Sunday, July 30, 2017

Is America Ready for a Single Payer Health Care System?

Each morning, as I read the newspapers in view of 3 birdfeeders, I send excerpts of news morsels to various individuals in an effort to stimulate a dialogue on issues of the day.  I am mindful how deluged we all are with a tsunami of unsolicited material.  I will not contribute to the cyber pile-on.  First, I’ll never forward an article that I have not read in full.  Secondly, I will send an item to an individual only if I have judged beyond a reasonable doubt that this person will feel that the time investment in the material will be judged to be time well spent. 

I engage in an active colloquy with one of my good pals, who is among the millions of Whistleblower readers who ponder these posts each week.  To my knowledge, he has never left a comment on the blog, which is somewhat unexpected of this rather voluble individual.   As he has opted to remain anonymous, I will not ‘out’ him here, although perhaps this post may be the catalyst to morph him from spectator to participant.

More than once this past week, my pal has importuned me for my view on a single payer health care system.  I shall do so now, in this very public forum.

Readers are aware of my views on our current health care system.  For those yet unacquainted with my insider’s view of the health care reform, I refer you to the Health Care Reform Quality category on the right side of the screen where you can digest several edifying entries. 

We already have a single payer model in this country.  It’s called Medicare and it is wildly popular with enrollees.  A single payer system can be regarded as a Medicare-for-All program.

I have written many times that I believe that Obamacare was designed to be an interim measure until a full and complete government nationalization of our health care system could be accomplished. How ironic it would be if single payer emerges because the GOP majority who favor private sector solutions can't bring a bill to the president's desk. 


Single Payer Health Care Will be a Heavy Lift

I will support a single payer system, if the following features can be guaranteed.

  • Universal access for every American.
  • Fair and reasonable compensation for physicians and health care professionals.
  • Pays physicians and health care institutions in a reasonable time period.
  • Adequate number and distribution of primary care physicians.
  • Eliminate the dreaded ‘prior-auth’ for prescriptions which tortures physicians and our patients.
  • Reforms an unfair medical practice tort system.
  • Reforms medical education so that students are not routinely saddled with 6 figure debts.
  • Incorporates innovations to reduce over-diagnosis and overtreatment which bleeds the system and harms patients. Both patients and the medical profession are culpable here.
  • Affordable medications understanding that the pharmaceutical industry needs a profit motive to spend hundreds of millions of dollars of research to develop treatments for cancer, arthritis, dementia, diabetes and various chronic illnesses.
  • Defines clearly what medical care is not covered by the plan.  Everyone wants coverage for experimental treatment regardless of the cost for an afflicted family member, but this is beyond possible.  We cannot pay for every conceivable medical test or treatment, even if some experts regard it to be ‘promising’.  What should the standard be?  Perhaps, FDA approval might be a starting point for this discussion.
  • An impartial appeals process that is fair to all parties and issues a decision in a timely manner must exist.  Fund promising clinical trials so that patients who have exhausted conventional treatment, can altruistically help to generate new medical knowledge.
  • Ensures that patients, physicians and hospitals who contact SinglePayerCare can reliably and promptly reach a living, breathing human being who can answer the question or solve the problem without dropping the caller into a labyrinth of horrors.
  • While the costs to patients must be reasonable, they need to have some ‘skin in the game’ in order to serve as a break in what is now a runaway train of unnecessary medical care.
  • Medical quality must be championed and fairly measured, which would be a departure from current sham and scam ‘quality metrics’ that are in place.
  • Futile medical care should not be provided even if demanded by patients and their families, although I recognize that this is a sensitive issue.  Families understandably ‘want everything done’ as they cling to vain hopes.  And, while I don’t mean this to be callous, it’s easier to request a service when someone else is paying for it.
  • Has proper incentives and access to primary care so that routine medical issues are not clogging up our emergency rooms. 
  • Separate medical institutions’ economic interests from the public interest.  I surmise that the United States has the highest per capita of CAT scan machines on the planet.  Would private hospitals and nursing homes willingly surrender control or even ownership to the federal government to serve the greater good?  (You may laugh now.)
Single payer?  Bring it on!   I think, however, that this would be a very heavy lift.  We have a Medical Industrial Complex (MIC) riddled with waste and conflicts of interest and very powerful players who are making a fortune off the system.  Perhaps, if we were designing our health care system de novo, we would establish a single payer system, as other nations have done. 

Think of the health care reform issue as we do term limits for our senators and congressmen.  We all know that it’s a good idea, but it will never happen.  Legislators, like those in the MIC, do not seem capable or willing to place our interest over theirs. 


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