Canadian club.

• Author: Henderson, Rick
• Position: Editorials - Editorial

Single-payer systems may be simpler than ClintonCare, but that doesn't make them good.

THE MIND-NUMBING COMPLEXITY OF Bill Clinton's Health Security Act has revived interest in simpler alternatives. The early winners of this rhetorical struggle advocate a government-run, single-payer medical system.

In the September 6 Newsweek, Gregg Easterbrook makes a thoroughgoing case for nationalized health care. "National health systems control costs," writes Easterbrook, "and market-based systems, no matter how conscientiously designed, do not." Whether their model is Canada, Germany, or France, Easterbrook and other advocates of a government-run system maintain that such plans will cut bureaucracy, enhance choice, and preserve quality. Consider their arguments:

* Simplicity. Right now, the U.S. medical bureaucracy costs proportionately twice as much as Canada's. Easterbrook cites a General Accounting Office study which estimates that a national health system would spend $67 billion less on administrative costs. He admits, however, that this $67 billion would be a one-time saving and would be wiped out by one year's normal health-care inflation.

And it's ludicrous to assume that any government-run system, no matter how lean its initial design, would remain bureaucracy-free. In 1948, Great Britain's National Health Service employed 350,000 staff members and managed 480,000 hospital beds. By 1991, it had 800,000 staff but only 260,000 beds.

* Choice. Dr. David Himelstein of Physicians for a National Health Program says a single-payer plan lets individuals choose their doctors.

Sure. You can choose any doctor you want, as long as the doctor is a general practitioner. Since every other Western government caps how much medical money the nation will spend, prospective doctors are funneled into general practice rather than specialties. In France and Germany, the government pays medical-school tuitions. Bureaucrats then decide what type of medicine each physician will practice. (ClintonCare would set up a national board to set the "correct" proportion of G.P.s and specialists in training.) Only 40 percent of physicians outside the U.S. are specialists; 80 percent here are.

That's not a problem if you need only a penicillin shot. But if you have a more complicated illness, you'll probably wait for treatment.

* Quality. Easterbrook says cost controls won't necessarily sacrifice quality. He cites an American example in which single-payer works well: Rochester...