A Single Payer Healthcare System? Have you seen the UK lately!
This is a primer for citizens on the US healthcare system. And an argument for bringing back a cleaned up version of our health insurance programs before the (Un) Affordable Care Act.
The recent story about a little baby boy in the UK who is facing termination of life because the single payer government healthcare system doesn’t have the resources to pay for his survival has lit yet another firestorm around which type of payer systems are best for healthcare.
As a health economist and medical provider with many years of experience both diagnosing and prescribing in the US healthcare system and almost 20 years interfacing with both government and private sector healthcare payers in the US, Europe, and Asia, I am uniquely qualified to help others understand our healthcare delivery system.
I think Americans owe it to themselves to understand what the American healthcare system is comprised of so that they can make intelligent decisions and opinions on what it is they want the government to do and not do in the effort to develop a smart, efficient and high quality healthcare delivery system. For those who find it confusing — are we a single payer system or not — you are not alone.
Here’s the simplest answer: The US health delivery system is actually a combination of government (Federal & State) sponsored healthcare (Medicaid and Medicare) AND employer-sponsored (private) healthcare plans.
The two main government plans, Medicaid and Medicare, have different intended uses: Medicaid was created to provide healthcare for the indigent, the disabled, and orphans without parents or families who could provide for them. Medicare was started to provide government healthcare to senior Americans, and it is a mandatory program for those 65 and older, regardless of the ability or inability to pay for insurance, and that means that the rich are forced into it as well. This never made any sense, since we could save countless millions by dropping the requirement for those who opt out and show proof of private coverage. That’s a discussion for later.
In summary, we are a combination of socialized and privatized medicine and that makes us fairly unique in the world.
One aspect of Medicaid with which many Americans are not familiar is that it is primarily paid for by each individual state with a disproportionately small portion paid for by the federal government. This model allowed states to decide the priorities of the spend based on what their citizens needed. It was not intended to be an unending, unlimited free insurance plan for able-bodied, unemployed, or illegal alien persons. But the progressive liberal agenda that pervaded our system for far too long loosened the rules for coverage and blew up its costs. Just like unemployment insurance started out covering a limited number of weeks and then exploded into two years, or what Newt Gingrich called “the equivalent of an Associate’s degree,” Medicaid eligibility rules loosened to the point of absurdity. These expansion tactics have resulted in overload and severe burdens on our government provided healthcare systems.
It is important to understand that Obamacare was not a new or magical program. All Obamacare did was force states into an expansion of their individual Medicaid programs beyond what Medicaid was intended for. By forcing states into blowing up their state Medicaid plans and mandating universal eligibility, people were dis-incentivized from working to get their insurance and the competitive market for preventative medicine and innovation in coverage plans was doomed. This is, in great part, the reason for the sheer strangling of healthcare resources.
In addition, the deductibles in Obamacare, that portion that you the patient must pay out of your own pocket before the insurance starts paying, are incredibly prohibitive. The “Gold, Silver, and Bronze” levels all have deductibles in 2017 averaging $6,000–12,000 for each year! As I explained to a visitor from the EU who tried to argue that “at least everyone had insurance,” — if they can’t meet the deductible they have no insurance!
I think we all understand the need for a government program to provide healthcare for a certain segment of society that are in need but…we also need to maintain, support and grow the privatized portion of our healthcare system through employer incentives, innovation in designing useful insurance plans, tax credits for those financially able to purchase their own coverage, and free market choices to enable patients to get some skin in the game.
We are America — and we should never become a totally single payer healthcare system if we are to thwart socialism and communism. Single payer systems drain the bulk of resources, fail to provide adequate care, and encourage dependence. If you disagree I invite you to study, really study those truly single payer systems abroad that are choking on their profuse debt with long wait times for healthcare, and making life and death decisions from their statehouses, not their medical institutions (i.e. Canada, UK, Venezuela).
We need a partnership of government programs and privatized coverage plans where both can take advantage of the competitive environment of a free market. Only then can we achieve good access to treatment and excellence in healthcare for all Americans.