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
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