In this guest post by my colleague Dr. Jim Kahn, he covers a broad range of US health policy issues. A version of this post also appears on his website: HealthJusticeMonitor.org. You may not agree with all his points, but that’s the beauty of Sensible Medicine
Quite a lot truth here, but he exaggerates sometimes. I also doubt lack of adequate insurance added 300,000 extra deaths from COVID. That would be almost 30% of total COVID deaths
The argument that a single payer system is "less racist" is problematic. I struggle with the premise that any inequities in society that exist between groups of people are always due to racism. Labeling every socioeconomic disparity as due to racism doesn't help anything or fix any problems. Also the author claims that 13 states didn't expand medicaid because they are racist. Those states were led by republicans who have a different view on the role and the size of the government. This article equates all republicans as racist. Calling a party racist if they disagree with government policies and have a different philosophy of the role of government is not a way to bring people together. Let us not forget the liberal governments forcing masking and school closures that disproportionally affected Black students and will likely magnify the disparities in achievement going forward.
Personally I like the idea of a single payer system to streamline care and get rid of all the middle men who are profiting off the system and driving up costs. However it would have to include some rationing. The expectation in America is everyone should get access to every expensive, new medicine and should get all the end of life care they want even if futile. The cost of such a system in this country would be prohibitive. Having also worked at a VA, I can tell you government often costs much more to run that a private practice and is extremely inefficient- administrators worked roughly from 9 to 4 with an almost 2 hr lunch break. Then they all get huge government pensions, 6 months paid maternity leave, etc. How can we possibly afford such a system? Not to mention federal employees essentially cant be fired. Furthermore, after all the non evidence based draconian Covid restrictions the federal government forced on us, I can't imagine trusting them with our health care system.
I have a simple question on a complex subject- how in the world can an economy and sickness care system support a "growing" population where 74% -soon to be more- is overweight or obese? There is simply so much illness associated with this lifestyle risk factor encouraging multiple medical risk factors. It seems unless and until we as a society and institutionally, openly acknowledge, educate and support setting up better, as individuals and groups, improved calorie in and out practices, disease, premature and protracted, will continue as norm, without a system in the world to countermand. Maybe it is time for some intellectual honesty related to causes and effects?
I agree with the comments above. I think the author does an adequate job of pointing out some of the flaws with the system (mixed in with unsubstantiated left wing nonsense). But his single payer solution is stupid. The greatest proof of his bad solution is his suggestion that the VA is a model of good healthcare delivery. Having worked in several different VAs during my training, good luck to us all should our healthcare system turn into one giant VA. I can only associate the VA with horror to our nation’s veterans.
Thank you for stating what I was thinking. I thank God that my husband was on the VA system, because they paid for his drugs, but I would never trust them for new knees or hip surgery. They are good for some things, but to think that should be our standard of care is frightening. The Affordable Care Act did so much damage to the health system. In fact, some people say the ACA was passed to break the system and force us into a single payor. If that is the case, it is working.
Thanks! Would be great to compare notes on the VA experience. What my colleagues tell me, and the formal studies support, is better coordination of care, and better outcomes than elsewhere in the system. (of course I don't think single payer is stupid, but I'll leave that for now) - JGK
When the author states "A tiny but vocal group of doctors argued to end all COVID precautions (including masking) which would most harm under-vaccinated and -resourced populations." one can only conclude that he has absolutely no clue about evidenced-based medicine, and all of his prescriptions are completely and utterly flawed, and much of what he says is filled with half-truths and falsehoods. His wokeness shines through with the nonsense related to the various statements on racism. With all due respect, physicians are among the most liberal of groups, and bandying around the term racism only has a negative effect such that anything the author says cannot and should not be taken seriously.
That doesn't mean to say that there aren't issues with the US healthcare system, but even a brief look at the single payer system in the UK tells one that that is not the solution, because the UK NHS is in a complete and utter mess, despite the fact that UK doctors are not just excellent but in many ways trained far better than their US counterparts.
