Current status of ACA and Republican lethargy is giving advocates of a Single Payer System the platform and time to steer the conversation. What would Single Payer really look like?

Let’s discuss this in two dimensions. One which might look like Medicaid or Medicare but a second that might look like Canada. Both directions likely paint a picture that most Americans will not like nor accept. Hey, maybe this will be fun!

Let’s set the stage for a Medicare-like single payer system which can easily be imagined because we all know someone on Medicare. Generally, these folks also have a Medicare supplement as well as Part D Rx coverage so we view their coverage as 100% with no gaps.  Plus, the cost of Medicare Part B + Med Supplement + Part D Rx is usually less costly than a fully insured plan for the member. That sounds appealing doesn’t it.

But, many providers won’t accept Medicare payment levels and the many who do only do because their practice some how requires it. If every provider were to be reimbursed at Medicare levels many experts think that the quantity and quality of our Nation’s doctors and surgeons would be lower.

Would a Medicare-like healthcare system be as appealing to folks if the number of available providers were reduced by a third or possibly one half of what is available today? I doubt it would be but we do have a test population on which we can analyze the impact of fewer providers. Just look to the millions for Americans who have signed up on Individual plans during the past 3 years under the ACA. Most studies show the number of providers available in PPO plans to be 50% lower than just a few years ago. That’s 50% fewer Docs available for your treatment. Sound appealing now?

Let’s look at a Canada-style single payer system. First, set aside the stories of tens of thousands of Canadians coming south to the United States to get the treatments they need but can’t get at home. Many of our citizens simply could not afford to go somewhere else for care or to pay for the care from local providers not covered by the single payer system. It would be too much out of pocket for most of us so we would be stuck with the providers who decided to stick it out and practice in our home area.

Let’s assume an American living in the US needs treatment, such as cardiac surgery, under this Canada-style system and can’t afford to go any where else for the care. The person would see a primary care doctor first which might take 4-5 weeks then the primary care doctor might determine that the patient needs referred to a cardiologist which might take another 6-8 weeks. Of course during this time the member is experiencing the symptoms and possibly pain associated with his/her cardiac condition. But it continues.

The cardiologist might say “Yep, you are going to need cardiac surgery” so the cardiologist instructs the member to contact the appropriate surgeons in the area to schedule a surgery. Studies show that the wait time for surgery in this style of healthcare system can be from 3 months up to 10 months depending on circumstances. So from first visit to actual surgery could take up to a year. How many American will be satisfied with that level of care.

Currently in the US healthcare system people can go from diagnosis to surgery in a matter of hours if needed. Whether that speed is appropriate for all surgeries is irrelevant because that speed is what we expect and to which we are accustomed. We are all used to the pace of healthcare delivery in the US so will our citizens settle for a system that delivers less?

There, you have two examples of what a single payer healthcare system might look like in America. I realize that you might be skeptical of this opinion or these examples but can anyone name one function that Government took over that was more efficient than before? We can look at the care our veterans receive from the VA as the last-best example of why we must fix our private healthcare delivery system and avoid the inevitable pitfalls of single payer.

I normally would wax on about facts, figures and examples but I think enough is enough, don’t you? But, let us know what you think because we are all in this together.

So, let your Representative hear that we need some real action!
Until next week.

Mark Reynolds, RHU


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