Lack of Competition Harms Doctors
Another disturbing aspect of a single-payer system is the lack of competition among payers, which would reduce physicians' control over standards of care and reimbursement.
In a pure single-payer system, doctors can only contract with the one payer available. Currently, in the United States, physicians have some choice of insurers to work with, and even in Medicare or Medicaid, doctors can opt out. But they couldn't do so in a pure single-payer system.
"Providers remain ostensibly independent, but the single payer exercises significant controls," such as determining what services are "necessary," wrote John McClaughry, founder of the Ethan Allen Institute, a free market think-tank in Montpelier, Vermont. The single payer is a "monopoly HMO," he added.
Critics say the single-payer program might start with acceptable reimbursement rates as a way to get physician buy-in, and then ratchet them down because there is no alternative. As Dr Accad has already pointed out, the single payer can reduce reimbursements with impunity, because it has a monopoly.
Rather than restrict choices further, opponents of a single-payer system want to open up choices in the current system. "We should strike down state barriers to insurers and allow their products to be sold nationally," says Jim Geddes, MD, a trauma surgeon near Denver.
Noah N. Chelliah, MD, a cardiologist in Grand Forks, North Dakota, agrees. "Auto insurance premiums are low because insurers had to compete with each other nationwide," he says. "The same could be done for health insurance."
"When physicians become essentially employees of the government, which is what happens in a single-payer system, then everything pretty much breaks down," Dr Geddes says. "Only physicians are the best position to determine the quality of care. We're the number-one patient advocates."
However, Dr Geddes does not believe that the United States would allow complete termination of commercial insurance. He thinks there would probably be private plans that people could purchase on their own, as is the case in the United Kingdom. However, "this would lead to a two-tiered system," he says. "I've seen it in the United Kingdom, and it's not what we should have here."
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Cite this: Leigh Page. Single-Payer System: Why It Would Ruin US Healthcare - Medscape - Sep 29, 2015.
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