by Stuart A. Hayman, M.S.
With every presidential campaign cycle, we resurrect the debate about our “broken” healthcare system. This means that every presidential candidate must be prepared to discuss his or her ideas regarding the best way to address healthcare reform. As I write this article, there are still more than a dozen candidates vying for the Democratic nomination for president. Some of these candidates are promoting socialized medicine in the form of a single-payer system as the answer. Others are calling for a form of single payer that utilizes our existing government system (i.e., “Medicare for All”). We are also hearing about alternatives such as Medicare buy-in; a combination of public and private or subsidized private options; and reinstating the Affordable Care Act (ACA) as it was originally created.
At the same time we are hearing from Democratic presidential candidates, we are also being told that Senate Republicans are working on their own healthcare solution. Regrettably, we have been hearing this same sound bite from Republicans in the Senate since before the passage of the ACA.
Despite the success of the ACA in reducing the number of uninsured, there remain fundamental problems with the U.S. healthcare system that warrant solutions. According to the Kaiser Family Foundation, as a result of the ACA, “The number of uninsured nonelderly Americans decreased from over 44 million in 2013 (the year before the major coverage provisions went into effect) to just below 27 million in 2016. However, in 2017, the number of uninsured people increased by nearly 700,000 people, the first increase since implementation of the ACA*." Another unfortunate statistic was recently brought to light by the Commonwealth Fund: “Of people who were insured continuously throughout 2018, an
estimated 44 million were underinsured because of high out-of-pocket costs and deductibles**.” Thus, while the ACA was very successful in many ways, it has not proven to be the panacea many had hoped for.
One of the most significant problems the Affordable Care Act did not address is the lack of price controls on the pharmaceutical industry. Despite promises from both President Trump and Congress that price gouging would be addressed, no sensible limits have been put on
pharmaceutical prices. The most logical assumption is that inaction on this issue is the result of the extreme financial power of pharmaceutical companies and their influence on Capitol Hill. It is estimated that U.S. drug prices are two times higher than comparable drugs in Europe.
There are countless stories of U.S. patients who have no choice but to go without needed medications, improperly ration medications, and/or purchase cheaper alternative medications that may not be safe or effective. All of these options put patients’ health at substantial risk. Additionally, inflated drug prices are directly correlated with years of preventable
health insurance premium inflation.
Is a Single-Payer Healthcare System the Answer?
In April 2019, I attended the annual House of Delegates meeting for the Medical Society of the State of New York. I was very fortunate to hear Dr. Shawn Whatley, a past president of the Ontario Medical Association and the past chairman of emergency services for a regional health center in Toronto, talk about the Canadian single-payer healthcare system. Dr. Whatley is also an accomplished author and a Munk senior fellow at the Macdonald-Laurier Institute in Toronto.
Dr. Whatley summarized the good and the bad associated with Canada’s single-payer healthcare. The good includes lower office overhead, only one set of rules to learn since there is only one payer, and doctors need not worry about a patient’s ability to pay. On the flip side, however, the bad includes rationed care, lack of access, excessive wait times, care
inefficiencies, and mediocrity of care.
Dr. Whatley also discussed the fascination that some U.S. politicians have with the Canadian system. As an example, he identified presidential candidate Sen. Bernie Sanders. Sen. Sanders is a strong proponent of a single-payer, government-run healthcare system. Under Sen. Sanders’ proposal, there would be one system for all, meaning that the purchase
of additional healthcare services would not be allowed even for those who could afford these services.
In late 2017, Sen. Sanders visited Canada to learn about the Canadian system. This visit, however, was limited to the three top hospitals in very exclusive and affluent neighborhoods in Canada. Apparently, the citizens in these areas donate hundreds of millions of dollars to supplement these hospitals. Thus, the senator did not receive a balanced view of hospital
care in Canada. He didn’t see that in the vast majority of hospitals, patients waiting for beds are stranded in crowded hallways. He didn’t hear about patients waiting as long as 10 months for tests such as MRIs.
According to Dr. Whatley, practitioners in Canada have known for two decades that, “People with higher socioeconomic status get more care and wait less for it.” In his November 6, 2017, blog post “Weekend With Bernie While Canada Waits,” Dr. Whatley cited a study published in the New England Journal of Medicine that showed that “wealthier patients got 23 percent more heart procedures and had 45 percent shorter wait times than poorer patients, in Ontario.” The fact is that single-payer systems such as Canada’s do not provide equal levels of care for all their citizens.
Another fact about the Canadian healthcare system that is never mentioned by those touting this solution is the cost associated with a single-payer system. Dr. Whatley cited estimates from the Fraser Institute when stating that while the average cost per person in Canada is $4,600, “families earning in the top 10 percent pay up to $40,000 per year.”
Like many ideas that are being put forth by our political candidates and elected officials, the devil is in the details. Clearly there are a lot of details about the Canadian system that are being left out of the discussion. While I believe that the vast majority of Americans do wish to see universal healthcare, I don’t believe that a Canadian-style single-payer system is the
answer. What Canada does provide is a significant amount of data for anyone truly interested in finding a solution that could work in the U.S.
This is a pivotal time for physicians, patients, and the future of medical care delivery in this country. As important stakeholders, you can still make a difference. This discussion should not be driven by legislators and special interests groups, who often fail to consider issues relating to quality or safety. Just as we would not want a system that prioritizes profits over people, we also cannot afford to implement a solution that would result in rationed, substandard care in place of the quality healthcare Americans have come to expect.
Allowing politicians to solve our most pressing healthcare issues without the input of practicing physicians is not acceptable. It is imperative that all NYSSA members read this message as a call to action. It is vital that you educate and inspire your colleagues and your patients to make their voices heard. I encourage every NYSSA member to get involved in
the political process and to support the NYSSA’s political activities going forward. At the very least, your financial support of the advocacy efforts undertaken by the NYAPAC and ASAPAC will help ensure that physicians have a seat at the table.
*Kaiser Family Foundation. Key Facts About the Uninsured Population. Dec. 7, 2018. Retrieved from www.kff.org/uninsured/fact-sheet/key-facts-about-the-uninsured-population/.
**Collins S, Bhupal H, Doty M. Health Insurance Coverage Eight Years After the ACA: Fewer Uninsured Americans and Shorter Coverage Gaps, But More Underinsured. The Commonwealth Fund, February 2019. Retrieved from https://doi.org/10.26099/penv-q932.
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