The single-payer infection

U.S. doctors shouldn’t be tempted

Agrowing number of physicians now believe they have the cure for our nation’s health care maladies — a government-run, single-payer system.

Fifty-six percent of doctors support single-payer health care, according to a new survey by physician recruitment firm Merritt Hawkins. Ten years ago, the numbers were almost reversed, with six in 10 doctors opposing single-payer.

The health care status quo is far from perfect. But single-payer will make things only worse for doctors and patients alike. To stay true to their professional oath — “first, do no harm” — physicians must shun single-payer.

Proponents of single-payer maintain that government-run systems make quality care more accessible for patients and reduce administrative waste. Neither assertion is true.

Single-payer systems seem affordable only because governments impose arbitrary restrictions on what they’ll pay for care. These price controls result in severe shortages, which force governments and health care providers to ration treatments, medications and services.

Patients experience this kind of rationing by waiting for care. In Canada’s single-payer system, the median patient waits five months after referral from a general practitioner to receive treatment from a specialist. Across the Atlantic, roughly 4 million patients were waiting to see a specialist in England’s government-run National Health Service this past June.

Even routine procedures are delayed. To reduce costs, the NHS recently imposed stringent approval processes for procedures such as cataract removal, hip replacements and knee surgery. The Royal College of Surgeons condemned the move as “unfairly and unnecessarily prolonging the time patients will spend in pain.”

Single-payer systems also spawn resource shortages. More than half of the Canadian province of Ontario’s neonatal intensive care units couldn’t accept new babies in August due to overcrowding. Hospital bed shortages in England routinely force surgeons to cancel critical cancer operations.

Some countries deny access to lifesaving care altogether. Just look at how the NHS rations medication for hepatitis C, which afflicts roughly 215,000 Britons. The NHS pays only for treatment for 10,000 patients each year. Those who aren’t lucky enough to be among those 10,000 must deal with chronic pain, liver complications — even a heightened risk of death.

It’s baffling why medical professionals who devote their lives to caring for patients would get behind a brand of health care reform where such substandard care is the norm.

Doctors also better prepare for a hit to their finances under single-payer. In 2014, U.S. hospitals reported that they suffered more than $14 billion in losses because of underpayment by Medicaid, the government health care program jointly run by the feds and the states. Between March and September 2015, free-standing children’s hospitals reported an average of $9 million in losses apiece because of Medicaid.

Physicians have to jump through numerous hoops just to claim any payment from Medicaid. In a 2013 study, primary care doctors in Washington state were three times more likely to report problems with Medicaid’s reimbursement

wait times than for private insurers. And they were nearly twice as likely to call the amount of time they spent on Medicaid paperwork a problem, compared to commercial insurance paperwork.

Physician salaries would also take a haircut under single-payer. According to a 2011 study published in Health Affairs, primary care doctors in Canada earn two-thirds as much as their U.S. counterparts. The average Canadian orthopedic surgeon earns less than half what a U.S. orthopedist does — despite doing more procedures.

More work for less money drives doctors from the profession. By 2022, the NHS expects at least 40 percent of its general practitioners to leave the workforce because of low morale. Officials in England say that they’ll have to spend about $130 million to import as many as 3,000 new doctors from abroad to alleviate the nation’s doctor shortage.

Too many doctors have caught the single-payer bug. Let’s hope a look at the reality of single-payer abroad will be enough to cure them of this infectious disease.

Tim Brinton