Psychologists and all of these factors play

psychologists, and all of these factors play significant roles in determining health outcomes, but
they escape the orthodox economic analysis and expose a severe [*712] limitation of a model
that assumes maximizing behavior. An understanding of the psychosocial variables that explain
and predict health behaviors, and thus good health, could valuably inform health care policy. n21

This Article proceeds as follows. Part I challenges the conventional presumptions that motivate
Medicaid policy , chiefly, that an insurance gap is responsible for health disparities. It reports
evidence suggesting that an individual's insurance status is largely a choice variable , and that
improving inequalities in insurance status and access to health care is unlikely to end health
disparities. Perhaps more significant, disparities in consumption of health care itself - let alone
health insurance - may have little effect on health disparities . This relates to a broader and
increasingly popular claim that the United States over-consumes health care without enjoying
material improvements in health. n22 Thus, a policy geared to improve health by providing
health insurance is doubly flawed.
NHI results in lower quality care—long waits, reduced quality, price controls,
funding crises, physician shortages, and poor medical technology.
Fleming 6
— Kevin Fleming, internist and geriatrician in the Division of General Internal
Medicine at the Mayo Clinic, M.D. — Creighton University School of Medicine, fellow in Geriatric
Medicine at Mayo Graduate School of Medicine, 9-22-2006 ("High-Priced Pain: What to Expect
from a Single-Payer Health CareSystem", Heritage Foundation , Accessed Online at
-
health-caresystem)
Policymakers should ignore imagined outcomes and focus closely on the performance of existing
models : the British, Canadian, and other state-run systems . In these systems, health care is
subject to bureaucratic and political rationing and driven by political and budgetary pressures.
This leads to inevitable adverse effects, including:
 Long waits and reduced quality . In Britain, over 800,000 patients are
waiting for hospital care . In Canada, the average wait between a
general practitioner referral and a specialty consultation has been
over 17 weeks. Beyond queuing for care or services, single-payer sys -
tems are often characterized by strict drug for mularies, limited
treatment options , and discrimination by age in the provision of care. Price
controls , a routine feature of such systems, also result in reduced drug,
technology, and medical device research .
 Funding crises . Because individuals remain insulated from the direct costs
of health care , as in many third-party payment systems, health care
appears to be "free." As a result, demand expands while government
officials devise ways to control costs . The shortest route is by pro -
viding fewer products and services through explicit and implicit
rationing .