James Burdick, MD, proposes a doctor-run single-payer system
By Joyce Frieden
Medpage Today, July 15, 2016
A single-payer healthcare system could work in the U.S., but only if doctors are involved with running it, according to James Burdick, MD.
“When the Clinton health plan failed in late 90s, it started to bother me,” said Burdick, a retired transplant surgeon. “Then I started thinking about how we could make it work. The idea of single-payer wasn’t what I was thinking about — I was thinking about how to make it work, and that meant doctors.”
Burdick, a Harvard Medical School graduate and currently professor of surgery at Johns Hopkins University in Baltimore, has written a book, “Talking About Single Payer: Health Care Equality for America,” to explain his idea. One purpose of the book is to counter peoples’ objections to a single-payer system, in which healthcare costs are paid for by the government and financed through income taxes.
“A little over 50% of the healthcare in this country is provided by government programs now — when you add up Medicare, Medicaid, the VA [Department of Veterans Affairs] and a few others — so it’s not such a wild idea to have the government pay for healthcare,” he told MedPage Today in a phone interview.
Critics say that a single-payer system restricts peoples’ choices in healthcare, but Burdick said that under the current system in which many workers get healthcare through their employers, “the employee is actually getting whatever healthcare package is negotiated by the employer and the insurance company the employer is using, so immediately the choices they might have are interfered with by the negotiation between the employer and the insurance company.”
Under Burdick’s proposal, a quasi-governmental organization called a Health Security Board would be established; it would be overseen by the Department of Health and Human Services but would not be an official government agency. The board would include a variety of providers including physicians, nurses, paramedical personnel, hospital administrator, and laypeople, and its job would be “to oversee the healthcare choices that doctors and their patients make.” Among other duties, the board would decide what would constitute “essential health benefits” to be paid for by the government, as well as help oversee healthcare quality and specify what items need to be incorporated into an electronic health record.
“One of the biggest things from the doctor’s point of view is the remarkably complicated system in place now,” Burdick said. “You may have as many as 1,000 different payers for a group of doctors or for a hospital, and the federal government has another set of rules that are increasingly interfering with ‘best’ clinical practice’ and taking time from helping take care of patients, so those things could vanish if we have the system the way I envision it — the patient goes in, everybody has access, they see their doctor, and all these things [like] billing can be dealt with, without interfering with the doctor-patient relationship.”
The Health Security Board “is a pure issue of government control,” Burdick said. “If the rules are handed down by the government, that’s government control. I’m saying the rules need to be handed down to doctors by doctors themselves.”
One thing the Health Security Board would not do is set prices. “This system is not going to be responsible for telling the country how much to pay a doctor,” Burdick said. “The country’s going to have to [figure that out] separately.” The board would discuss how healthcare would be funded and how many of what type of physician would be needed.
One of the most important cost issues is the price of drugs, Burdick said. “I think there is a general understanding that if we had a national system and a single wall for negotiation with drug companies, that their prices would have to come down. The converse question is, [does that] limit innovation, do we make it harder to get the drugs we need for patients, and I make the argument that the answer is No if we do it right.”
“The country could put together a process for negotiating a drug price that could be a lot lower while still recognizing the extraordinary value of all the pharmaceuticals to cure patients,” he added.
The system Burdick envisions would also have a role for state governments. “The process of arranging for payment but not for actual care decisions — logistics and certificates of need — the states would have a role as well.” That includes financing. “So the states would pay some and the federal government would pay some, and that income comes as a single ‘bolus’ payment to the physician and the hospital.”
The Canadian single-payer system is a good example of federal-state cooperation, he noted. “If you talk to Canadians they love their system, and they have a provincial system — the federal government pays [a certain amount] and the province pays the rest.”
Within the U.S., the way the organ transplantation system is structured is a great example of how things can work under a quasi-governmental organization — in this case, the United Network for Organ Sharing, an organization Burdick, as a retired transplant surgeon, is very familiar with. “It’s really a wonderful model for how the medical profession can make care decisions in this quasi-governmental, quasi-private structure I propose for the whole country. Nothing’s perfect…but it’s so much better than what we’ve got now.”
Joyce Frieden is news editor at Medpage Today.