Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

Would single payer work? The real devil is in the details.

Matthew Hahn, MD
Policy
August 4, 2017
Share
Tweet
Share

When I began my career as a physician in the late 1990s, I was relatively apolitical. Since then, as our health care system has crumbled, and as its demise (and our repeated failure to fix things) has increasingly affected my patients and my practice, I have become very political. In 2008, I began giving lectures in the community in support of a single-payer health reform model. My political leanings tend to land me in a largely single-payer crowd, and single-payer’s simplicity and non-profit ethics appeal to me. But since opening a small practice in 2009, my experiences and observations on the front lines of health care have made me question whether a single-payer system is necessarily the best way to organize our health care system.

I believe quite strongly that every American needs affordable, high-quality health care. And I don’t necessarily care how we achieve that. A single-payer system, typically defined as a model where payment for health care is organized under one non-profit government insurance program (somewhat like our current Medicare system); where individuals pay a set annual fee (in the form of a tax) that covers all health care costs and everyone is covered and has access to comprehensive care, seems like a great idea, at least on paper.

One thing is for certain. Our current multi-payer model is incapable of providing the solution we need. Recent events argue strongly that the “free market,” referring to our system of private for-profit health insurance companies, is unable to provide affordable, comprehensive health care for all. Under the Affordable Care Act (the ACA, or Obamacare), when insurance companies are prohibited from excluding sicker patients, and when they must provide a minimum comprehensive set of benefits, by their own admission, they are unable to make enough money. Multiple insurers have either left or are threatening to leave the Obamacare insurance exchanges. To remain viable, health insurance companies are raising premiums, already far too high for many Americans or restricting care. So, patients either pay too much or go without the care they need. That is not a working system.

Recognizing such weaknesses, Republican lawmakers are now proposing that insurance companies once again be allowed to exclude patients with pre-existing conditions and to sell inexpensive policies that offer minimal coverage. It seems silly to even have to argue the point, but what is the value of an inexpensive policy if it doesn’t cover the care you need? Once again, this is clearly not the answer for the nation’s health care needs.

Is a single-payer system the answer? First of all, I am not confident that, despite Obamacare’s well-known failings and the likely failure of current Republican efforts to “reform” the system, that there is enough political support to pass single-payer legislation. That is not a critique of a single-payer system, of course, but it may be the reality for the foreseeable future, and it makes the question somewhat moot.

Beyond that, the real answer is that the devil is in the details. We currently spend over $3 trillion annually on health care in the U.S., accounting for about 18 percent of the GDP, which is far too much. The only way we can hope to provide universal access to health care in the U.S. is to eliminate enough unnecessary health care expenditures from the current system to both cover the added costs of bringing millions more people into the system and at the same time, lower overall health care spending to a more sustainable level. That is a tall order no matter the approach.

The number one argument for a single-payer system is its simple design, and the reduction in administrative costs that would occur if we went from many insurance companies (our current multi-payer system), each with its own set of rules, to just one. It is an appealing notion.

What gives me pause is the fact that the federal government, responsible for administering a single-payer system, is the reason for much of the waste that exists in the American health care system today. American doctors and nurses today are held hostage by multiple layers of distracting and wasteful rules and regulations created by the federal government. It never gets better, and there is every indication, based on newer rules and regulations in the pipeline, that it will get worse.

The crazily convoluted rules that define how doctors are paid for their services were created by the federal government. Federal HIPAA regulations, intended to protect patients’ privacy, are so voluminous and complicated that compliance is impossible (or just incomprehensible). When the government got involved with electronic health records, its Meaningful Use program was so poorly conceived that it set information technology in this country back ten to twenty years.

Considering this reality, it is reasonable to question whether we would want the federal government, defined today by bureaucratic waste and administrative overkill, in control of a single-payer health care system. Without significant bureaucratic reforms, a single-payer system could in many ways be just as bad as the broken system we have today.

That is not to say that I am against single-payer health care reform. It is to say that the real devil is in the details. To be successful, a single-payer system must include dramatic and detailed plans to simplify and streamline current health care rules and regulations.

And in the interim period between now and the time that there might be adequate political support for a single-payer system, bureaucratic and administrative simplification needs to go forward. With it, our current health care system would be much better. Without it, any approach to reforming our health care system may be doomed to fail.

Matthew Hahn is a family physician who blogs at his self-titled site, Matthew Hahn, MD.  He is the author of Distracted: How Regulations Are Destroying the Practice of Medicine and Preventing True Health-Care Reform.

ADVERTISEMENT

Image credit: Shutterstock.com

Prev

Here's how being a parent changes you as a physician

August 4, 2017 Kevin 0
…
Next

Inappropriate patient behavior is not OK

August 4, 2017 Kevin 12
…

Tagged as: Public Health & Policy

Post navigation

< Previous Post
Here's how being a parent changes you as a physician
Next Post >
Inappropriate patient behavior is not OK

ADVERTISEMENT

More by Matthew Hahn, MD

  • This doctor got COVID. Here’s what it taught him.

    Matthew Hahn, MD
  • These leaders will not fix health care

    Matthew Hahn, MD
  • The demonization of socialized medicine

    Matthew Hahn, MD

Related Posts

  • An argument in favor of single-payer health care

    David Penner
  • Are physicians ready for single-payer health care?

