Single-Payer System: Why It Would Ruin US Healthcare
Many doctors believe that the real problem with the Affordable Care Act (ACA) is that it didn't go far enough—that what it should have been, if it had been politically possible, was a single-payer system that extended health insurance to all Americans and would have benefited doctors and patients alike.
However, a recent Medscape article looked at the problems inherent in a single-payer system, dubbed "Medicare-for-all," and identified many that could be significant.
One critic noted 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 rule. This would inevitably result in shortages of some services and gluts of others.
And with no competitors, central planners could arbitrarily decide what physician payments should be. Studies of countries with universal coverage show that their doctors earn up to 70% less than doctors here.
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 multipayer system, doctors can choose which insurers to work with—even opting out of Medicare and Medicaid, as doctors are increasingly choosing to do. They couldn't in a pure single-payer system.
Critics also point to waiting lists so long in the much-vaunted Canadian single-payer system that some Canadians choose to come to the United States or other countries to receive timely care. Britain's National Health Service, often held up as model of how single-payer can work, is plagued by chronic problems in the quality of care that put some patients at life-threatening risk. The closest analogue we have to a single-payer system here, the Veterans Health Administration, has been rocked by scandals about untimely access and is staffed by too few doctors, who, one critic charges, "work shorter hours just punching a clock."
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http://www.medscape.com/viewarticle/855271
