Category: Single Payer Fallacies
In my last post, I tackled the issue of profit in health care because this is among the main talking points when people say that the United States needs to have a single payer “health care” system so that the profit motive is removed. They mistakenly believe that such a system will guarantee access to medical care for everyone, usually using the reasoning of greed in the delivery of health care.
I have some news for these people though. I have written about this issue in previous posts, but I think it bears repeating in this context. The United States has a majority of “not-for-profit” hospitals, which are tax-exempt because they are supposed to provide charity care. According to statistics from the American Hospital Association (1), there are 2,845 “non-government not-for-profit” hospitals in the United States. The same statistics also report that our country has 1,034 investor-owned “for-profit” hospitals.
So, here is a question … if the country has more than twice the number of “non-profit” hospitals than we have “for-profit” hospitals, why are medical care costs so high?
I have a dirty little secret for you – a large number of our “non-profit” hospitals are raking in HUGE profits.
I refer to an article about Oregon “non-profit” hospitals in The Willamette Week. It is entitled “The Five Things Hospitals Don’t Want You to Know About Obamacare,” written by Nigel Jaquiss (2). He reports that Oregon’s 60 “non-profit” hospitals are taking in windfall profits. According to this article, Providence Health & Services has stockpiled $6 BILLION in cash reserves.
Isn’t this a little over the top for a “non-profit organization?”
The fundamental purpose in giving “non-profit” hospitals tax-exempt status is that they, in return, would benefit the community where they are located by providing charity care for people who cannot afford the medical or surgical services they require. Apparently some county tax assessors are getting wise to this scam though because three Illinois hospitals were stripped of their tax-exempt status in 2011 because they were not providing a sufficient community benefit. (2)
Unfortunately, far too many “non-profit” hospitals continue to extract exorbitant fees from patients’ commercial insurance policies while raking in whatever Medicaid pays for patients who would have been their charity cases before Obamacare’s Medicaid expansion became effective in Oregon.
You may ask: “How do these ‘non-profit’ hospitals use the huge profits/surpluses they amass?
First these hospitals pay their executives VERY WELL For instance, the Willamette Week article reported Providence’s tax filings reveal that nine of its employees were paid more than $1 million per year while another 27 of them earned at least $500,000 per year with most of these high earners being administrators.
Additionally, Oregon hospitals have been buying up doctor’s groups and other medical facilities that were “for-profit.” Then they also spend millions on building rehabilitation. For instance, Providence is forking out $85 million to give its St. Vincent Medical Center a “face-lift.”
I’m sorry, but I just have to comment here. Can you imagine the people with medical issues, who might also have financial challenges (maybe even being just temporarily out of a job), who could be materially helped by even half of that $85 million? Yet now that Obamacare has resulted in a Medicaid expansion in Oregon, tax-exempt “health care” systems like Providence are raking in bucks from paying Medicaid patients and yet putting out very little in community care.
If this is what NOT MAKING A PROFIT is all about, I think I will choose good old-fashioned HONEST profit.
The doctor for whom I worked for two years (and now serve as an independent contractor) does his best to make his surgical services affordable by offering cash prices to the uninsured or self-insured employers that are half the price a hospital would charge, and people in my community have told me that he provides charity care, but that is not something he advertises.
Not to belabor this, but there are also Direct Primary Care practices that continue to gain traction. They are third-party free (which means they DO NOT accept any insurance). Yet they offer a full spectrum of routine care for a very low monthly membership fee as well as additional services for very reasonable fees. Ironically these kind of practices (along with low-cost, price-transparent surgery centers and dermatology practices) are for profit.
I ask you. Which is best – those people who amass large amounts of money that does not even get taxed or provide much in the way of community benefit and yet act “holier than thou” because they are supposedly “non-profit” or those who actually make a living profit from their work in the medical field with reasonable pricing and charitable hearts to help people without being paid when it is needed?
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*This is the last post in my series regarding Single Payer Fallacies – for now. I strongly felt I had to tackle these typical arguments that so many people give for why our country should establish a single payer system, which do not hold water as far as I am concerned.
