Is a Single Payer Universal Health Care System the Answer?

The Obama administration is pushing forward strongly with the idea of creating a public alternative to private insurance. In fact President Obama has stated that if he could start the system over from scratch that it would be a single payer system. That means the government is the only source of medical care.

So what’s wrong with that?

Plenty - and it doesn’t take too much thought or research to see what the issues are.

A single payer system would provide basic care to everyone. True. So, what if you need more than “basic care”?

That’s when things become complicated.

Right now, you get to choose who your doctor is and together, as you sort through your particular medical condition, you get to work out a plan for how your care will be handled. It is between you and your doctor and is limited only by what your insurance company will pay for and what you are willing to absorb out of your own pocket. Single payer systems don’t generally work like that. Under a single payer system you would have to go to your prescribed doctor, emergency room, or urgent care. Based on your diagnosis the doctor would be forced to pursue what the government panel considers to be the most effective solution. Of course when I say effective, I mean that in every sense of the word. Not just from a medically beneficial perspective, but from a cost perspective.

The cost in single payer program can become astronomical very quickly. The government has to make adjustments and decisions to control those escalating costs. That means doctors will have their fees determined by the government and in some single payer systems cash payments between the patient and doctor are not permitted. Suddenly the financial benefit of becoming a doctor is limited and the number of people willing to go through fifteen years or more of schooling at tremendous personal and financial cost decreases. You have fewer doctors. Of course the increased expense and time of specializing in any particular area would also have less long term financial benefits. So the result is fewer specialists; fewer pediatric oncologists, fewer neurosurgeons, fewer electro physiologists, and every other specialist.

Specialties themselves would be limited; considering all doctors would be paid by the government. The more specialists you have the more costs go up. The more specialists you have the more experimental treatments you have and the more cost intensive procedures you have. Things like medical implants, spinal fusions, pacemakers, defibrillators, hip replacements, and cochlear implants are all very expensive. Their use would have to be limited. There would have to be certain criteria and even a triaging of sorts for every patient to see if they would benefit the most in the long term by receiving such a procedure. This may not mean much to you if you are young and healthy, but what if you older and develop bradycardia. You’re tired all of the time and you just don’t have enough energy to do the things you want to. But you’re not bed ridden. You won’t die without the implant. Plus you are older now and the quality of life benefit would have to be weighed against your age. You are eventually passed over because your condition wasn’t severe enough, or there were more patients who were younger and would benefit for a longer period of time. They get a pacemaker, you get a walker so you don’t pass out trying to walk around.

Sound ridiculous? Why do you think Canadians have been coming to the US to get medical procedures for years? The number of medical procedures and devices is rationed. Medicine is no different. Chemotherapy? I’m sorry but you are in your sixties and the people would not see the long term cost benefit. It would help you and you would live another ten or fifteen years but you’d probably be on public assistance the whole time. We need to save that treatment for someone in their thirties who might be able to work and pay into the system for another thirty years.

Arthritis? You’ll need to just manage that with over the counter medications.
Macular degeneration? You’ll have to go blind in one eye before we can give you medicine to save the second one.
Breast cancer? We’ve deemed a double mastectomy is really the best long term solution for most of our cases, so that is what you are going to get.

Of course just like the benefits to doctors are limited, the benefit to other medical businesses are limited as well. What if… Medtronic thinks that they can cure spinal cord paralysis with a new surgery and an electronic implant… but the research is too expensive and the government would never pay for more than a couple dozen a year, even if they could find a specialist who could perform the surgery. Or, what if… Merck thinks that they have a promising lead on a drug that will reverse the effects of autism if given to children under four… but the research and testing is expensive and the medicine would cost thousands of dollars over the course of the treatment, the government just wouldn’t buy enough to make it cost effective for their business.

Fewer incentives = fewer technological breakthroughs/ fewer medicines

That’s not all. Medical devices are tricky. These things have microprocessors, multiple stacked die, assembled through a several hundred step procedure, and they are implanted into the worst possible conditions for electronics. Sometimes they fail. Lawsuits come up. Will people be prevented from suing the doctor? Or the government? Right now Medicare tries to spread the devices that they use over the different providers so that any recalls by any particular company will effect the smallest percentage of patients. So if there are only two companies producing a device, they each get about half the business. Of course that could be a billion dollar business, so soon you have five companies. The original developers of the technology now see less of the business, even if they produce the best product. Government decisions.

The end result is that in a single payer system you see a significantly lower level of care. There are fewer specialists so wait times can become extreme. In Canada they joke (meaning they really ‘observe’ because it’s true) that for high risk pregnancies there is a ten month waiting period. Services, medicines, procedures, and devices are rationed and limited. Some have even said that the only reason the Canadian system even functions is because people can always come to the US if they know of a service that cannot be provided in Canada.

Our medical system has some problems and things can and should be done to improve it. Steps should be taken to open up competition in health insurance. Medical savings accounts should be readily available and encouraged along with retirement savings. Also, tort reform needs to be enacted to protect good doctors and companies from frivolous law suits. There are many avenues to take towards improving our health care system and bringing down the escalating costs. A single payer universal health care system, however, is not the answer.