I’m For Single Payer Now

My thoughts on healthcare during my adult life summed up in one sentence: I endorse universal healthcare but not socialized healthcare. In other words, I think that everybody should have access to healthcare, but if you are willing to pay higher premiums, you should have more choice in which doctors you see. But the Republicans are now forcing my hand and the Democrats have been too inept and/or complicit to stop them. I now have no choice but to support a single payer system, despite how much of a quagmire I think it will be. Allow me to explain.

First, why was I against socialized healthcare a.k.a. single payer a.k.a. Medicare for all in the first place? In short, a single payer system in a country of our size would lead to far too much bureaucratic waste that would impede our ability to get adequate and immediate care. Too much red tape. Not enough doctors getting to practice medicine as they see fit. Proponents would counter, “single payer is great because everybody would get healthcare.” But universal healthcare accomplishes that too, so why do we need single payer?

With single payer we will have the government dictating how medicine is practiced. There will be standardized guidelines for how everything is treated. Government employees will determine what tests can be ordered. Approvals will be necessary before doctors can get the tests ran even if they deem them necessary. Now, before you start screaming about death panels, that is not why I am implying. Emergency rooms will still be able to order stat CT scans for brain bleed diagnoses and cancer patients will get their necessary treatment. No, what I’m referring to are tests that doctors use to rule out certain maladies that the government will deem too expensive and not statistically meaningful (or whatever other jargon they concoct). Will that cost lives? Absolutely.

Let’s look at a less tragic example. As a personal injury lawyer I get clients all the time who have been involved in accidents of all sorts. They tell me that they went to their doctors at Kaiser and were told that they could not see an orthopedist or be referred for any radiologic studies except X-rays despite the fact that it was clear that they needed MRI’s. What Kaiser essentially did and is doing in these situations is to try to wait out the patients’ pain to see if it will dissipate before ordering up an “unnecessary” MRI study. Is this costing a life? No. But why must medicine be practiced that way? With single payer, that will be the norm because economics will dictate the guidelines for doctors.

As the child of an Internal Medicine physician, and a great one at that, I can’t tell you how many times I’ve come across patients of my Dad who have told me “your Dad saved my life. He literally saved my life.” I smile and then ask them what happened. Many of them recount stories about how they went in for tests that came back clean but that my Dad examined them and re-ordered the test or ordered up another test that someone else told them wasn’t necessary, but ultimately led to the proper diagnosis, early detection, and life saving treatment. That sort of medicine will not be practiced under a single payer system. The guidelines will not allow for it.

So why am I for single payer? Because we’re already living in the single payer “guidelines” system that worries me so much but instead of government bureaucrats dictating medicine, it’s insurance companies. One thing I neglected to mention about my Dad’s practice is that he stopped taking insurance with the exception of Medicare about a decade ago precisely because insurance companies were dictating how he practiced medicine while at the same time jacking up rates on his patients and decimating the payments to him for his work.

As a result, doctors like my Dad are a dying breed. The doctor in private practice who knows your name, your spouse’s name, your favorite food to cheat on your diet with. The doctor who’s there to congratulate you in good times and console you when times are tough. Those doctors’ days are numbered. And it is our fault.

Now we have conglomerates like Kaiser as the standard. I know plenty of people who are very happy with Kaiser. But I also know plenty of people who aren’t. More and more doctors are finishing their residencies and finding that it’s almost impossible to go into private practice both because it’s tough to compete with the Kaisers of the world and also because insurance companies pay so little to doctors compared to twenty or thirty years ago that it takes away their ability to make a living.

So where does that leave us in the present? Right now we have a system where you need approval from your insurance company for everything. I call Anthem before I use the bathroom just to make sure I don’t get dinged. Speaking of Anthem, did you know that Anthem Inc. made $22.5 billion in revenue last quarter? And that’s a pittance compared to the leader in the industry, UnitedHealth Group which celebrated $48.7 billion in revenue last quarter. Those numbers continue to rise like clockwork.

Question: What exactly is an insurance company like Anthem or UnitedHealth Group? Answer: Insurance companies are middlemen.

Why on Earth are health insurance company profits soaring like this when insurance premiums for consumers skyrocket and doctors are getting paid less? Well I guess I just answered my own question there. If I had my druthers, we’d be regulating the insurance industry and mandating that they take on all comers without spreading losses due to insuring those with pre-existing conditions on to the rest of us. Also, we wouldn’t allow giant mergers which have led to the insurance industry becoming a monopoly. Sure they compete against each other, but those giant profits are already contracted for and booked. All of their reimbursements stink. All of their premiums are far too high for what they provide. Ask any doctor.

What we should do is get back to regulation the same way Teddy Roosevelt did: Trust busting. When the insurance companies start crying that they will be making 10% less, we’ll just remind them that UnitedHealth Group’s quarterly profits after such a decline would still amount to $44 billion. That’s $176 billion per year in revenue. Instead of complaining that they have more customers and more service charges to pay out, how about they just say thank you for the free money and the ability to run the most guaranteed moneymaker since Las Vegas opened sportsbooks.

But that won’t happen. The Republicans are winning this one, even if they lose in the short run in the Senate. Why? Because Obamacare is really a Republican idea rebranded with a hero of the Democrats. The insurance companies have already won. It’s just a question of margin of victory. The Democrats’ pockets get lined with the same insurance money that goes to the Republicans. As for the Democrats opposed to the insurance industry’s behavior, they’re either too spineless or too ineffective to get anything going in the way of another plan.

We’re stuck. Unless we get rid of the health insurance companies. Will that lead to a panacea? No. But it will lead to billions of dollars back in the pockets of American citizens instead of to the insurance companies. Thankfully I don’t believe that there will be a tremendous shortage of good doctors because there are still plenty of people out there who want to help others. They don’t care about lesser compensation. But will the quality of healthcare continue to drop in our country as a result of going to single payer? Yes. We as Americans have already decided that the quality of our healthcare is not as consequential as it should be. But, the quality of care will be no different under single payer than it is under medicine dictated by insurance companies. So we should at least save some money after accepting the current state of medicine. I hate saying this but here it is once more: I am for a single payer system here in the U.S.