Now that the heat is really on the Senate to pass a bill repealing and replacing Obamacare, I need to go back to refuting the arguments against doing that. I think my next post will be about refuting the phony CBO estimates of the effects of replacing Obamacare with a more free market policy for medical and surgical care delivery. If you want to come along for the ride, please subscribe to my email list; the form is at the upper right of this post. Then you will automatically receive any new posts in my blog every Thursday morning.
I am also working on a report about the history of “health care,” or I should say the delivery of medical surgical care in this country, to provide education and some context as to where we are now.
I cannot even begin to count the number of times I have read comments and posts from people on social media, or in response to articles, where someone says that health care should not be for profit. Yes, on its surface, it sounds like a very noble sentiment. But that is just the surface.
We must start by digging beneath the surface of such platitudes, and consider what place health care has in everybody’s lives.
Those who advocate for single payer health coverage insist that “health care” is a basic human right.
In an article on the Medinnovation and Health Reform website, Richard L. Reece, MD (1) provided an excellent line of demarcation between medical care and health care. I will quote it for you verbatim:
“Medical care is what doctors can do for you. Health care includes what you do for yourself – such as diet, exercise, and lifestyle.”
As Shakespeare once said, “Ay, there’s the rub.”
With these two very common-sense definitions, which have been conflated as if they are really synonymous, we can discern the separate purposes of each term. I would conclude that the correct meaning of the term “health care” is how we, as individuals care for ourselves. Unless we are severely disabled in some way, we are all personally responsible for own own health care. If we maintain a sensible diet, level of physical activity, and avoid such unhealthy habits as smoking or inappropriate drug use, we can expect to remain relatively healthy. We can also take the responsibility to see a primary care physician for some basic preventive procedures, but that is our prerogative. Because it is our prerogative, we should have our own choices in which practitioners we see and how we pay for those procedures such as cholesterol testing, mammograms, etc.
For those of us who are physically and mentally capable of managing our own lives, I should add that common sense should guide us to budget some money for medical expenses that will help us to stay healthy or catch a problem soon enough to do something about it. I know that some people have had a problem with politicians making this statement, but it is really common sense – it might be a good idea to forgo the latest smart phone or video game system in favor of stashing away money for some basic medical services. One great freedom-loving way to do this free of too much government interference is to either maintain a Health Savings Account or get a low-cost membership to a Direct Primary Care practice if there is one available. Both routes are affordable even to lower income people, and anyone with an average intelligence should be able to manage such responsibility for their own health.
By the way, on the physical activity front, it takes little to no money to exercise – just personal discipline that anyone has the capability of developing. One does not have to belong to a gym; they can regularly walk, run, or buy some very inexpensive home exercise equipment and/or workout videos. Walmart and Target have very inexpensive exercise aids; I should know because I have bought them.
However, life happens, and there are illnesses and accidents that we cannot control. Let’s say that someone has a serious car accident that is not even their fault (it happens) and they are injured. Then that person will clearly need medical care with the hope of healing and becoming healthy again. However, in that case, they are clearly not receiving “health” care; they are receiving the medical services of a doctor who must assess the extent of their injuries and recommend treatment. Of course, there are illnesses or conditions that can happen to a person no matter how they manage their health. I don’t think I have ever heard of a way to prevent multiple sclerosis. Once again, they would be receiving medical care that will hopefully take them back to a condition of general health or at least be able to maintain a relative degree of health and well-being.
I go back to the original definition of health care then. As long as we are not incapacitated in some way, we are capable of managing our own health care. Those who are incapacitated in some way will clearly need a personal caregiver and someone to provide the medical care they need to maintain life as well as possible. I do not object to some public provision to make sure the health and medical needs of the most vulnerable people are met. However, all of society should not be lumped into that system; instead such a system should be tailored to meeting the special needs of the most vulnerable people. In fact, I would argue that single payer systems such as Canada’s have been moving toward enabling physician-assisted suicide, so those who are considered to be a “burden” to society could be encouraged to exit the world, which is hardly my idea of care.
Let’s get back to the issue of doctors “profiting” from caring for people. Should not a physician who has very specific skills in treating illnesses and injuries have same livelihood the rest of us expect? Remember these physicians have sacrificed personal lives, a decent post-college income, often a sizable portion of future earnings to pay off debts for their training, and most often sleep, to take people from a state of illness or injury to health again whenever possible. And yes, those who practice general medicine can encourage their patients to do what it takes to get or stay healthy.
