Single-Payer: Just another form of bureaucratic control
by James Veltmeyer, MD | June 07, 2017
Have you or a loved one ever been refused medical treatment because your insurance company refused to pay? Would you feel better if it was a government bureaucrat refusing to pay for your treatment, instead of an insurance company commissar? Of course not. Yet, this is the alternative that the misguided advocates of “single-payer” health care are offering Americans.
The fact is that the “single-payer” model is just another form of bureaucratic control, substituting government interference in critical medical decisions for insurance company interference. Both destroy the doctor-patient relationship, lead to rapidly rising costs due to the stifling of competition and choice, and eventually lead to rationed care.
The “single-payer” proposal being discussed in Sacramento is the classic big government solution to a crisis largely manufactured by government, whose mandates and subsidies have distorted the health care marketplace for decades, bringing us to the point where health care is becoming unaffordable to millions of our fellow citizens. The California plan would cost $400 billion, more than double the entire state budget and require a massive and regressive payroll tax to fund it. It would be another huge incentive for businesses and jobs to flee California to other states.
Even in Bernie Sanders’ Vermont, “single-payer” collapsed once the politicians realized that there was no way to pay for it without destroying the economy and driving doctors out of their profession.
Advocates of this government-managed approach to health care point to Canada as a success story. However, the Canadian success story is largely a myth. Their system works well if you never get sick or require surgery. If that happens, thousands of Canadians flee to their “safety-valve” neighbor to the south, the United States where they can get the treatment they need without being placed on a waiting list for months or years. As Candice Malcolm writes in National Review, “In Canada, the government determines what procedures are medically necessary. Bureaucrats, not doctors, decide which procedures and treatments are covered under the CHA (Canada Health Act ) – based on data and statistics rather than the needs of patients.” Doesn’t that sound a lot like what we have today with Anthem, Cigna and Aetna making these medical decisions instead of doctors? Does it really matter whether a highly-paid bureaucrat in Washington or Sacramento is telling you you can’t have back or heart surgery or a faceless executive at Blue Cross is telling you the same thing?
Other advocates of “single-payer” point to Medicare as a shining example of a system that works. Yet, Medicare really isn’t even “single-payer” as 86% of its beneficiaries must enroll in supplemental or private “Medigap” policies to cover what Medicare doesn’t. And, when was the last time you looked at the financial condition of this program? $60 billion per year (10% of its total budget ) is being lost to waste, fraud, and abuse and the Hospital Insurance Trust Fund will be insolvent in just thirteen years.
The time is long overdue to consign both the third-party payer system and single-payer to the dustbin of history. We should instead enact a completely new health reform based on the direct-payer model as embodied in the Medical Association Membership ( MAM ) plan. For a low monthly fee, you receive all your routine care from your own doctor, including basic tests. No copays and quick access. Poor and low-income people receive a government voucher to pay the monthly fee. Doctors are freed from paperwork and government and insurance company mandates that drive up the cost of medicine. Low-premium catastrophic health insurance remains to cover life-threatening health events, accidents, and emergencies. A government voucher going directly to the individual, not the insurance company, will pay for that policy for the poor and low income.
Instead of more centralized planning, bureaucratic control, price fixing, and a deteriorating quality of care, why not give Americans back control of their own health care, free to choose what they want and need, in consultation with their trusted physicians? To paraphrase Ronald Reagan, maybe when we get the government and insurance companies out of health care, we can get the doctors and patients back in.
Dr. James Veltmeyer is Chief of the Department of Family Medicine at Sharp Grossmont Hospital in La Mesa, California. His views are his own and do not necessarily reflect the views of Sharp Grossmont Hospital or its staff. Dr. Veltmeyer can be reached at firstname.lastname@example.org