Waning Enthusiasm for Single-Payer
The VA scandal and the demise of the Vermont plan were not the only defeats for a single-payer system in 2014. Activists in Colorado failed to get enough signatures to get a single-payer measure on the November ballot. And in Massachusetts, Donald Berwick, MD, the former CMS administrator who ran for governor on a single-payer platform, won only 21% of the vote in the Democratic primary.
Even in Europe, the heart of the single-payer movement, the concept has encountered embarrassing defeats. In Sweden, owing to access problems in the country's single-payer system, about 10% of residents have opted for private health insurance, according to the trade group for Swedish private insurers. And in Switzerland, almost two thirds of voters rejected a single-payer proposal.
In the United States, public opinion has been shifting away from support of "healthcare for all" ever since the build-up to President Obama's Affordable Care Act (ACA). Gallup reports that in 2000, 59% of Americans said the nation has a duty to provide healthcare for the poor. The number peaked in 2006 at 69%, but in polls since 2009, a slight majority of Americans oppose that responsibility.
Single-payer advocates are actually a subset of those calling for universal care, which includes advocates of multipayer approaches, such as the ACA. An April 2014 Rasmussen poll found that 37% of eligible voters support a single-payer system.
Why Single Payer Is Still a Threat
Even though the single-payer movement has taken a beating recently, Dr Geddes doesn't think it's going to go away. He already sees many aspects of it in Medicare and Medicaid, which depend on central planning.
Dr Geddes says that just like a single-payer system, Medicare imposes arbitrary rules created through central planning. For example, Medicare dictates that certain patients have to be in the hospital for a certain number of days before they can be referred to a rehab hospital. Often, he says, patients can be transferred earlier, but they are forced to stay in a high-cost hospital bed. "The rules actually force doctors to waste resources," he says. "That's how a single-payer system operates."
Furthermore, Dr Geddes thinks the ACA will be just a temporary stop on the way to a single-payer system. Despite cost controls in the ACA, insurance premiums are rising significantly. He believes that health insurance will eventually become unaffordable, and the US public will rise up and call for abolishing private insurance and establishing a single-payer system.
That would be the wrong way to go, Dr Geddes says. "Our private healthcare system is working," he says "We have the finest healthcare system in the world, and it continues to get better."
Even as much of the rest of the world has embraced single-payer and other forms of government-controlled healthcare, such as price controls, they are completely dependent on medical advances created by the US system, he says. Advances in pharmaceuticals, medical equipment, and many surgical techniques come from the United States, where a free market encourages entrepreneurs, Dr Geddes says.
"The incentive is potential windfall profits," he says. "But if you take it away, the whole process of innovation will cease. No other country could take up the slack." Dr Geddes is a regent of the University of Colorado, whose state-of-the-art Anschutz Medical Campus hosts biotech firms financed by venture capital firms and others.
Even within the United States, he says, Medicare and Medicaid depend on the cost shift from private payers. "The only way physicians can afford to participate in Medicare is that they get higher payment from commercial insurers," Dr Geddes says. "Single-payer advocates talk about 'Medicare for all,' but if Medicare were standing alone, it would fall flat."
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Cite this: Leigh Page. Single-Payer System: Why It Would Ruin US Healthcare - Medscape - Sep 29, 2015.