Donald Bowling

12-06-97

Should the United States Implement a Single Payer Approach to Health Care?

Health care reform as proposed by many U.S. politicians means that our government would take a central role in the restructuring of the finance and operation of healthcare facilities. This restructuring can range from minor reorganization of the healthcare system to full scale socialization as in a single payer plan. Government health care reform can take place under many different plans. However, this paper will focus on the single payer plan and the different aspects of setting up such a plan in the United States. In the single payer healthcare system, the government pays for all of the nation's health care costs and controls services offered to its citizens. Many governments in Europe have adopted different types of single payer systems. However, we will focus on the single payer system of Canada. We will use the Canadian plan as a model to examine what would happen if the United States adopted a similar health care plan. The plan of our northern neighbor is a good model for comparison because it was the basis for many of the proposed health care reform measures introduced in Congress during 1994 session.

Most Americans agree that the cost of health care has reached outrageous proportions, and consumes a large proportion of our individual incomes. As a nation we spend $1,000 billion per year on health care. This amounts to about 1/7 of our national gross domestic product (Markus 1997). In the 1994 state of the union address, President Clinton declared that health care reform was his top priority and shortly afterwards he presented his own health care bill to Congress. Many senators and representatives also presented their own health care legislation at the same time. After review of different proposals, Congress decided not to reform the healthcare system. However, surveys by the American Medical Association have shown that 97 percent of Americans believe that we should reform our health care system (Opinions 1994). This raises the question: Should future policy makers try to reform and possibly socialize health care in America? I believe that the healthcare system should be reformed, but I don't think the single payer plan is the best solution.

The supporters of proposed US single payer plan claim that the plan would offer a comprehensive package of benefits to every citizen in the country regardless of job or social status. Citizens would be able to choose there physicians just like they do now. The single payer plan would eliminate duplication of administration tasks by abolishing the 1500+ health insurance companies of our current system. By doing away with these companies it is anticipated that the economy would save billions of dollars within the first year due to reduction of administrative tasks. Emphasis in the single payer system would be taken away from the profits of medicine, and instead focused on quality of patient's care where it belongs. Doctors would be offered greater anonymity allowing them to prescribe appropriate treatments to patients without interference of bureaucrats. The job of the physician would in no way change in terms of pay or speciality. The unnecessary duplication of expensive hi-tech equipment at neighboring facilities could be prevented. Equipment could be located where it would be used most effectively in providing treatment, while stopping duplication. Lastly, more emphasis would be put on early treatment and identification of a diseases before they progress to an acute stage. Early identification of disease would cost the system less than treatments in advanced stages (Symonds 1994).

The intent of the single payer health care is very idealistic. Most supporters claim they want all citizens to have access to a high standard of health care (better known as universal health insurance coverage). It is estimated that today 36 million Americans are without health insurance. These individuals often put off health care because of there inability to pay, forcing there ailment into a acute stage. They are forced to seek care when the sickness progresses and treatment is more expensive than if it had been caught earlier (Markus 1997). Through the single payer plan all citizens despite place of employment or income would have health insurance coverage. However, because everybody is afforded healthcare the more fortunate citizens in a society must pay medical expenses of their own as well as the expenses of the able bodied but non contributing members of society. Non-contributing members of society would get the same coverage as productive citizens who pay taxes that cover the cost of medical treatment. (Byron 1994).

The most profound benefit of socialized health care is the reduction of the current health care bureaucracy. There are presently 1,500 insurance companies which all have different ways of doing business. Policy holders and health care staffs must decipher different forms, and different coverage plans. A single payer system is centralized with one set of forms and one coverage plan. Supporters of the single payer plan estimate that by cutting bureaucracy and duplication of certain tasks in health care that we would save $100 billion a year in administrative costs. However, the problem is once we get rid of the 1,500 insurance companies we also are abolishing jobs of the millions of workers employed by the insurance companies. Supporters of the single payer plan say that administrative costs would be reduced by 25 percent (Brand 1994). However, there is no ground for this argument. Canada has reduced administrative costs by mere 6 percent and the US Medicare program (a takeoff on the single payer plan) has only reduced administrative cost by 1 to 2.5 percent. Health insurance companies also invest large amounts of money to earn interest on premiums paid by subscribers. If these companies were to shut down, their investments would most likely be sold or redistributed causing a possible economic crisis in the country. While simplification of bureaucracy sounds like a noble idea, in this case, jobs would be taken away and investments patterns of the economy would be disrupted (Lynch 1997 ). These trade off of jobs and economic security in return for a very small monetary savings on medical cost is not worth it. The most threatening thing about a government takeover of insurance companies is that it would be a violation of the U.S. Constitution. It would be an intrusion on private sector property and market share of insurance companies. The U. S. Constitution protects these property rights, government intrusion on the healthcare industry would violate one of the fundamental rights upon which this country was founded (Kelley 1994).