And incidentally, when the author states in his final conclusions that "There is strong support for fundamental reform – single payer", my only reply is just where is this person coming from. This statement is pulled out of the air, and there is very little support for a single payer system, and there would be even less support if people knew exactly what that entails and what a disaster other single payer systems are, including Canada and the UK. Perhaps look to Germany for a better solution.
The German model seems to be working well. As you note the UK NHS model is coming apart from perpetual under-funding. But in the UK a parallel system works quite for those who can afford it.
Thank you, Dr. Kahn, (and Vinay), for this super-charged piece. I look forward to taking a deep dive into all your references, before responding in greater depth. As a traditional Catholic conservative, with 40 yrs in health care (retired last August), I have struggled mightily with the many issues you identify. Yes, I agree that our health care system is functioning very poorly. However, I come down against single payer, since it will eventually lead to government bureaucrats instituting health care mandates (some life vs death) for ALL citizens and non-citizens, e.g., the current COVID caper. The genesis of Medicare/Medicaid 50+ yrs ago set us up for our current health care situation. It is time for a wholesale change, though it would be very disruptive to most stakeholders (that may include everyone). Several ideas: local control and the principle of subsidiarity should prevail. God cannot be left out: a religious and ethics representative need to be present on any committee. Human nature alone will lead to big mistakes such as Roe v Wade. Think of all those little human beings who had no say in the matter of their own lives! They got the worst “health care” of all. But they never had to pay Medicare taxes.
Interesting piece with provocative conclusions/ suggestions.
I practice in Canada….not all rainbows and sunshine either….we are 2nd last on OECD rankings….but US brings up the rear, and by some margin in some areas/metrics.
Norway ranks first, but tiny country, and the usual refrain is whether that system can scale.
But countries like UK or Germany, which sport some variation of hybrid public/private systems, seem to fare generally relatively well.
I think moving to single payer is third rail stuff politically in the US. A middle ground seems more realistic (if only barely). Coming from the other end of spectrum (single payer in Canada), a hybrid system has some appeal also.
But if they say recognizing the problem is a start, (and spending the most per capita with the worse life expectancy should fit that bill), this essay might do that. If only your leaders will listen.
The UK has universal healthcare. They had approximately a similar number of COVID deaths per capita as USA
Quite a lot truth here, but he exaggerates sometimes. I also doubt lack of adequate insurance added 300,000 extra deaths from COVID. That would be almost 30% of total COVID deaths
The argument that a single payer system is "less racist" is problematic. I struggle with the premise that any inequities in society that exist between groups of people are always due to racism. Labeling every socioeconomic disparity as due to racism doesn't help anything or fix any problems. Also the author claims that 13 states didn't expand medicaid because they are racist. Those states were led by republicans who have a different view on the role and the size of the government. This article equates all republicans as racist. Calling a party racist if they disagree with government policies and have a different philosophy of the role of government is not a way to bring people together. Let us not forget the liberal governments forcing masking and school closures that disproportionally affected Black students and will likely magnify the disparities in achievement going forward.
Personally I like the idea of a single payer system to streamline care and get rid of all the middle men who are profiting off the system and driving up costs. However it would have to include some rationing. The expectation in America is everyone should get access to every expensive, new medicine and should get all the end of life care they want even if futile. The cost of such a system in this country would be prohibitive. Having also worked at a VA, I can tell you government often costs much more to run that a private practice and is extremely inefficient- administrators worked roughly from 9 to 4 with an almost 2 hr lunch break. Then they all get huge government pensions, 6 months paid maternity leave, etc. How can we possibly afford such a system? Not to mention federal employees essentially cant be fired. Furthermore, after all the non evidence based draconian Covid restrictions the federal government forced on us, I can't imagine trusting them with our health care system.
I have a simple question on a complex subject- how in the world can an economy and sickness care system support a "growing" population where 74% -soon to be more- is overweight or obese? There is simply so much illness associated with this lifestyle risk factor encouraging multiple medical risk factors. It seems unless and until we as a society and institutionally, openly acknowledge, educate and support setting up better, as individuals and groups, improved calorie in and out practices, disease, premature and protracted, will continue as norm, without a system in the world to countermand. Maybe it is time for some intellectual honesty related to causes and effects?
