I Am A Republican Doctor and I Favor Single Payer

I Am A Republican… Can We Talk About A Single Payer System?
by David May April 23, 2013 04:02

I am a Republican. For those who know me that is not a surprise. I live in a red state. I have never voted for a Democratic presidential candidate. I can field strip, clean and reassemble a Remington 12-gauge pump blindfolded. And on top of it, I think we should talk about having a single payer national health care plan. The reason is quite simple. In my view, we already have one; we just don’t take advantage of it.

Firstly, Medicare and the Center for Medicare and Medicaid Services (CMS) are de facto setting all of the rules now. They are a single payer system. When we go to lobby the Hill, we lobby Congress and CMS. Talking to Blue Cross, Aetna, Cigna and United Health care is essentially a waste of time. All the third party payers do is play off the Medicare rules to their advantage and profit. They have higher premiums, pay a somewhat higher benefit and have a significantly higher level of regulation which impedes the care of their customers. This is no longer consumer choice but effectively extortion, a less than hidden shake down in which the “choice” for a family of four is company A at $900 per month or company B at $1100 per month. The payers are simply taking advantage of the system, playing both ends against the middle.

Secondly, in order to move forward with true health care finance we need complete transparency in cost and expense… and we need it now. As was noted in a recent Time magazine piece on the hidden cost of health care, our current system is a vulgar, less than honorable construct more akin to used car sales than medical care, cloaked under the guise of generally accepted accounting principles and hospital cost shifting.

Thirdly, with a single payer system would potentially come real utilization data, real quality metrics and real accountability. The promise of ICD-10 with all of its difficulties is that of a much more granular claims-made data. We could use some granularity in health care data and we will never achieve it in big data quantities without a single payer system.

Lastly, I think that the physicians should be in charge of health care and not the insurance companies and hospital systems. With a single price structure, it becomes all about medical decision making, efficiency, the provision of care to our patients, and shared decision making, all of which we do well.

How, you might say, could a Republican come to such a position? The simple answer is I really think it is quite Republican. Oh, I know there will be many raised eyebrows and many critics. I accept that. I understand the fact that no single payer system is perfect, that it is “socialist,” that it is “un-American.”

I would submit to you, however, that it is un-American to allow many of our citizens to be uninsured, that it is un-American to shunt money away from a strong military in order to support a bloated, inefficient and fraud-laden health care system, that it is un-American not to be open and above board with the cost of what we do, the expense of that service and the profit that we make. Mostly, it is un-American to let this outrageous health care injustice continue.

I would be interested in hearing your thoughts in the comment section below.

From the comment section:

Thank you for having the foresight to recognize that Single Payer, in a sense, is MMedicare for all and is cheaper in every country that has taken on Single Payer in some form.

bravo is all i can say, it is about time someone stands for what is ethically and morally right for ALL AMERICANS - not only the middle class and high end takers.

It is with great relief that I read the author's comments and input on the possibilities of Single Payer in the USA. He is correct on all counts. I have been researching health reform policy for many years and I keep coming to this same conclusion. The recent Brill article in Time Magazine was an unexpectedly bold expose on the accounting/finance practices of our current billing system. The profit-motive of skimmers in the Wall St. insurance cartel are obviously not in favor of MDs or patients. As for whether or not we will "kill" innovation without our so-called Free Market, the answer here is No, we will not kill innovation. As it is, bench-science research, which leads to products, is often grant funded at early and important stages -- by Taxpayers. The Pharmaceutical and Med Device Mfg industries piggyback off the research and development projects which have been Taxpayer funded at US universities. Their marketing (and whining) about R&D would say otherwise. We can do Single Payer. As the author most eloquently points out, we are already nearly there.

You are absolutely correct that a single payer system is the only way to contain costs and provide access to health care based on need and affordabilty. Another virtue of single payer is its abilty to demonstrate and implement system health system reforms. This has been hampered in the past by direct appeals to Congress by self interest groups that have inhibited purchase of services and devices through open bidding and more recently forced EMR expenditures without the necessary requirements that provide national benefits (see above). Data and feedback to providers is essential to assure qualty care but so is use of cost effective technologies and development of system changes that permit cost effective care to be provided and concerns for the health of people over the health of institutions to be achieved. Full implemementation of the Independent Payment Advisory Board, diminishing congressional intereference with care, and full funding of the CMS Innovation Center and public health education funds, all threatened now by congressional resisitence to these worthy provisions of the ACA are necessary. A single payer system is the best way to pay for care but we have an imperfect system of providing for care - both have to be addressed to attain affordable, sustainable, universal care.
The medical profession can never achieve our professional goals of providing the best care for all at a sustainable cost unless the financing of care is focused on those goals and not on profit maximization. Some form of single payer is essential for this to occur but we as a profession do not yet understand that and as a result are becoming manipulated tools subservient to private corporate interests

Bravo, Dr. May! I have been working to advance the cause of single payer for several years now. I don't recall having heard or read a more concise, more elegant statement of the facts. I am particularly struck by your reference to politics: "How, you might say, could a Republican come to such a position? The simple answer is I really think it is quite Republican." Outstanding. I never thought I'd have to admit that (at least in this regard) I'm a Republican! Thanks again.

And I'm a Yellow-Dog Democrat (I'd vote for a yellow dog before I'd vote for a Republican), and I couldn't agree with you more! Thanks for making such an articulate argument for a single payer system.

Our current health-care "system" is a violation of the Hippocratic Oath, which states, in part, "First do no harm!" In spite of this noble statement, our for-profit health care system does grievous harm to many Americans. It requires them to purchase health care insurance when a full 30% of their purchase price does NOT go to paying for their health care, but into the insatiable pockets of some in the health-care insurance industry. Health care insurance is so expensive that low-income folks frequently cannot afford it at all, or if they can afford it, can only afford inadequate insurance plans that will not protect them from a catastrophic illness. David May is right - the only way to actually make sure that everybody is covered is to extend Medicare to cover everybody, and eliminate any and all reliance on private for-profit health care insurance. The overhead costs of Medicare are less than 1/10th of those of the private health care insurance industry, so at least 97% of the taxes we pay to support Medicare For All will actually go to pay for the health care of Americans. Medicare "Advantage" plans should be eliminated as they, too, are an unnecessary monetary drain on the system. Instead Medicare should be expanded so that it covers everything that is currently covered by these plans, including all medications, and more. Will this mean an increase in taxes? Yes it will, but the increase in taxes will be LESS than we currently pay for our health care "insurance", so it will be a huge net bargain for the American People, and this should be the basis on which the argument for it is made. We should do this NOW!

Thank you, Dr. May, for your fine impressive accurate letter. I've sent it on to the rest of my colleagues in my group prcatice! I rejoice in your promotion of patriotic, all-American health care! Thankfully and sincerely, S. Milton Zimmerman, M.D. (Graduate of the University of Pennsylvania School of Medicine, Class of 1954, and practicing family medicine in New York State for over 50 years)

My comment:

I, too, am a Republican doctor who favors single payer health care. We need more of both Republicans and doctors to take an honest look at the failings of the American 'free' enterprise health care system. Stop criticizing and start finding solutions. If you are genuine with your assessment, you, too, will come to realize that single payer health care is the solution that works.

Dr. Joe Jarvis

Taxonomy: