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Single-Payer System: A Remedy Rejected

Single-Payer System: A Remedy Rejected

In September 2009 a friend hosted a “focus group” as part of my campaign for Congress. There were seven physicians among the people in that meeting, and we began talking about the American health care system and President Obama’s health care proposals being considered in Congress.  The physicians told me that American health care overall was broken, inefficient, and much too expensive.  The best national answer, they said, was a single-payer system, something like an expanded Medicare or the Veteran’s Administration program, but  with affordable limits on care, tests, drugs, malpractice litigation, and  so on to lower  costs.   The doctors  agreed, with regret,  that there was no chance that Congress would approve a single-payer system (remember  the “socialism” and  “death panel”  political attacks).  In their view, it would be smarter to do nothing rather than spend political capital tinkering to make  existing care, which was based on a fundamentally defective private-health-insurance-company model, work better. The doctors’ judgment made sense, and I came out against what became known as “Obamacare,” a stance which made some of my political supporters very unhappy.

Medical care consumes about 18% of America’s gross domestic product, twice the percentage that is typical in Europe.  But our results are less good in terms of life expectancy and other measures of the effectiveness of care  than results are in several other countries.  In terms of energy and materials, medical tests whose frequency and complexity exceed Western norms is part of the excess consumption problem.  Thomas Lee, M. D., the Editor in Chief of the Harvard Heart Letter, discussed in his April 2012 issue “whether some doctors might recommend and deliver too much care.”    Dr. Lee states that “overuse is driven more by our fragmented health care system than by individual avarice….Together, medical progress and the fee-for-service environment conspire to fuel overuse and medical cost inflation.”

Some other academic physicians agree with my focus group practitioners that our system is too wasteful.  Dr. Arnold S. Relman, a former editor in chief of The New England Journal Of Medicine and Harvard professor, argues that a single-payer nonprofit system, with doctors organized into large, multi specialty groups like at the Mayo Clinic, would save enormous resources.  Some of Dr. Relman’s proposed savings come from eliminating the private health insurance industry, which Dr. Relman describes as “a parasite on the health care system.”

Once again, I suggest that our dysfunctional political system is a fundamental barrier to implementing sensible solutions to big problems.  Like other folks, the various segments of the health care industry have lobbyists and political campaign funds to distribute.  As normal human beings, they will continue to use that power to protect their economic turf, sometimes even when the common good of the rest of us suffers.

Imabe by Bmramon at en.wikipedia [GFDL ( or CC-BY-SA-3.0-2.5-2.0-1.0 (], from Wikimedia Commons


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