Single-Payer Is Not So Simple or Smart

Let’s start with three facts. First, patients are unhappy and growing unhappier with the nation’s medical care system. People want changes. Second, there are plenty of proposals out there. Third, this plenitude, indeed plethora of proposals demonstrates that none have the single right answer.
In medical practice, multiple treatment approaches usually show that there is no single best treatment. But just because there may be no best treatment, some treatments can still be worse, or altogether wrong. And so it is with health-care policy.

The search for a best solution has become so frustrating for the searchers that many large medical organizations are calling for a single-payer system. It seems simpler. It sounds simple. What could be wrong with that?

We remember the “Call to Action” in the Journal of the American Medical Association several years ago. More recently, the American Academy of Family Physicians and other responsible political organizations have started advocating the single-payer solution. One of the best reasons for a single-payer system, they say, is to free the patients, medical personnel and physicians from the burden of more than 400 different insurance forms. True. But the benefits end there. One form of thousands, government clerks still have this insatiable desire that every blank be filled. This means patients and their physicians will have to divulge a lot more information than necessary, wasting everybody’s time and money, and giving up what little privacy they’ve managed to preserve.

Some thoughtful physicians have the attitude that a single-payer system wouldn’t be bad because the government so far has left them alone or that dependence on government would somehow be better than dependence on their current employer. We know a talented physician who spent several years in prison because he was falsely accused by the government and convicted — on the basis of perjured testimony — of incorrectly billing insurance companies. Another stopped practicing because of similar accusations based on an unintended $37 billing error by a secretary. The single-payer system cannot work if the lessons of history are any indication.

We should be able to learn valuable lessons from one of the most prominent single-payer systems in the world. This system was developed over many years, with the advice of some of the greatest experts in the world, with minimal political bickering and with solid backing of the entire country. This nation even included the right to health care in its Constitution.

Yet this nation, the former Soviet Union, was renowned for the gross inequity and inadequacy of its medical system. For example, the doctors practicing in Moscow were essentially evenly divided into two medical systems. One system provided reasonable quality medical care for the nomenklatura, or party elite, who numbered about 5 percent of the population. The other 95 percent of the population was treated in very low quality hospitals and facilities by the other half of the physicians.

Remember managed care? In the December 21, 1995 issue of the New England Journal of Medicine, Cambridge, Mass., physicians Steffie Woolhandler and David Himmelstein complained about their professional limitations under corporate managed care at the same time that they pushed for a single-payer system. In a footnote, Himmelstein noted that he was being terminated by his corporate employer. He did not understand that a single-payer system is also essentially a single-employer system. If a single-payer government fired him, he would be permanently out of a medical job, unless he left the country.

Do we really want to make everyone’s personal medical care the subject of a political experiment? Any single-payer system ultimately depends on government’s monopoly on the lawful use of force. And who controls the government? The politicians and bureaucrats working for them.

This points to another problem with the single-payer “solution.” When there’s a change in the political winds, it can be like the calm in the eye of a hurricane — a short period of transition from violent winds from one direction into equally violent winds blowing in the opposite direction.

Political control of payment ultimately means that decisions about health care will be political, especially when the government decides it doesn’t want to spend as much money as patients require or hospitals and physicians need to do their jobs.

A single-payer solution would also foster even more of an entitlement attitude in the recipients. In practice, physicians note that some recipients of Medicare and Medicaid are demanding and non-appreciative. On the other hand, people who paid their own bills or were given charity care by individual physicians are usually more appreciative and interested in learning about their own ailments and how to manage them.

We therefore suggest that, if the government wants to stay involved in citizens’ medical care, that it focus on people who actually need assistance rather than trying to control everyone. Attempts to try to control everyone remind us of America’s failed past experiment with alcohol Prohibition. By using focus instead of force, government might be able to recover some respect from those resisting current attempts at central control.

The single-payer system is not so simple or smart especially when given Americans’ abhorrence of the long-term results of single-payer medical solutions. Americans should have the inalienable right to choose how they want to meet their medical needs. This founding principle alone should be enough to cancel the idea of a one-size-fits-all monopoly.

When freedom of choice is so important to Americans in every other aspect of their lives, why are we so eager to give it up in matters of life and death?

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Michael Arnold Glueck, M.D., of Newport Beach, Calif., writes extensively on medical, legal, disability and mental health reform. Robert J. Cihak, M.D., of Aberdeen, Wash., is president of the Association of American Physicians and Surgeons. Both doctors are Harvard trained diagnostic radiologists. Collaborating as The Medicine Men, they write a weekly column for WorldNetDaily as well as numerous articles and editorials for newspapers, newsletters, magazines and journals nationally and internationally.