Health insurance is again in the political spotlight as Democratic presidential candidate Bernie Sanders promotes his version of single-payer that he calls “Medicare for all.” He says it will improve care, reduce administrative burdens and allow physicians to focus just on practicing medicine. Dissenters say it’s a pipe dream that will only lead to rationed care, lower reimbursement rates and long waiting lists.
Single payer is held up by supporters as the ideal egalitarian healthcare model. If other nations can provide expansive medical care for their citizens, they ask, why can’t the U.S.? Opponents disparage the idea as anti-choice; they predict the implosion of the healthcare system and demise of physician autonomy.
Could single payer be the boon to medical practice its supporters insist? Or would we end up with a system that limits care and ignores best practices in favor of the bottom line? Who’s right?
The short answer is, both sides are.
Why single payer?
While the Affordable Care Act insured more people, single payer advocates say it has done little to relieve the administrative burden on physicians, and may have even made it worse. They point out that the legislation has precipitated new regulatory requirements, new practice models and reimbursement structures by both government and private insurers.
A nationwide Physicians Foundation Survey of 20,000 doctors revealed common physician complaints of increased paperwork and overhead, too many different rules and rates from too many different payers and too much time spent arguing about coverage instead of delivering care.
Many physicians worry that patients cannot comply with care plans because high premiums and deductibles prevent them from getting necessary medications or follow-up care. Moreover, they say, too much time is spent on insurance-related bureaucracy. That same survey found that 20% of provider time is spent on non-clinical paperwork. More than two-thirds (69%) feel that their autonomy is sometimes or often limited and their decisions compromised. Additionally, physicians feel pressured to keep up with demand, but a vast majority (80%) report being at full capacity or overextended.
The U. S. spends more on healthcare per capita than all other Western countries, except for Norway and the Netherlands, according to a 2014 Commonwealth Fund report. Although many Americans gained coverage under the Affordable Care Act, the U.S. is the only industrialized nation without a true “universal” system. Despite the high level of spending, most health performance measures are only average, and many are worse than those of other industrialized nations.
“We spend about $3.2 trillion on health and about a third of that is on administration,” says Robert Zarr, MD, president of Physicians for a National Health Program (PHNP). The organization, which includes some 20,000 physicians, medical students and other health professionals, has been pushing for a single-payer national health system since 1987. Zarr gave up his private pediatric practice to work at a Washington D.C.-area clinic, which he says allows him to spend more time with patients instead of paperwork. He contends that a move to
single payer could cut about 15%, or over $400 billion, from total health-related expenditures, just through administrative savings.