed urgent surgery two months after he had died. One 16-year-old boy in British Columbia waited three years for an “urgent” surgery, during which time his condition deteriorated so much that he became a paraplegic.

Canadians have to travel abroad to countries with functioning health care systems in order to be treated:

These cases are, unfortunately, not isolated; a survey of specialists found that average wait times exceed what is deemed clinically “reasonable” for fully 72 percent of conditions in Canada. The situation continues to worsen every year: In 1994, the average gap between clinically reasonable delay and actual delay was only four days, and by 2018 had grown to 23 days.

[…]With one million waiting, many Canadians turn in desperation to U.S. health care—the very system some U.S. policymakers propose to transform. In 2017 alone, Canadians made 217,500 trips to other countries for health care, of which 52,500 were to the U.S., paying out of pocket to skip the waiting.

Outdated equipment, outdated drugs, staff shortages:

 While the average employer-sponsored private insurance plan in Canada covers between 10,000 and 12,000 drugs, most public plans in Canada only cover 4,000. Canada has 35 percent fewer acute care beds than the U.S., and only one-fourth as many magnetic resonance imaging (MRI) units per capita—indeed, it has fewer MRI units per capita than Turkey, Chile, or Latvia.

[…]Some common treatments are simply unavailable to Canadians. For new pharmaceuticals, for example, Canada’s policy of forcing down prices so that American consumers essentially pay for Canada’s research and development has led to years-long delays for Canadian patients.

[…]Cutting corners on facilities and using outdated drugs show up in Canadian mortality rates. Thirty-day in-hospital mortality rates in Canada are 20 percent higher than in the U.S. for heart attacks, and nearly three times the U.S. level for strokes. Cancer age-standardized mortality is 10 percent higher in Canada than in the U.S.—despite far healthier lifestyles.

[…]When it comes to personnel, Canada underspends on medical staff and doctors, ranking 29th out of 33 among high-income countries for doctors per 1,000 population, accounting for a large part of those wait times. Canada has half as many specialist physicians per capita as the U.S.

[…]With such shortages and waiting lists, Canadian emergency rooms are packed. So packed that Canadians sometimes just give up and go home. Of Canadian ER visitors who are seen, 29 percent report wait times of over four hours, three times the U.S. level.

[…]Canadian seniors are 65 percent more likely to have visited the emergency room (ER) four or more times in the past year than American seniors.

Ultimately, nearly 5 percent of Canadian ER visitors end up leaving without ever being treated, giving up on a medical system that is perennially “free” but out of stock at the moment. In one study at two ERs in Alberta, 14 of the 498 walkaways were subsequently hospitalized, and one died within the week.

And keep in mind how things work in a single payer system. You pay up front through your taxes. The harder you work, the more you pay into the system. When you want treatment, you just get in line behind people who never paid one dime into the system – like all those low-skill refugees that Canada imports from Middle Eastern countries to build up the socialist voting bloc.

Canada’s single payer health care: pay up front, take a number and wait until you die

Price of healthcare per Canadian household (Source: Fraser Institute)
Price of healthcare per Canadian household (Source: Fraser Institute)

I post a lot of research from Canada’s Fraser Institute, but they are not the only think tank that publishes research on the efficiency and costs of single payer health care in Canada. This time, I found a report from the Heritage Foundation, where they go over quality of care, taxes, out of pocket costs, coverage, rationing, waiting lists, staff shortages, substandard equipment, and outdated drugs.

Here’s the report from the Heritage Foundation. I’ll focus on the differences.

Canadians pay slightly less in out of pocket costs:

The OECD calculates that Canadians spend 1.6 percent of GDP on out-of-pocket health spending, compared to 1.9 percent in the U.S.

[…]While these numbers are very close, they are actually getting closer. Since 1970, U.S. out-of-pocket spending as a percentage of total medical spending has been falling steadily, from 33 percent in 1970 to about 10 percent in 2017.19

Meanwhile, Canadian out-of-pocket spending has been falling much slower, so that by 2016 it totaled 15 percent of total medical spending—a higher proportion than in the U.S.20

 As a result, Statistics Canada warned in early 2020 that the percentage of Canadians experiencing large out-of-pocket burdens is growing, writing that “[b]etween 1998 and 2009…the percentage of households spending more than 10% of their total after-tax income on health care rose by 56%.”

Canadians pay more in federal and state taxes:

Federal taxation excluding social security contributions, then, comes to 28 percent of GDP in Canada, compared to just 19 percent in the U.S.—meaning 51 percent more.

