I don't understand the appeal of single-payer proposals to so many otherwise reasonable people. Is it the alleged simplicity? But the plans generally add layers of commissions, agencies, boards and other bureaucrats. The certainty of scheduled payments and prices? The apparent control? But most plans -- as in Canada, England, Tennessee, Vermont and Hawaii border on bankrupting the governments. So what is it? I don't know. But, here in Colorado there were six proposals from different parties advocating a single-payer system to the 208 Commission, including one of the four finalists.
For the uninitiated, a single-payer health plan means that the government -- or a quasi-government agency -- purchases or provides all of the health care within an area or for a population. Medicare is one kind of single-payer plan. England and Canada have another. The plans are financed through taxes (sometimes called assessments) from individuals, employers or on goods and services. There are two basic variations -- 1) where the plan proposes to provide almost unlimited health care benefits at a very low cost (based on the rationale that administrative costs and "evil, outrageous profits" are eliminated); or 2) a tiered plan where the government provides basic services of some benefits, and individuals may purchase more extensive coverage from the greedy, profit-driven insurance companies.
In Colorado, four of these plans propose to offer dental, vision, mental health, rehabilitation and alternative treatments, in addition to the usual medical, surgical and hospital care. Of course, while the patients get unlimited care of every kind and dimension, the doctors are treated with less respect than most fast food workers. (I mean no disrespect for fast food workers or their employers, but that industry is well-known as an excellent entry level into the workforce.) In almost any fast food store, workers will get a raise of their hourly wage based on their experience, attitude, aptitude and skills. So, at any one time, two people working together side by side may well be earning different hourly wages. Both are competent, but one may have two years experience, while another has only worked for six months, one is eager to do and learn while the other is content to just do her job, one has an acquired sensitivity for making perfect burgers while the other makes good burgers -- but they're just not quite up to perfect. Under single-payer logic, both would always and forever make exactly the same amount of money for frying the same number of burgers on any particular shift. They both might get more or both might get less, but would make the same as each other.
Under single-payer plans. all doctors performing a particular procedure or treatment will receive the same fee -- regardless of whether one has just gotten his medical license or has been practicing for 20 years, or whether one surgeon is an artist with real aptitude and flair while another is competent but perfunctory or mechanical. It is the service or treatment or procedure that is what determines the pay scale and not the doctor. Of course, this is exactly what happens with Medicare and Medicaid right now -- and is one reason many doctors opt out of those programs.
Of course, under a true single-payer system -- one that encompasses everyone in a geographical area, doctors can't opt out and continue their profession. So, they quit. And why not? How much joy can a doctor receive from learning new techniques, advocating for his patients, making innovations in her practice when other doctors who do less get paid the same? What kind of justice is that? Why should excellent, wonderful doctors want to practice in a state where they receive no acknowledgment or payment for their excellence, and instead are treated no differently than the barely competent doctor who does the same number of examinations, treatments or procedures?
The blog of Freedom and Individual Rights in Medicine (FIRM)
