Is single payer appropriate for the United States?

Is single payer appropriate for the United States?

There is much debate, especially with the recent passing of the ACA, over the most cost efficient and health efficacious method to deliver healthcare in the United States. While most would agree that our current system is convoluted and expensive, there is no clear consensus as to what would be the most practical solution for healthcare delivery in the United States. Many counties opt for a single payer system, wherein the populace pays taxes to the government and the government is the sole payer to healthcare providers. This sounds good in theory by opening up access to providers to all Americans, maintaing care for the chronically ill, and reducing the confusion in covered services. Yet, when analyzed, a single payer system would dramatically increase the wait times for not only surgical or radiographic intervention, but even simple checks ups. The lower physician salaries would drive many out of the profession into a higher return on investment career. The lower salaries for all medical professionals and corporations would decrease their investment in new technology, ultimately decreasing the quality of care received [1]. It has been shown by Cutler and McClellan that healthcare spending in new technology has significantly increased both quantity and quality of life with certain interventions [2], while some others fall short. This does not mean that investment in technology is inefficient, but rather investment in the right technology is the key rather than investment for investments sake.

Further, the demographics of those countries with single payer systems do not overlap with the demographic reality of the United States, implying that a single payer system may work when most of the population is similar in lifestyle and genetic background, but may fail with such a diverse situation as there is in the United States. Looking at the 34 member countries of the OECD in it’s newest data from 2011, the vast majority of countries are homogeneous in the nature of their populace[3]. In addition, although many of the member countries score better in overall health and life expectancy than the United States, it can be inferred that this is because of their lifestyle and not necessarily due to their “superior” healthcare system. As evidence, the United States has a disproportionate increase in diabetes and obesity as compared to other OECD nations. This implies a problem prior to entering the healthcare system rather than after. There is also a significant difference between life expectancies of whites and blacks in the United States, further adding to the conclusion that the demographic differences in the United States may contribute to the complexity of successfully caring for our diverse population [3].

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Originally from OECD data but slide screenshot from Dr. Markowitz lecture.

Originally from OECD data but slide screenshot from Dr. Markowitz lecture.

According the  United States Department of Commerce: “The United States leads the world in the production of medical technologies and is the industry’s largest consumer” [4]. As Americans, we expect quick results, the best technology, and access to our healthcare providers. With a single payer system, access actually decreases with increase demand on the remaining providers. In addition, investment in new technology decreases because of less profit to healthcare companies. As a result, the development and implementation of new technologies suffer. The reason the United States leads the world in medical technology is because of the market we provide for its development. This includes both the access to a large marketplace of patients and the higher payments for those services. Although the U.S may lag the world in certain measures of health, that does not mean switching to a single payer system is the answer. Our demand for the best technology, immediate or quick access to services, and demographic diversity all guide us away from both our current system and a single payer system, but toward a unique, yet to be developed system. A mix of open market competition between providers and healthcare systems is sure to be important, with this increasing access and lowering costs. Regulation must be put in place as “rules of the road” but over regulation as is the status quo currently is crippling. 

 

[1] http://www.heritage.org/research/reports/2009/04/single-payer-why-government-run-health-care-will-harm-both-patients-and-doctors

[2] David M. Cutler and Mark McClellan Is Technological Change In Medicine Worth It? Health Affairs, 20, no.5 (2001):11-29

[3] http://www.oecd.org/els/health-systems/49105858.pdf

[4] http://selectusa.commerce.gov/industry-snapshots/health-and-medical-technology-industry-united-states