I agree with the comments above. I think the author does an adequate job of pointing out some of the flaws with the system (mixed in with unsubstantiated left wing nonsense). But his single payer solution is stupid. The greatest proof of his bad solution is his suggestion that the VA is a model of good healthcare delivery. Having worked in several different VAs during my training, good luck to us all should our healthcare system turn into one giant VA. I can only associate the VA with horror to our nation’s veterans.
Thank you for stating what I was thinking. I thank God that my husband was on the VA system, because they paid for his drugs, but I would never trust them for new knees or hip surgery. They are good for some things, but to think that should be our standard of care is frightening. The Affordable Care Act did so much damage to the health system. In fact, some people say the ACA was passed to break the system and force us into a single payor. If that is the case, it is working.
Thanks! Would be great to compare notes on the VA experience. What my colleagues tell me, and the formal studies support, is better coordination of care, and better outcomes than elsewhere in the system. (of course I don't think single payer is stupid, but I'll leave that for now) - JGK
When the author states "A tiny but vocal group of doctors argued to end all COVID precautions (including masking) which would most harm under-vaccinated and -resourced populations." one can only conclude that he has absolutely no clue about evidenced-based medicine, and all of his prescriptions are completely and utterly flawed, and much of what he says is filled with half-truths and falsehoods. His wokeness shines through with the nonsense related to the various statements on racism. With all due respect, physicians are among the most liberal of groups, and bandying around the term racism only has a negative effect such that anything the author says cannot and should not be taken seriously.
That doesn't mean to say that there aren't issues with the US healthcare system, but even a brief look at the single payer system in the UK tells one that that is not the solution, because the UK NHS is in a complete and utter mess, despite the fact that UK doctors are not just excellent but in many ways trained far better than their US counterparts.
And incidentally, when the author states in his final conclusions that "There is strong support for fundamental reform – single payer", my only reply is just where is this person coming from. This statement is pulled out of the air, and there is very little support for a single payer system, and there would be even less support if people knew exactly what that entails and what a disaster other single payer systems are, including Canada and the UK. Perhaps look to Germany for a better solution.
The German model seems to be working well. As you note the UK NHS model is coming apart from perpetual under-funding. But in the UK a parallel system works quite for those who can afford it.
Thank you, Dr. Kahn, (and Vinay), for this super-charged piece. I look forward to taking a deep dive into all your references, before responding in greater depth. As a traditional Catholic conservative, with 40 yrs in health care (retired last August), I have struggled mightily with the many issues you identify. Yes, I agree that our health care system is functioning very poorly. However, I come down against single payer, since it will eventually lead to government bureaucrats instituting health care mandates (some life vs death) for ALL citizens and non-citizens, e.g., the current COVID caper. The genesis of Medicare/Medicaid 50+ yrs ago set us up for our current health care situation. It is time for a wholesale change, though it would be very disruptive to most stakeholders (that may include everyone). Several ideas: local control and the principle of subsidiarity should prevail. God cannot be left out: a religious and ethics representative need to be present on any committee. Human nature alone will lead to big mistakes such as Roe v Wade. Think of all those little human beings who had no say in the matter of their own lives! They got the worst “health care” of all. But they never had to pay Medicare taxes.
Interesting piece with provocative conclusions/ suggestions.
I practice in Canada….not all rainbows and sunshine either….we are 2nd last on OECD rankings….but US brings up the rear, and by some margin in some areas/metrics.
https://www.commonwealthfund.org/publications/fund-reports/2021/aug/mirror-mirror-2021-reflecting-poorly
I can’t imagine spending 4 hrs a day on EMR.
Norway ranks first, but tiny country, and the usual refrain is whether that system can scale.
But countries like UK or Germany, which sport some variation of hybrid public/private systems, seem to fare generally relatively well.
I think moving to single payer is third rail stuff politically in the US. A middle ground seems more realistic (if only barely). Coming from the other end of spectrum (single payer in Canada), a hybrid system has some appeal also.
But if they say recognizing the problem is a start, (and spending the most per capita with the worse life expectancy should fit that bill), this essay might do that. If only your leaders will listen.