I would like to add to that, most of us expect to “profit” to some degree from our work, and many of us are not as skilled as a physician and have not undergone what a physician does to be trained in their work. Yet we expect that OUR livelihoods should provide us with more money than it takes to feed, shelter, and clothe us as well as maintain our health. We want our dinners out, movie nights, vacations, top-of-the-line smart phones, etc. Those should all be funded by profit, not basic living costs. Ditto for doctors.
I have barely warmed up on this subject, and it’s already about as long as the last one, so I will simply leave you here … for now. I will take up the subject again in my next post.
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*If you would like to receive regular notifications of my posts, please subscribe to my email list. It is located to the upper right of this post.
At this time, the purpose of my emails is to inform you of my latest blog post so you don’t miss out on anything I write. I am also planning on providing you with some interesting educational information in the near future regarding how the United States got to the crazy place we are in right now with the dual goals of general health of the public (I hate the term “population health”) and making sure people with medical and surgical needs receive the care they need. I personally find it fascinating.
How many of us remember that when we were children and were trying to get our parents to let us do something we really wanted to do, and they were reluctant to approve, we would use the line, “But everybody’s doing it!” Of course, the standard parental retort was, “If everybody jumped off a cliff, would you?”
How do you argue with that logic?
As the controversy in the United States rumbles on about the best way to deliver and pay for health care, I hear a line similar to our childish coaxing of our parents being used by those who want to substitute our current health care “system,” if you could call it that, with single payer health care.
This is what I generally read, more or less, when someone decides that the only way out of the country’s current health care troubles is establish a single payer system:
“Most of the other industrialized countries have single payer health systems.”
To me, establishing a single payer system in the U.S. could be compared to jumping off a cliff – it is downright dangerous for many reasons, and we don’t need to do it just because all the “most of the other industrialized countries have single payer health systems.”
Before I go any further in this discussion, maybe it’s time for me to define this single payer health care phenomenon that so many people tout as the best way to deliver health care. Although I believe that most people understand this, single payer health care is administered and paid for, using various methods, by the central government in a country (in our case it would be the federal government if it, God forbid, were implemented on nationwide basis). The funding for these “health care systems” is generally provided by taxing the populace. A couple of states in the union have attempted and failed to implement single payer “health care.” Those states are Vermont and Colorado. Now California is attempting to establish a single payer system.
In fact, according to an article on the website called “Healthy California,” (1) the California Senate voted 23 to 14 on June 1 to pass Senate Bill 562. This bill appears to be just in the “concept” stage right now, but its basic premise is to guarantee universal health care to every Californian. Once again, I am SO GLAD I don’t live in California anymore.
Single payer health care systems have become, for the most part, a pipe dream for people who believe that everybody should have access to health care.
But does everybody have access to the health care they need in those systems?
In my last post, I already stated that British doctors have been very unhappy with the pay and the working conditions in the National Health Service, Britain’s single payer health system. According to the article I was working from, many of the doctors were ready to go on a “work stoppage.” Work stoppages would deprive people of access to care. So how is care access improved?
However, that is just one element contradicting the “access to health care” argument for single payer health care. The media in Britain and Canada regularly bemoan troubles with access in their single payer systems.
Here are just a couple of examples.
According to a 2015 article in CBC News/British Columbia, entitled “Patients’ ‘Lives Ruined’ As Hip Surgery Waits Grow” written by Kathy Tomlinson (2), the average 2013 wait times for hip replacement surgeries in British Columbia were 48 weeks. They were 54 weeks in Alberta (note: more than a year). The article portrays the stories of two women who were in excruciating pain and disabled because of the long wait that is not a necessity in the United States.
In an April 2017 editorial in the National Review entitled “The Pitfalls of Single Payer Health Care: Canada’s Cautionary Tale,” (3) author Candace Malcolm states that Canada’s situation has not improved. Actually, it appears that Canada’s situation is only getting worse.
Malcolm writes that the “government central planners” in the Canadian health care system address the issue of fund scarcity by rationing care and capping the number of procedures that are offered in a given year. Well so much for access to and quality of care in “Medicare for All” system.