[…]This excess taxation is largely a result of health spending, which has bloated provincial budgets to nearly three times the taxes of U.S. states.

Provincial taxes have grown to nearly the same level as federal taxation. Meanwhile, provincial health costs have risen to fully 37 percent of provincial budgets in 2016—up from 33 percent in 1993 – —and range as high as 42 percent.

Canada’s Fraser Institute has estimated this excess tax burden from public health costs at roughly $9,000 for a household of two adults with or without children or $750 per month in additional taxes.

When I wanted an MRI I was scheduled the same week
When I wanted an MRI I was scheduled the same week

Canadians wait far longer for treatment than Americans:

Medical waiting times have become a national crisis in Canada, and continue to worsen. The average wait time for medically necessary treatment between referral from a general practitioner and a consultation with a specialist was 8.7 weeks in 2018, 136 percent longer than in 1993. Patients then have to wait again between seeing the specialist and the actual treatment, another 11 weeks on average, 97 percent longer than in 1993.

From referral to treatment, then, it takes an average of 19.8 weeks (see Chart 2) to be treated, in addition to the original wait to see the family doctor in the first place—this for “medically necessary” treatment, not cosmetic surgery.

In contrast, nearly 77 percent of Americans are treated within four weeks of referral, and only 6 percent of Americans report waiting more than two months to see a specialist.

As for appointments, a 2017 survey of American physicians in the 15 largest U.S. cities found that it took just 24 days on average to schedule a new-patient physician appointment, including 11 days for an orthopedic surgeon and 21 days for a cardiologist.

As a result of these long waits, by one recent estimate, at any given moment, over one million Canadians—3 percent of the entire population—are waiting for a medical treatment.

These lists can average six months, and often much longer in rural areas, which tend to suffer from doctor shortages so severe that many do not even have a family doctor. Overall, 15 percent of Canadians did not have a regular health care provider in 2017.

The shortages ripple through the system; one doctor in Ontario called in a referral to the local hospital, only to be told there was a four-and-a-half year wait to see a neurologist.

In Canada, people die or become inoperable on waiting lists:

A Montreal man was finally called for his long-delayed urgent surgery two months after he had died. One 16-year-old boy in British Columbia waited three years for an “urgent” surgery, during which time his condition deteriorated so much that he became a paraplegic.

Canadians have to travel abroad to countries with functioning health care systems in order to be treated:

These cases are, unfortunately, not isolated; a survey of specialists found that average wait times exceed what is deemed clinically “reasonable” for fully 72 percent of conditions in Canada. The situation continues to worsen every year: In 1994, the average gap between clinically reasonable delay and actual delay was only four days, and by 2018 had grown to 23 days.

[…]With one million waiting, many Canadians turn in desperation to U.S. health care—the very system some U.S. policymakers propose to transform. In 2017 alone, Canadians made 217,500 trips to other countries for health care, of which 52,500 were to the U.S., paying out of pocket to skip the waiting.

Outdated equipment, outdated drugs, staff shortages:

 While the average employer-sponsored private insurance plan in Canada covers between 10,000 and 12,000 drugs, most public plans in Canada only cover 4,000. Canada has 35 percent fewer acute care beds than the U.S., and only one-fourth as many magnetic resonance imaging (MRI) units per capita—indeed, it has fewer MRI units per capita than Turkey, Chile, or Latvia.

[…]Some common treatments are simply unavailable to Canadians. For new pharmaceuticals, for example, Canada’s policy of forcing down prices so that American consumers essentially pay for Canada’s research and development has led to years-long delays for Canadian patients.

[…]Cutting corners on facilities and using outdated drugs show up in Canadian mortality rates. Thirty-day in-hospital mortality rates in Canada are 20 percent higher than in the U.S. for heart attacks, and nearly three times the U.S. level for strokes. Cancer age-standardized mortality is 10 percent higher in Canada than in the U.S.—despite far healthier lifestyles.

[…]When it comes to personnel, Canada underspends on medical staff and doctors, ranking 29th out of 33 among high-income countries for doctors per 1,000 population, accounting for a large part of those wait times. Canada has half as many specialist physicians per capita as the U.S.

[…]With such shortages and waiting lists, Canadian emergency rooms are packed. So packed that Canadians sometimes just give up and go home. Of Canadian ER visitors who are seen, 29 percent report wait times of over four hours, three times the U.S. level.

[…]Canadian seniors are 65 percent more likely to have visited the emergency room (ER) four or more times in the past year than American seniors.

Ultimately, nearly 5 percent of Canadian ER visitors end up leaving without ever being treated, giving up on a medical system that is perennially “free” but out of stock at the moment. In one study at two ERs in Alberta, 14 of the 498 walkaways were subsequently hospitalized, and one died within the week.

And keep in mind how things work in a single payer system. You pay up front through your taxes. The harder you work, the more you pay into the system. When you want treatment, you just get in line behind people who never paid one dime into the system – like all those low-skill refugees that Canada imports from Middle Eastern countries to build up the socialist voting bloc.

How well is Canada’s “Medicare for All” health care working for patients?

Wait times in weeks (Source: Maclean's magazine)
Wait times for health care treatment in Canada (Source: Fraser institute)

I get into conversations about politics with my co-workers about who they like in the 2020 election. And I also ask them which particular policies of the candidates they like best. The one they like most is Medicare for All, with “for All” including illegal immigrants. When I ask them which country has got Medicare for All working, they say “Canada”. Let’s take a look at Canada’s health care system.

Here’s a nice article from Mona Charen, posted in TownHall.

She writes:

It’s true that all Canadian citizens and legal residents (though not immigrants there illegally) get “free” health care, but only in the sense that you don’t get a bill after seeing a doctor or visiting a hospital. Medical care is subsidized by taxes, but the price comes in another form as well — rationing. A 2018 report from the Fraser Institute, a Canadian think tank, found that wait times between seeing a general practitioner and a specialist average 19.8 weeks. That’s the average. There are variations among specialties. Those hoping to see an orthopedist wait an average of 39 weeks in Nova Scotia, while those seeking an oncologist wait about 3.8 weeks.

[…]Imagine the anxiety of learning that you need an MRI to find out whether the mass in your breast is anything to worry about and then being told that the next available appointment is in 10 weeks. In addition to the psychic price, Canadians who had to wait for treatment expended an average of $1,822 out of pocket last year, due to lost wages and other costs. The Fraser Institute also calculated the value of the lost productivity of those waiting for treatment — nearly $5,600 per patient, totaling $5.8 billion nationally.

[…]When there’s an artificial shortage of a good or service, a black market usually follows. I have heard from several Canadians that paying doctors bribes to jump the line is not uncommon. But Canada has another pressure reliever: Ninety percent of Canadians live within 90 miles of the U.S. border, and medical centers in Buffalo, Chicago, Rochester and elsewhere receive tens of thousands of Canadian patients every year.

Regarding that last point, I’ve written many times about socialist politicians in Canada electing to travel to the United States for care, and that’s because (as you might expect) health care outcomes for Canadians are vastly inferior to health care outcomes for Americans. And keep in mind that the delay from specialist to GP does not take into account the delay to see the GP, or the delay from seeing the specialist to actually getting treatment.

And how much are Canadians spending for the privilege of waiting 19.8 weeks to see a specialist? Well, the average cost of Canadian health care is about $13,000 per household per year, paid through taxes. What that means is that people who work pay for all the health care being provided, including the health care for people who don’t work. But when it’s time to get treatment, those who pay the bills get in line behind those who don’t pay anything.

So how good is American health care? Maybe Canadians are waiting in line because their health care is so much better than ours.

American health care

One of the best health care policy experts writing today is Avik Roy, who writes for Forbes magazine.

Here is a recent column, which I think is useful for helping us all get better at debating health care policy.

Excerpt:

If you really want to measure health outcomes, the best way to do it is at the point of medical intervention. If you have a heart attack, how long do you live in the U.S. vs. another country? If you’re diagnosed with breast cancer? In 2008, a group of investigators conducted a worldwide study of cancer survival rates, called CONCORD. They looked at 5-year survival rates for breast cancer, colon and rectal cancer, and prostate cancer. I compiled their data for the U.S., Canada, Australia, Japan, and western Europe. Guess who came out number one?

The United States came out number one, and you can click here to see the larger graph of the complete results.

Some people like to point out that the United States has a low life expectancy, but there’s a problem with those numbers.

The article continues:

Another point worth making is that people die for other reasons than health. For example, people die because of car accidents and violent crime. A few years back, Robert Ohsfeldt of Texas A&M and John Schneider of the University of Iowa asked the obvious question: what happens if you remove deaths from fatal injuries from the life expectancy tables? Among the 29 members of the OECD, the U.S. vaults from 19th place to…you guessed it…first. Japan, on the same adjustment, drops from first to ninth.

It’s great that the Japanese eat more sushi than we do, and that they settle their arguments more peaceably. But these things don’t have anything to do with socialized medicine.

