By Dr. Aaron Carroll
The Incidental Economist, July 25, 2012
I can’t count the number of times I’ve been told this week that it’s just a “fact” that single payer systems lead to increased wait times. It appears that pointing out that this is not true is “rude”. So be it.
Let’s start with some simple facts. Wait times occur when there are too many patients and too few appointment slots. That can happen when there are too few doctors or when there are too many people who want appointments. So, yes, if you have a doctor shortage, you can get increased wait times. If the system wants to keep spending low by limiting visit slots, you can get increased wait times. If you increase the number of insured people dramatically, you will get increased wait times.
Note that any of those things can occur with or without a single payer system. They can occur with an entirely private system. If you massively decrease the number of uninsured, as the ACA will attempt to do, it’s entirely possible we will get wait times. This will happen whether people become insured through private insurance in the exchanges or through government insurance (Medicaid). The type of insurance is irrelevant. If there are way more patients calling for appointments, and the number of doctors is static, wait times will likely increase.
So if wait times are your main concern, then you’re likely against reducing the number of uninsured by any means. The outcome is the same.
None of this has anything to do with single payer.
Now it’s possible that single payer systems can lead to increased wait times. In Canada, they keep spending far below what we put out. They do so partially by spacing out visits for elective procedures and such. That’s a conscious decision, and it leads to some people waiting for elective care. But that’s an outcome of their financial conservatism, not the single payer system. Other countries (think France) don’t have the same issues with elective procedures because they spend more money. Our single payer system (Medicare) has far fewer spending restraints, and does not suffer from the wait time problem.
We could convert the entire country to Medicare tomorrow, increase the number of physicians, and have no wait times at all. We could convert the entire country to private insurance in a Switzerland-like system, make no changes to the number of physicians, and see wait times go through the roof. This really is a zombie idea.