The only assertion made by Malcolm that I would argue with is the ranking of care quality for Canada as one step above the United States. The ranking was done in 2014 by the Commonwealth Fund, which appears to be very pro-Obamacare and uses metrics that many doctors view as irrelevant. The reference to this ranking is a little confusing because Malcolm goes on to say that many Canadians resort to the United States to get the care they need and that the U.S. provides a “parallel private system for very sick and very rich Canadians while acting as the driving force for global medical innovation.”
The British National Health Service doesn’t necessarily provide exemplary care either.
In one heavily publicized situation, a man who was suffering from frostbite after he fixed his son’s car in wintry conditions was told he would have to have his leg amputated below the knee. However, that surgery was called off. This man did his best to self-treat his gangrenous toes. and he visited a doctor every six weeks, but he eventually learned that he would need to have those toes amputated.
One British article in Metro about the situation was entitled “Man Cut Off Own Toe With Pliers After Being Forced to Wait for Operation.”(4)
The article reported that 57-year-old Paul Dibbins was told he would have to wait six weeks to have his toes removed even though they were gangrenous and there were clearly no other remedies. He is quoted as saying, “I did it because it’s what had to be done, my doctor told me my toes were going to kill me.”
Clearly, the British health care system did not comprehend the urgency of the situation – either that or the system had more very urgent situations than it was equipped or funded to handle adequately. So, I would argue that access to needed care was not in available in that case.
The Independent, an English publication, published an article in October of 2016 entitled, “‘Myth’ That NHS is Best Healthcare System in World ‘Must Be Debunked,’ says Conservative MP.” (5) The article was forecasting an upcoming speech by Owen Paterson, a conservative member of Parliament. Author Aine Fox wrote that Paterson was expected to speak regarding a report commissioned by UK 2020, a think tank founded by him. One of the many assertions in the report states that avoidable deaths resulting from serious diseases were more numerous, by the thousands, than many other places around the globe.
An interesting point I have observed whenever I read about demands by British citizens, doctors or leaders “to fix” the problems in the NHS is that the government is expected to take full responsibility for the remedies.
How about some enterprising, free-thinking physicians there stepping forward to suggest that the British government set some basic policies that would free people to develop a much more functional free market system? However, sadly enough, when people are stuck on a belief that the government bears responsibility for some aspect of their lives, it is hard for them to break away from that belief.
In light of all this knowledge, does the U.S. really want to get entrenched in that path? Why can’t we find another way to solve problems in U.S. health care that do exist?
Other solutions do exist, and they are already active in the U.S. economy – surgical centers with low transparent pricing, Health Savings Accounts, Direct Primary Care practices that do not accept third-party payments … and others.
I am trying to cut through the nonsense regarding the “reasons(?)” the U.S. should establish a single payer “health care” system. If you want to receive future posts debunking the single payer myths, consider yourself invited to subscribe to my email service that you can sign up for directly to the upper right of this post. I think the next myth I will tackle will be the issues around profit motives in health care.
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I have recently posted a few articles on my Twitter feed and Facebook professional page about a new push to establish a single payer health care system in California, which I have newly dubbed the Socialist Republic of California, although it has been that way for many years. I never thought I would say this years ago, but I am very happy that I don’t live there anymore.
I suppose the single payer scheme was relatively predictable since the state is one of the leftist capitals of the United States.
Some of the reasons people frequently give for the U. S., as a whole, establishing is a single payer system is that “for profit” medical care is immoral. I think that is a big issue to tackle right off the bat, and debunk a few myths of the high moral standing of other countries who have single payer health care systems.
Let’s start by examining the way health care has been delivered for at least the last 30 or so years, and the costs associated with its delivery. When I was much younger, in my early twenties and I am 60 now, a visit to the doctor’s office for a health problem was relatively inexpensive. I remember needing to see a doctor because I was having pains around my rib cage that just were not going away. I was living with my parents at the time and trying to get my career going after finishing college and a career job immediately after that had not worked out so well. I had no insurance at the time, but the cost of the office visit was $25, which was really pretty reasonable even back then. My mother volunteered to pay it for me at the time, which I thought was very generous because I felt that it was my responsibility.
