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: