Another look at a "single payer" system (Part 1)

Posted by Stephen Weinberg, MD FACC FACP

Let’s take another look at a single payer system. 

I have had numerous recent conversations with people regarding a single payer model. In an effort to bring additional clarity to the discussion and cut through the complicated math from the previous post, this post will attempt to simplify the issue.

As soon as one brings up the concept of a single payer health system, there is a great deal of pushback. The arguments include predominantly that this is socialism, the government cannot run any program of that size efficiently, it controls too much of the country’s economy, and the government cannot be trusted to do what is in the best interests of patients and will use this opportunity to ration healthcare similar to Canada and  the United Kingdom.  All of these ascertains may be true in theory, but it seems that, in reality, this is likely not the case.

From a very practical standpoint, Medicare is the largest single payer system in this country. Having been enacted in 1965, it has grown to cover about 55M people, or 1/6 of our population. I have practiced Cardiology since 1978 and I cannot recall a single patient who does not like Medicare. On the contrary, there is not a day that has gone by when a patient did not complain about their private health insurance carrier. These complaints range from lack of coverage, the need for referrals, inability to obtain necessary testing and treatments, rapidly escalating premiums, among others. I never hear that from Medicare patients.

Medicare is efficiently managed with an overhead of about 1.5% compared to private insurance overhead of about 15-20%. A huge difference.

The argument that the government would control a large part of the country’s economy cannot be denied. The US healthcare sector is about 1/6 of the total economy. Legislative controls and oversight could be applied similar to what exists now, which is controlling Medicare effectively; as compared to private insurers with premium increases of 20-30%, higher deductibles, higher copays and less coverage.

The argument that the government cannot be trusted to do what is in the patients’ best interests is also false. Once again, Medicare has always provided comprehensive care coverage since inception, unlike private health care insurance, as virtually anyone will attest who has private coverage.

The issue of rationing care is likewise untrue. This has never been the case with Medicare, as opposed to Canada and Great Britain. The difference between us and them is that the other countries have a fixed, capped budget for healthcare expenses so once the money runs out, care stops. This leads to long waiting periods for testing and care, as well as rationing. This is one of the mechanisms by which they can control costs. In the US, by contrast, there is no budgetary cap. The expenses are open-ended, so care is not rationed. Furthermore, the discussions regarding “death panels” that occurred when Obamacare was being legislated were totally false and were used only as scare tactics by opponents.

So, the arguments against a single payer are without merit. Since Medicare has been successful and extremely well accepted by senior citizens as well as the vast majority of the population, why not provide everyone with the same insurance coverage? As shown in the prior post, we are already spending more than enough money to insure everyone with comprehensive coverage and still save $260B annually. 

The next post will detail how to provide "Medicare for all".

Stay tuned.