Dr. Whatley: Single-payer healthcare – the good, the bad and the nutty – THE DIRECT PRIMARY CARE JOURNAL

Dr. Shawn Whatley


Shawn Whatley is past-president of the Ontario Medical Association. He has worked in emergency medicine, as a coroner, in a vein clinic, and as a surgical assistant. He also held a leadership role at a large suburban hospital. He now practises family medicine in rural Ontario. Visit his blog at shawnwhatley.com.in rural Ontario. Visit his blog at shawnwhatley.com.

The Nutty

  • Hospitals lose money for seeing more patients; doctors earn more for seeing more patients
  • Unlimited sick days for some nurses
  • March madness: hospitals spend like crazy before year-end or lose funding for next year
  • Pharmacists paid more for same service than MDs (e.g. flu shot)
  • Black market in radiology and lab licenses
  • NPs and midwives earn more per patient than MDs
  • Labs have fixed budgets: more tests means less profit per test

Bigger Issues

Single payer healthcare also raises other, more challenging problems:

Those who know cannot speak. The system suppresses dissent. People cannot speak up, because they have nowhere else to work. Professionals working in hospitals or academia must stay quiet. Single-payer systems give tremendous power to administrators who run the monopoly. It enriches and expands government. Price controls appear to limit costs, but profits are found in other ways. For example, price controls force doctors to shorten visits, unbundle care, up-code, or stop providing a service. Centrally planned single-payer systems function on Hayek’s Fatal Conceit, the assumption that planning is possible:

The curious task of economics is to demonstrate to men how little they really know about what they imagine they can design.

Local knowledge is impossible to capture or to use in managing the system. Single-payer systems incentivize collusion with government to exclude competition. It creates a psychological change in Canadians. Whereas choice empowers patients, single-payer fosters dependency on the system. It creates increased demand for fixed price services but decreased availability of those services. Single-payer assumes that bigger is always better. But bigger often becomes too big to manage. A CEO of A.T.&T. once said, “A.T.&T. is so big that, if you gave it a kick in the behind today, it would be two years before the head said ‘ouch.’”


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