Doctors in favor of a single-payer health care system

The following are two letters to the editor of the New York Times printed 5-24-16. They caught my eye because they display a lack of understanding of health insurance and how a single-payer system would actually work.

First, under a single-payer system each element of the system is still about profit. Which segment of Medicare from physicians to device makers, to scooter makers to the claims processors is not about profit? Even if you consider a UK system with employed physicians, it’s still about individual profit … in that example something worth striking for. Are US physicians willing to lower their incomes in line with the U.K. and most of Europe?

While we can do better in terms of coordinated administration, that is a small part of health care costs as are insurance company profits.

Does anyone seriously believe a single-payer system can be affordable without forms of care management, pre-authorization, etc.?

docopleratingThe primary driver of health care costs is health care, period. This means the type and amount of health care received and the cost of the services provided (reflecting the aging population and health status of the entire population). To lower costs requires changing all those elements of the system.

Our frame of reference for a single-payer system is not realistic. You cannot simply drop the US health care system and the expectations of Americans into a European-style system. There are significant trade offs that are rarely talked about such as government agencies directly involved in determining appropriate health care, hospital stays in multi-patient rooms, waits for health care that are not typical in the US. and in some cases assignment to hospitals and physicians.

We also forget the examples of the VA and its ongoing delivery problems caused by bureaucracy … and the inability for Congress to think out-of-the-box and come up with solutions. And dare I mention the billions of dollars in Medicare fraud caused in large part by faulty and inadequate administration.

We may yet end up with a single-payer system in the US, but we should not expect business as usual either providing or receiving health care and we should expect ongoing changes to deal with growing costs.

To the Editor:Re “Why a Single-Payer Plan Would Still Be Really Costly” (The Upshot, May 17):

As a physician who favors a single-payer plan, I cannot disagree with your analysis about the high cost of moving to this type of health care plan.

Our present system is really all about profit — from the medical device makers to the pharmaceutical industry to health care workers and medical administrators to insurance companies. The challenge to bring down costs, under this system or single-payer, is large.

Yet we have seen what the free market has done over the last 70 years, and it has not been a success in terms of cost control. Indeed, health care costs are going to get significantly worse if we continue our present system, a combination of private and government payment.

Only a single-payer system has any chance to control costs yet guarantee that all citizens will have health care coverage. To stand pat with free-market fervor or to go backward, such as eliminating the Affordable Care Act, will deprive many of medical care while still driving up costs.

In the long run, the present system will cost far more than a single-payer option, and the sooner we proceed in that direction the better. 


Middleton, Wis.

The writer is a retired internist.

To the Editor:

Our health care costs more because our administrative costs, a result of a financing system that relies on for-profit insurance companies, are so high. Some of those costs are borne by physicians, who must pay for complex billing systems, denial management, preauthorization requirements, collections management and bad debt, as well as devoting patient time to discussing insurance coverage rather than medical issues.

If we substantially decrease those costs to physicians, as a single-payer system would do, we could decrease insurance payments to physicians and still give all of them a raise. No economic miracle involved; just a matter of the people who do the work, rather than a wasteful middleman, taking home the money.



The writer is a retired internist.


2 replies »

  1. I see a single-payer as a loss of all check and balances. When there is competition, efficiencies will be found.

    What I think needs to happen and maybe it is already done and that is to standardize the admin procedures so that payment can be streamlined. From coding, billing, to forms it is a mess. I called BC/BS yesterday and it took them 10 minutes to figure out what I was entitled to under my policy. How am I or my doctor’s office suppose to figure it out?


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