US doctors should realize the nightmares inherent to single-payer
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Do American doctors want single-payer?

Two 2017 surveys — by Merritt Hawkins and LinkedIn — asked U.S. doctors whether they support or oppose a Canadian-style single-payer health-care system. Both studies indicate that a large number — 42 to 56 percent — of practicing physicians say yes.

Some claim this was a “change of heart,” comparing a 2008 Merritt Hawkins survey to the current one. However, it is difficult to know whether doctors’ opinions have changed because the two surveys asked different questions.

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However one parses the data, it is clear that many U.S. clinicians say they favor single-payer, despite the risk that they might take a financial hit.

 

Most U.S. doctors do not understand how our health-care policies work. They do understand that the system constrains them rather than helps them. Clinicians desperately seek something that makes it simple and easy to care for patients and gives relief from the regulatory burden. Therein lies the deceptive attractiveness of single-payer.

Single-payer is sold to doctors as simplicity itself. They are told there will be one form to fill out, one insurance agent to deal with, a uniform, straightforward payment procedure, one standard set of rules, and low operational costs. Single-payer proponents assure doctors they can return to doing what they want to do and are trained to do: care for patients.

Single-payer sounds too good to be true because it is! No government bureaucracy is simple or inexpensive. The government collects large sums of health-care dollars from American taxpayers, but then pays the bureaucracy first. The care in health care gets the leftovers.

It is true that single-payer bureaucracies cost less than what the U.S. now spends, but they still spend way too much on bureaucracy — diverting that money from care. More ominous for patients is the way that single-payers spend less: they ration care.

The British National Health Service (NHS) has an agency called N.I.C.E. (National Institute for Clinical Excellence), which is tasked with allocating health-care spending. N.I.C.E. decides which medical procedures are “Not Cost Effective” and denies payment for these treatments. For example, N.I.C.E. classified kidney dialysis, roughly $10,000 per month in the U.S., as Not Cost Effective in people over age 55. Without dialysis or a transplant, kidney failure causes death. Single-payer in Great Britain allows people to die over an age threshold even though they could be saved.

Single-payer advocates say doctors love their system. If so, why did British doctors go out on strike twice in 2016?

It is doubtful that U.S. doctors would support single-payer if they understood it meant rationing care for their patients.

The wording in the 2008 Merritt Hawkins single-payer survey is noteworthy. “Given the alternatives, do you believe the United States should adopt a single-payer, Canadian-style health system?”

In the early 20th Century, medical insurance was purchased to ameliorate financial risk. Insurance covered wages lost due to illness and partial medical expenses after the patient had paid the bill. In the 1930s, insurance companies began to offer policies that were prepayment plans for care. This established insurance as a third party payer.

The only health-care system today’s physicians know is based on third party payment. Most doctors cannot even imagine free-market health-care. They are not used to competition, and worry that patients may actually shop for a physician or hospital instead of insurance directing patients to them by contract.

Nonetheless, U.S. physicians desperately seek relief from the insurance nightmare and government’s overwhelming regulatory burden. Doctors have been promised that single-payer will be a simpler, hassle-free system in which they can return to practicing medicine.

Finally, U.S. doctors mistakenly believe single-payer will allow the proper doctor-patient relationship: doctor advises and patient decides.

Single-payer is central control of health care. The government replaces doctors by deciding what care is allowed, when and how it is provided, and what the government will pay for that care.

The budget dictates availability of services, not patient needs. The reality of single-payer is that patients die waiting in line for care. Such “death-by-queueing” is well documented in Canada and in the U.S. VA system.

U.S. doctors must realize that single-payer makes Washington the decision maker, not the patient. In Canada’s single-payer, the courts grant the government the legal authority to pull the plug even against the patient’s wishes.

If U.S. doctors understood all of the above, it is difficult to believe that those who swore the Hippocratic Oath would support single-payer.

Dr. Deane Waldman (@SystemMD), MD, MBA, is a retired pediatric cardiologist and director of the Center for Health Care Policy at the Texas Public Policy Foundation. He serves on the board of directors of the New Mexico Health Insurance Exchange and is the author of The Cancer in the American Healthcare System.


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