Supporters of the single payer plan claim comprehensive coverage will provided for all citizens. However, different politicians have different ideas about what comprehensive includes and excludes. Individuals that once had coverage for some elective surgeries may not have the same indemnity under the single payer plan. Some individuals may not need or want psychiatric and drug rehabilitation coverage that proposed U.S. single payer plans provide. It becomes the job of bureaucrats to dictate what kind of coverage plan is best for the public. Politicians are left to make value judgements on which kinds of health care are needed by the most people. Interest groups who lobby for a particular type of coverage (which their company provides) have influence on what kind of coverage is provided in other single payer systems and most likely would if the U.S. implemented a single payer system (Wilson 1994).

Currently, the United States has the one of the highest standards of health care in the world. This is partially due to large investments in high tech equipment by medical providers. This technology often costs large amounts of money per use while little is received in terms of diagnostic assistance or lives saved. Since socialized health care systems are often pressed to conserve funds, one way to cut prices is to stop expensive testing and treatment methods which do not produce results. Since hi-tech equipment is very expensive and is not used to it's full capacity, bureaucrats will most likely centralize high technology that remains into research hospitals (as in the Canadian system). This centralization of technology causes patients to be routed where the equipment is, or sometimes for the equipment not to be used at all when it is applicable. If we cut out these high tech treatments from our health care system, the standard of health care will inevitably go down (Lynch 1997).

Supporters of socialized health care claim that physicians would be private individuals free to charge fees or they could work exclusively for the government. However, upon closer examination of existing single payer plans, socialized health care is evidently not possible without putting doctors and health care staff under governmental regulation. Physicians who select the "private route" will be forced to negotiate fees annually with the government. During these negotiations private doctors are often forced to take the same (or less) pay as government doctors. Due to the time it takes to negotiate pay and limited success in negotiations, doctors would be better off giving up their private status to work for the government (Amiel 1996). During healthcare reform in Canada officials assured hospitals that they would remain private. But, despite these promises, hospitals were not allowed to expand, they were downsized, and sometimes even completely shut down. Patients were routed by the government to certain major hospitals leaving smaller ones to fend for themselves without the necessary clientele for financial stability. Most likely the same thing would happen to smaller hospitals in the U.S., if the single payer plan was implemented (Wooldridge 1992).

Supporters of the single payer plan promise that patients would have choice of physicians (Chamberland 1994). However, this is only true to a certain extent. A patient, of course, is free to choose his or her doctor, but under existing single player programs the physician must be a general practitioner. The luck of the draw assigns specialists to patients. Under single payer programs, governments persuade doctors to take up general practice and medical schools steer students toward general practice. When a patient needs specialized care, the numbers of specialists are so few that the patient must often wait to receive treatment (Henderson 1994). General practitioners often care for large numbers of patients, thus forcing them to work faster and spend less time with each patient. This lack of time hinders the personal relationship between doctor and patient. It is estimated that the demand for service would increase by 30 percent per physician if a single payer plan was implemented in the U.S. (Symonds 1994). The relationship between doctors and patient is further complicated by "gag orders". Gag orders are government mandates that force doctors who receive government funds to tell patients only what the government wants them to say according to a set of guidelines. This censorship dictates that less expensive treatments be recommended to patients despite a physicians personal feelings of what should be done. In 1971 the Supreme Court ruled that "gag orders" were permissible when government money is involved in medical funding. It is a likely that if government socialized health care was implemented, that the number of gag orders would increase in efforts to reduce costs, despite promises of increased doctor anonymity (Mohr 1994).

Single payer health plans force the implementation of cost saving measures to keep tax rates under control. Despite promises of comprehensive, care cost cutting measures often result in lack of funding for major non emergency surgeries. This trend can be seen within the Canadian health care system. Waiting lists have been established in this country to deal with patients needing non emergency surgery, and most Canadian patients have to wait an average of five weeks (Symonds 1994). In 1992 it was estimated that 0.7 percent of the Canadian population was waiting for a surgery, amounting to 17,700 people. If the same percentage of the U. S. population were awaiting surgery, the number would be 1.5 million (Miyake and Walker 1993). Supporters of social health care however are able to show that Canada has no wait for emergency surgeries. They also point out that the hospital capacity in the U. S. would act as a safety valve to prevent waiting lists (Chamberland 1994). However these supporters are forgetting that the real reason for waiting lines is lack of funding. As a result of the lack of funding the extra facilities would be useless in combating the waiting lists. Often after the long wait, Canadian patients find that the surgery is to be preformed on an outpatient basis. Out patent surgery cost less, by not allowing a patient to recover fully in the hospital, resulting in an increase risk of post surgical complications. If money is not available for treatment, promises of comprehensive care do not matter (DeMont 1996)

In a socialized system of health care working citizens are forced to pay for the health care of non-productive citizens. As a result of government take over of heath care systems, many jobs would be lost, and our national economy would be compromised. Doctors would be under direct control of bureaucrats whose main goal is to slash prices. A person would be equivocated to the cost of his or her illness in the governments eyes. Though the socialization of health care is a noble idea in that it helps society take care of those less fortunate, the quality of health care for the average citizen would decease. It is clear that we must do something to reform our health care system, but I seriously doubt that the single payer plan is the best answer.

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17-18