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.
