By Morton Tavel, M.D.
The News-Press (Fort Myers, Fla.), April 20, 2016
When considering the best way to solve our country’s health care woes, I am reminded of Winston Churchill’s famous comment about democracy as a form of government, in which he stated, in effect: It’s a terrible system, but everything else is worse. This same statement might apply to a single-payer system in medical care as proposed by Bernie Sanders at a recent Democrat presidential debate, for it, too, probably beats everything else.
First, a truly effective system will not be achieved unless we solve the many associated issues that include tort reform to control the exorbitant costs of physician medical malpractice insurance in many states, excessively high cost of drugs, inappropriate use of expensive tests and treatments, and several others. But all these issues can be solved, given the desire and, hopefully, willingness of our legislative bodies to work together for the benefit of all.
Although the Affordable Care Act (ACA, “Obamacare”) has been a step forward, it fails to address the problem of waste and complexity in the system. A single payer system would eliminate the entire commercial insurance industry — with $730 billion in revenues and a workforce of 470,000. Not only would this provide a more economical way to use healthcare resources by reducing expenses, it would also likely improve quality, and restore doctors’ authority. For all practices, administrative costs would plummet because there would be only one set of payment rules and forms, with the result that prior authorizations, narrow networks, and out-of-pocket payments could be eliminated.
There also appears to be evidence of growing physician support for a single-payer system. For example, a 2014 survey of Maine physicians conducted found that nearly 65 percent of respondents preferred the single-payer option over trying to fix the current system—up from 52 percent in a 2008 survey. Physicians in general now seem more open to a single-payer system.
Notwithstanding the Republicans’ constant calls for abandoning ACA, a majority of the population (51 percent) now supports Medicare for all, according to a national poll released recently. Many experts, however, believe that the movement for a single-payer system may start at the state level, since much of the public continues to mistrust Washington.
Although a government-run, single-payer system is the only way to provide effective basic medical health therapy and management, for those who desire a higher level of care — and can afford it — there should be a private-pay system, in contrast to the Canadian system. This would constitute a two-tiered system. This might be objectionable to egalitarians that wish to have a “one size fits all” system, but would be the most pragmatic approach.
Usually those against single payer system trot out the usual vague objections that we are becoming “socialistic.” But what about our current Medicare system and Social Security itself; are those not socialistic?
Whether we like it or not, basic healthcare is like a utility—something everyone needs, and in the best interest of our society, everyone should receive. Although there are variations of the general theme as I have enumerated above, we are probably moving inevitably toward a single payer system. When it finally arrives, I believe everyone will be relieved, if not pleased, even including our warring politicians!
Dr. Morton Tavel lives on Sanibel.
PNHP note: Physicians for a National Health Program (PNHP) is a nonpartisan educational organization. It neither supports nor opposes any candidate for public office.