The American Healthcare "System" in 2005 -- Part 4: Why Not the Single-Payer Solution?

Editor's Note:
American Health System Reform has returned to the front burner for 2007-2008. MedGenMed ran a sequence of Webcast Video Editorials in 2005 that tried to tell the whole story -- past, present, and proposed future -- in 7 easy lessons. It was well received then with high readership but the politics was cold. The situation in American healthcare has not changed fundamentally since 2005, except that conditions have worsened and a new presidential campaign is upon us. Ergo, the politics of health "system" problems is now hot. So, we are republishing all 7, in order, on sequential Thursdays. Read, enjoy, or get angry, but let us know what you think. Send us your reactions, proposals, serious health policy articles, letters, brickbats, essays, whatever. Help us boil the pot to inform the profession and the populace.

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What's in a word? A lot.[1] The choice of the words "single-payer system" was a mistake made by its advocates many years ago, and one that they continue to make. Americans hate monopolies, and with good reason. The idea of a single payer for healthcare conjures up one image that the single payer must be government. Who else? It implies 1 monolithic, all-controlling monster that would even prevent American patients from using their own money for the medical care and healthcare that they want, should they be unhappy with what the single payer made available. This vision of total control may or may not be what the single-payer advocates actually want, but it is what people think. Since government in some form now pays for over 50% of total US healthcare costs anyway, maybe those reformers should use words, such as "main payer," and try to up the percentage to 75%, or some such. I think that their goal is to be certain that all Americans have basic healthcare and that no American goes bankrupt or loses his/her home because of healthcare expenses. But there are many ways, some that may even be possible in our lifetime, for achieving these goals short of threatening the "government uber alles" image of a single-payer system. That's my opinion. I'm Dr. George Lundberg, Editor of MedGenMed .

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