As controversy swirls around the Republican health plan, I find myself increasingly hopeful for single-payer health care. Yet common refrains critical of a government-run single-payer systems continue: “Do you want your health care to be like the VA, Medicaid, or, God help us, the Department of Motor Vehicles?”
These comparisons, however, are fundamentally misleading. The Department of Veterans Affairs health care system and Medicaid both exist within the perverse milieu of fee-for-service health care in which delivery of care is primarily profit-driven. At its core, this system creates financial incentives to perform procedures or prescribe medications that are meant to improve one’s health and quality of life. However, when compensation is based on mere delivery of these services in lieu of actual health outcomes, medical interventions can be unnecessary, expensive and sometimes inadvertently harmful.
I’m an emergency medical physician who has worked on the front lines of health care in this country for more than 30 years, and I believe it is this approach that has catapulted U.S. health care spending to nearly 18 percent of our GDP without commensurate improvement in health outcomes. Medicaid may be substandard, but it’s only because it is marginalized within the public-private hybridized market and pays physicians a fraction of what they would otherwise receive in privately operated venues.
Meanwhile, the VA is a single-payer system engineered exclusively for veterans, one of the highest risk populations in the country, and this concentrated disease burden is wildly under-resourced. The DMV, like an emergency room, is a great equalizer in which the wealthy and the destitute wait in the same lines for the same services. On any given day, most of my patients do not qualify for true emergency intervention. They show up to the emergency department and wait for long periods to receive hurried, costly primary care — the same care that could be delivered far more effectively and affordably with regular preventative check-ups. Similarly, at the DMV, those who follow protocol and make an appointment are in-and-out in 10 minutes while those who fail to do so wait in line for hours. Even the perennially maligned DMV offers a more effective approach hiding in plain sight.
When the Affordable Care Act passed, I predicted that momentum for a single-payer system would be on the rise. The reason? When exclusion based on pre-existing conditions became illegal, it created an existential impasse for the for-profit model. Single-payer has nothing to do with the government practicing medicine; suited bureaucrats won’t replace your learned doctors. Rather, it is the eventual replacement of the many insurance companies with one payer — the U.S. government.
Yes, there will be regulations around payments, much like there are now. And yes, taxes will increase, but they will replace unpredictable premiums and copayments that haunt the privately insured. As a physician, I witness firsthand every day the reason free-market forces cannot succeed in the long run. In a civilized society you simply cannot deny medical care to an individual who needs it simply because he or she cannot afford it.
It’s true that some of the people in emergency departments seeking primary care have made poor choices, yet many others are victims of circumstances beyond their control. And in the end, does this distinction even matter? We are the richest country on earth, and while it is common knowledge that there is a vast maldistribution of wealth in the United States, the current administration seems to be working tirelessly to increase this imbalance. We need to all pay our fair share to fund health care in a way that empowers people and truly makes America great. It’s time to join the rest of the civilized world. It’s time for single-payer health care.