    Bob Doherty
  • A health care solution to rival single payer

    Matthew Hahn, MD
  • A first-hand account of single-payer health care

    Darrel Moellendorf
  • What would an optimal single-payer health care system look like?

    Taylor J. Christensen, MD
  • Is now the time for single payer?

    Toby Terwilliger, MD

More in Policy

  • Why the U.S. Preventive Services Task Force is essential to saving lives

    J. Leonard Lichtenfeld, MD
  • Brooklyn hepatitis C cluster reveals hidden dangers in outpatient clinics

    Don Weiss, MD, MPH
  • Why nearly 800 U.S. hospitals are at risk of shutting down

    Harry Severance, MD
  • Innovation is moving too fast for health care workers to catch up

    Tiffiny Black, DM, MPA, MBA
  • How pediatricians can address the health problems raised in the MAHA child health report

    Joseph Barrocas, MD
  • How reforming insurance, drug prices, and prevention can cut health care costs

    Patrick M. O'Shaughnessy, DO, MBA
  • Most Popular

  • Past Week

    • Why primary care doctors are drowning in debt despite saving lives

      John Wei, MD | Physician
    • New student loan caps could shut low-income students out of medicine

      Tom Phan, MD | Physician
    • How federal actions threaten vaccine policy and trust

      American College of Physicians | Conditions
    • Are we repeating the statin playbook with lipoprotein(a)?

      Larry Kaskel, MD | Conditions
    • Why transgender health care needs urgent reform and inclusive practices

      Angela Rodriguez, MD | Conditions
    • mRNA post vaccination syndrome: Is it real?

      Harry Oken, MD | Conditions
  • Past 6 Months

    • COVID-19 was real: a doctor’s frontline account

      Randall S. Fong, MD | Conditions
    • Why primary care doctors are drowning in debt despite saving lives

      John Wei, MD | Physician
    • New student loan caps could shut low-income students out of medicine

      Tom Phan, MD | Physician
    • Confessions of a lipidologist in recovery: the infection we’ve ignored for 40 years

      Larry Kaskel, MD | Conditions
    • A physician employment agreement term that often tricks physicians

      Dennis Hursh, Esq | Finance
    • Why taxing remittances harms families and global health care

      Dalia Saha, MD | Finance
  • Recent Posts

    • The silent cost of choosing personalization over privacy in health care

      Dr. Giriraj Tosh Purohit | Uncategorized
    • How IMGs can find purpose in clinical research [PODCAST]

      The Podcast by KevinMD | Podcast
    • Why the U.S. Preventive Services Task Force is essential to saving lives

      J. Leonard Lichtenfeld, MD | Policy
    • Medicaid lags behind on Alzheimer’s blood test coverage

      Amanda Matter | Conditions
    • The unspoken contract between doctors and patients explained

      Matthew G. Checketts, DO | Physician
    • AI isn’t hallucinating, it’s fabricating—and that’s a problem [PODCAST]

      The Podcast by KevinMD | Podcast

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

View 29 Comments >

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

ADVERTISEMENT

ADVERTISEMENT

  • Most Popular

  • Past Week

    • Why primary care doctors are drowning in debt despite saving lives

      John Wei, MD | Physician
    • New student loan caps could shut low-income students out of medicine

      Tom Phan, MD | Physician
    • How federal actions threaten vaccine policy and trust

      American College of Physicians | Conditions
    • Are we repeating the statin playbook with lipoprotein(a)?

      Larry Kaskel, MD | Conditions
    • Why transgender health care needs urgent reform and inclusive practices

      Angela Rodriguez, MD | Conditions
    • mRNA post vaccination syndrome: Is it real?

      Harry Oken, MD | Conditions
  • Past 6 Months

    • COVID-19 was real: a doctor’s frontline account

      Randall S. Fong, MD | Conditions
    • Why primary care doctors are drowning in debt despite saving lives

      John Wei, MD | Physician
    • New student loan caps could shut low-income students out of medicine

      Tom Phan, MD | Physician
    • Confessions of a lipidologist in recovery: the infection we’ve ignored for 40 years

      Larry Kaskel, MD | Conditions
    • A physician employment agreement term that often tricks physicians

      Dennis Hursh, Esq | Finance
    • Why taxing remittances harms families and global health care

      Dalia Saha, MD | Finance
  • Recent Posts

    • The silent cost of choosing personalization over privacy in health care

      Dr. Giriraj Tosh Purohit | Uncategorized
    • How IMGs can find purpose in clinical research [PODCAST]

      The Podcast by KevinMD | Podcast
    • Why the U.S. Preventive Services Task Force is essential to saving lives

      J. Leonard Lichtenfeld, MD | Policy
    • Medicaid lags behind on Alzheimer’s blood test coverage

      Amanda Matter | Conditions
    • The unspoken contract between doctors and patients explained

      Matthew G. Checketts, DO | Physician
    • AI isn’t hallucinating, it’s fabricating—and that’s a problem [PODCAST]

      The Podcast by KevinMD | Podcast

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

Would single payer work? The real devil is in the details.
29 comments

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...