By Marianne Mattera
Reviewed by Zalman S. Agus, MD; Emeritus Professor at the University of Pennsylvania School of Medicine.
September 28, 2007
Presidential candidates might consider proposing a health care reform package that relies on a single-payer system, if results of a MedPage Today poll reflect the country’s mood.
When we asked visitors if it is time for the U.S. to adopt a single-payer health care system, 56% said, Yes, the current system cannot be fixed by half-way measures.
The 696 respondents represented most of the key segments of the health care equation — including physicians, nurses, nurse practitioners and physician assistants, pharmacists, health care administrators, and patients.
Economics was a big factor in the decision of many who voted for one source of financing. One respondent summed up the rationale: “The system is broken. A single payer system would save taxpayers millions of dollars when the middle men [in the insurance system] are cut out. There are too many rules, too many deductibles, too many games doctors have to play. The paperwork is a nightmare for doctors and patients alike.”
Another agreed, noting that the excess between cost of care and insurance profit would pay for all the uninsured.
Even physicians, who have traditionally opposed anything that smacks of national health insurance — as a single-payer plan would imply — came down heavily in the Yes column. They chose that option two-to-one over an answer that recognized that a single-payer system could mean “the end of whatever physician autonomy and patient choice still remains in this country.”
One doctor spelled out why he and his colleagues feel that way: “The only way to fix the system is single payer. Under the current system, choice of provider is limited by which provider is covered by [the patient’s] insurance. This combined with [insurers’] drug formularies already limits choices in care.”
Overall, only 20% of respondents were worried about maintaining choice and autonomy. Another 24% said there should be more players involved in the financing mechanism, but there should be a plan to cover the uninsured.
Those who voted No had strong opinions, though. Said a nurse practitioner with 30 years in health care, “I’ve seen the failures in multiple government-run programs and talked to doctors who fled the Canadian system because their patients were being denied care. There is no way government should run health care.”
One physician noted that the United States is a capitalist society and the only role of government is to maintain a level playing field. “It is the right of individuals and groups of individuals acting as ‘legal persons’ or corporations to trade capital goods, labor, land and money,” he said.
A colleague who supports a single-payer system, however, looks at competition from another angle. “The current health care environment takes away the competitiveness of our industries in the global arena. We need a basic universal health care system for all.”
Although universal coverage doesn’t necessarily translate into a single-payer system, that doctor is right about the timing of this debate, he said, “I am glad that this question on health care reform comes up now, before a new president is elected.”