Fast forward to our present health care situation. Costs appear to have gone through the roof for services that are administered the standard way of the last 35 years or so, especially since the advent of “managed care” and Preferred Provider Networks. There is almost always a third party payer involved – either government (as in Medicaid and Medicare) or a commercial insurance payer. So, it seems that the larger proportion of the country has just become accustomed to having some kind of “coverage.” Now some people in California are saying everyone in the state should be “covered,” but I say they are looking in the wrong direction to solve the issue of health care costs and access to medical care.
As I have stated in earlier posts, many of our costs for health care are the result of an unholy alliance between insurers and health care/hospital provider systems, many of them “NON-PROFIT,” in which these hospitals charge as much as 550 percent more than Medicare is reimbursed for the same services. Then the insurers and the health care corporations negotiate a discount well below that. Even if the discount is perhaps about 50 percent of the original outrageous charge, it is still crazy to pay any provider system THAT MUCH more than a standard Medicare reimbursement. Yes, many Medicare providers complain that Medicare reimbursements do not cover the cost of care provided to those patients, so they need to make it up in the private market with better commercial reimbursements, but 275 percent above Medicare reimbursement is INSANE. For more details on this situation, see one of my earlier blog posts: http://pollyhealthcare.net/health-care-vs-coverage/.
I have outlined our present situation because I believe that many people look at these shenanigans and think the only way out is to have a single payer system in which everyone gets medical care “for free,” and there is no profit whatsoever involved, as opposed to all of this insurance and provider nonsense. The trouble is that it’s not free. That health care will be paid for by everyone with an income that is enough to pay taxes on.
Here lies the rub, many of the health care systems touted as providing free and equal access for everyone, are incapable of fulfilling those promises. Is it moral to make promises to a population that cannot be kept?
To avoid overwhelming you with scores of examples of single payer government coverage falling far short of its noble goals, I will give you just one today. More will follow in other posts.
When people say the reason for single payer health care being the “moral” thing to do is because no one should go without care because of a lack of money, what happens if the lack of money is coming from inadequate funding from the government that sponsors that health care system?
According to a January 2016 article in Investors Business Daily, “Britain’s Health Care: So Bad Doctors Don’t Even Want to Practice There,” (1) doctors were threatening to go on strike a week from that article’s publication. The article cited poor pay and working conditions as the reasons for the threatened strike. When there is a single payer health system, doctors and nurses are treated as slaves of that system. Is enslaving doctors, nurses, and other health care workers moral? We wouldn’t do it to anyone else, so why are doctors and other providers the exception?
The aforementioned article reports the following:
“As many as 37000 ‘junior doctors, or doctors in training who represent just half of all doctors in the National Health Service,’ Reuters reports, have said, ‘they would stage a 24-hour stoppage next week, followed by two 48-hour strikes.’
A walkout of disgruntled doctors, the first in Great Britain since 1975, would affect non-emergency care and cause surgeries to be canceled, leaving many Brits, who rely on government health care, to go untreated.
Of course, going without treatment is already part of the British health care experience. The National Health Service is a broken system in need of an overhaul. It can’t continue as is.”
So I ask – do we really want to imitate this system?
I admit the United States has many dysfunctions in the way it delivers and pays for medical care, yet we should certainly not want to imitate the British system that is failing its populace. Governments are generally inept at providing services for people. Just look at our Veterans Administration health care. While some veterans swear by it, others feel they have fallen through the cracks, and according to news reports, some veterans have died waiting to receive necessary care. So the care provided in that government system is not any more “equitable” than it is in the commercial market.
To place a finer point on the fallacy of the moral argument for single payer health care, a system that provides a very “one-size-fits-all” experience and often leaves people feeling trapped in that system even when they are not getting needed care, is no more moral than any other system.
In the U.S., there are a growing number of alternatives to our health care system dysfunctions such as very inexpensive Direct Primary Care, which I describe in this post (http://pollyhealthcare.net/almost-everybody-is-missing-the-point/) or transparently priced outpatient surgical care, that could also be provided charitably by a few funding mechanisms I can think of – more about that later.
In conclusion, I believe the good old American spirit of innovation and problem-solving can be a much better solution for this country’s health care issues than the worn out mantra of “Medicare for All.” I am just warming up on this subject; there will be more to come.
Sources for further education: