The Single-Payer Experience

With a grain of salt we recommend the Daily Mail's article detailing present difficulties in the U.K.'s National Health Service, specifically in the delivery of maternity care.

We note this story not merely because it enumerates issues in the capacity of the NHS to deliver health services as a single payer system; that is, not merely because it illustrates what rationing looks like. We note it especially because it deals with maternity services.

In the past, maternity services were among the most efficient in the NHS. We think the reason is obvious: you can put off a gall bladder surgery or even make a cancer patient wait for chemo. But babies come when they come. So no waiting lists for maternity.

Well, so much for that idea. Sooner or later, the government's interest in keeping costs down runs afoul of the public's demand for services. And so new mums whose time has come can't find a hospital that isn't full.

We submit that whenever government works to control costs, it distorts the dynamics of supply and demand that get what's needed to people who need it. Whatever the inefficiencies of markets, and they are legion, they are not fixed by cost controls.

Note well that we recommend a grain of salt in reading this article. Like its cousins, the Daily Mail is a tabloid, addicted to sensationalism. These stories don't characterize every case. They're exceptional. Most Britons have babies with good care.

But we recommend only a grain, not a box, of salt. We have ourselves experienced the travails of the U.K.'s health system. We gladly laud its strengths while acknowledging its obvious and endemic weaknesses. And its weaknesses are readily explained by its economic model, which behaves very much as similarly modeled endeavors always have. This story is a demonstration of the same.

In closing, we decry those who say that the market presently "rations" health care in the United States. This observation makes two mistakes. First, it fails to note the degree to which the US healthcare market is unproductively regulated. Second, it puts a subject with a verb that yields a self-contradictory sentence. Rationing by definition is the distribution of goods and services apart from the market. Both markets and rationing are means of distributing goods and services. A superb way to obfuscate the present debate is to make "ration" an exact synonym for "distribute."