Single-Payer System: Why It Would Ruin US Healthcare

Leigh Page


September 29, 2015

In This Article

Single-Payer Would Be Bad for Doctors

A single-payer system—government-run healthcare for all—sounds like a noble ideal, but things quickly fall apart in the execution, according to its critics.

Michel Accad, MD, a cardiologist in San Francisco, says that because a single-payer system makes healthcare virtually free, "demand is almost unlimited," and the government has to set limits on what will be provided. Dr Accad writes a blog called "Alert & Oriented," which provides alternative views on healthcare systems.

Because the offer is so open-ended, Dr Accad says that single-payer systems in Canada, the United Kingdom, and other developed countries have to impose strict central planning. Rather than leave healthcare choices up to individual physicians, their patients, and free-market forces that could balance supply with demand, the government sets the rules.

These rules, Dr Accad says, are usually based on large quantities of data—comparing costs against probable outcomes—or on political considerations, such as the need to balance budgets without raising taxes. This approach, he says, will inevitably misallocate services. When central planning allocates care, there will be shortages of some services and gluts of other services. In particular, central planners will have a difficult time keeping up with cutting-edge technology and improvements in practice patterns.

Centralized systems also underpay physicians. "In a single-payer system," Dr Accad says, "planners decide arbitrarily what the payments should be, and payments fall because there are no competitors and no choice for providers to bid up payments."

Indeed, a 2011 study[1] found that reimbursements to US primary care physicians from public payers, such as Medicare and Medicaid, were 27% higher than in countries with universal coverage, and their reimbursements from private payers were 70% higher. Meanwhile, reimbursements to US specialists were 70% higher from public payers and 120% higher from private payers.


Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.