Finally, U.S. life-expectancy statistics are skewed by the fact that the U.S. doesn’t have one health-care system, but three: Medicaid, Medicare, and private insurance. (A fourth, the Obamacare exchanges, is supposed to go into effect in 2014.) As I have noted in the past, health outcomes for those on government-sponsored insurance are worse than for those on private insurance.

To my knowledge, no one has attempted to segregate U.S. life-expectancy figures by insurance status. But based on the data we have, it’s highly likely that those on private insurance have the best life expectancy, with Medicare patients in the middle, and the uninsured and Medicaid at the bottom.

If we’re going to discuss health care, then let’s discuss facts. We shouldn’t be picking a health care system from the campaign speeches of politicians who tell us that we can keep our doctor, and keep our health plan, and our premiums will go down. We tried electing a charismatic deceiver in 2008, and it didn’t work out. We lost our doctors, lost our health plans, and our premiums went up astronomically. We can do better than single-payer health care. We can do better than socialism.

We have single-payer health care already in the VA system – is it working?

VA health care wait times
VA health care wait times

This is health care policy expert Sally Pipes, writing in Investors Business Daily.

She writes:

new report from the Government Accountability Office has confirmed that the Department of Veterans Affairs can’t take care of those it’s supposed to serve.

The GAO has placed the VA’s health system on the “high risk” list of federal programs that are vulnerable to “fraud, waste, abuse, and mismanagement.” The agency is still struggling to recover from an 8-month-old internal audit that revealed that returning soldiers had to wait more than 90 days for care. Some patients died while waiting.

The GAO’s findings apply far beyond the VA. The agency’s problems — which include long wait-times and out-of-control costs — demonstrate what happens in any government-run, single-payer health care system.

The VA’s failings ought to give pause to the liberal politicians and policy analysts who would love to introduce single-payer health care for all Americans. But they don’t seem to have heeded the GAO report. Within a week of its release, Rep. John Conyers, D-Mich., called for “Medicare for All.”

Champions of socialized medicine used to point to the VA as proof that single-payer worked. In 2011, economist Paul Krugman called it “a huge policy success story, which offers important lessons for future health reform.” In a 2009 debate with me, Princeton professor Uwe Reinhardt said that there’s an example of a single-payer system in the U.S. that works — the VA.

The VA offers lessons about health reform — just not the ones single-payer’s proponents have in mind.

Defenders of government-run health care claim that it will control costs by cutting out middlemen such as insurance companies. The evidence shows otherwise. According to the GAO, the VA budget more than doubled between 2002 and 2013 even as enrollment increased by less than a third.

Single-payer’s “guarantee” of access to high-quality care is a myth, too.

“Despite these substantial budget increases,” the GAO report says, “for more than a decade there have been numerous reports … of VA facilities failing to provide timely health care.”

Over the last decade, more than 63,000 veterans have been unable to get a doctor’s appointment. At least 40 veterans have died because of long waits.

Things aren’t likely to get better anytime soon. The VA has yet to act on more than 100 GAO recommendations for improving care.

Last summer, lawmakers allocated $10 billion to a program intended to reduce wait times by permitting veterans to see private doctors outside the VA system. So far, the agency has only authorized 31,000 vets to seek private care — out of a possible 8.5 million.

That has to change — 88% of veterans say that they want the ability to choose where they receive their care.

However, there is one military person who is getting health care – convicted traitor Bradley Manning. He’s getting sex-change surgery while he is in jail for leaking national security secrets to our enemies. He won’t have to wait at all for his health care. This is what happens when you take money out of your wallet, give it to the government, and then hope that when you get sick, someone in the government will decide that you are worthy of treatment. Which you aren’t, unless they want your vote.

It’s not just the VA health care system – government-run health care doesn’t work in other places:

The United Kingdom’s National Health Service, for instance, is notorious for denying patients everything from certain cancer medications to hip replacements.

The program is also financially unsustainable. According to its own medical director, Bruce Keogh, “if the NHS continues to function as it does now, it’s going to really struggle to cope because the model of delivery and service that we have at the moment is not fit for the future.”

In Canada’s single-payer system, the average wait time between referral from a general practitioner and the actual receipt of treatment by a specialist was more than four months in 2014. That’s nearly double the wait time of two decades ago.

The Canadian system is the one that Democrats want to emulate – but Canada’s rich left-wing politicians come here when they want care. They don’t want to wait in line. Why should we want to wait in line? We need to prefer consumer-driven health care over government-controlled health care.