Daniel “Stormy” Johnson, Jr., MD, FACR
It is easy to understand why many physicians prefer a single-payer system or a public insurance plan. Most of us, especially practicing physicians, are absolutely disgusted with the abuse of physicians and their patients by insurance companies. Consider the amount of time wasted by staff in physicians’ offices navigating through telephonic Hell to get permission for a particular evaluation or treatment for no other purpose than harassment in hopes that the physician’s office will give up. That is reason enough for many physicians to want to abandon the whole idea of private insurance. All of us in the private sector understand this all too well.
The other reason that many physicians support a single-payer system or a public plan is that most of us are troubled by the number of people who at any one time do not have health insurance. The actual number is repeatedly vastly overstated by those who advocate a single-payer system, but the fact is that too many people do not have health insurance. But there are other solutions besides single payer that will solve the problem in positive ways without the baggage that comes with a single-payer system.
With respect to cost, there is good news. Of the three big issues of health system reform—cost, access, and quality—the debate has finally come around to acknowledging that our major current dilemma is cost. Even in a “perfect” system, cost would be an issue. In our current system, much of the access problem we have stems from cost. With respect to quality, it costs less to do something right the first time.
So if we are finally going to focus on cost, we need to ask why we have a cost problem. Of the myriad explanations, I would argue that the most important one is also the most amenable to correction. The person consuming the services is insulated from the cost of those services in most cases because someone else is paying for them. The only exception in our system is those rare individuals who are truly self-sufficient. Uninsured folks with no resources are eligible for Medicaid, and someone else is paying the bills. The person who shows up at the emergency department or in the doctor’s office for charity care doesn’t care about the cost because someone else is paying. The person in an HMO or with full insurance has only a small co-payment, intended as a barrier to seeking care, but is otherwise insulated from the true cost. Only those who are self-sufficient or who attempt to be self-sufficient truly feel the cost exposure.
Therefore, if everyone had some type of insurance and if the options included mechanisms like health savings accounts that would reward individuals for using the system in a cost-effective way, we would obtain true cost-effectiveness and radically reduce, if not eliminate, the problems that come from having large numbers of individuals who lack insurance.
Read it all at the link.
