After decades of experience with single-payer health-care systems, we know that they make health care harder to get and increase costs. Even in the unlikely event that government promises to pay for everything, there is no guarantee that such a system will pay enough to motivate others to provide the expertise and equipment required to treat a particular patient. As the Oregon Health Services Commission snippily told Medicaid clients who complained about their inability to find a doctor, "Having coverage does not always guarantee access."

Single-payer makes access difficult because government officials focus more on budgets than they do on patients. In a profit-oriented health system, patients can influence outcomes by changing their spending patterns. But only about 4 percent of citizens in industrialized countries are seriously ill at any given time. Politicians in search of votes are loath to spend huge sums on such a small population.

Instead, they buy votes by funding relatively inessential health programs to coddle the larger numbers. In Britain, the government provides transportation to and from its filthy hospitals and hellish emergency rooms. In 2001, Lisa Campbell's physician suspected appendicitis and sent the 18-year-old to the Royal Cornwall Hospital with a letter requesting urgent attention. She spent 12 hours on the hospital floor wrapped in a blanket. Despite a high fever, vomiting and excruciating pain, the hospital would not examine her until a gurney was available. It took two more days to diagnose appendicitis.

Since treating sick people is more expensive than letting them die, single-payer systems also discriminate against the elderly and powerless. In the Netherlands, elderly patients fear the hospital. The Dutch government lets doctors kill their patients. Dutch physicians in need of a hospital bed have simply administered lethal drugs to people they think will die anyway. Some countries do not even classify babies under two pounds as live births. This explains why U.S. infant mortality rates are high by international standards even though babies born in the United States have greater chances of survival.

In 1997, an estimated 20 percent to 30 percent of all patients on Canadian waiting lists were expected to die before getting care. Canadian officials responded to critics by saying that it was good that Canada used its health-care resources to their fullest capacity. Under single-payer care, it is better to let sick people die than to let expensive machines sit idle.

The poor performance of single-payer systems also can be seen in cancer-mortality ratios, the death rate divided by the incidence of disease. For breast cancer, the U.S. mortality ratio is 25 percent. In Canada and Australia, it is 28 percent; in Germany, 31 percent; in France, 35 percent; and in New Zealand and the United Kingdom, 46 percent. For prostate cancer, the U.S. mortality ratio is 19 percent; in Canada, 25 percent; in New Zealand, 30 percent; in Australia, 35 percent; in Germany, 44 percent; in France, 49 percent; and in the United Kingdom it is 57 percent.

Single-payer systems in the United States also generate poor results. Elderly veterans trapped in the Veterans Administration pharmacy-benefit program have access to only 12 of the 31 drugs most commonly used by elderly and disabled Medicare patients. In 1994, Medicaid bureaucrats decided to spend less on Epogen, a drug for treating anemia in dialysis patients. Patients denied Epogen got sicker, death rates increased and hospital bills went up. Only after five years of intense lobbying was this arbitrary policy changed.

The largest single-payer systems in the United States, Medicare and Medicaid, have sabotaged private health care by systematically over-promising, over-regulating and underpaying. Providers responded by charging private payers more often. Now that private payers have reached their limit, providers are simply refusing to take Medicaid and Medicare patients. The result has been skyrocketing private costs and a shortage of care for the poor and elderly patients who are dependent on government programs.

Market systems reward those who reduce costs by increasing their profits. Government systems offer no such incentive, with the result that single-payer health care is extraordinarily costly to run. Wharton Professor Patricia Danzon calculated that, with all costs included, the overhead of the Canadian system is about 45 percent of claims. Her estimate of overhead for U.S. private insurers was about 7.6 percent of claims. Health actuary Mark Litow estimated that Medicare and Medicaid spend about 27 cents on overhead for every $1 of benefits. Private insurers spend about 16 cents. In Oregon, a decade-long attempt to rationalize Medicaid spending by running it like a single-payer system succeeded only in reducing access and doubling spending.

Unlike single-payer, market-based reforms offer a real opportunity to reduce costs. The RAND health-insurance experiment conclusively demonstrated that people who used their own funds to buy health care reduced spending by 30 percent without harming their health. Medical savings accounts (MSAs) build on this result by making it possible for people at all income levels to self-insure for routine health-care costs. Reducing claims reduces everyone's overhead, making health care - and health insurance - more affordable.

The savings are surprising. Calculations for the Denver market using current premiums for individual policies suggest that an MSA health-insurance plan would save a couple with two children and average medical expenses about $500,000 over 40 years. At age 65, $140,000 would be left to cover additional expenses in old age.

Fifty years of experience has shown that single-payer systems produce lousy health care at exorbitant costs. Isn't it high time to try something else?

Linda Gorman is a senior fellow at the Independence Institute, a free-market think tank in Golden.