Three urologists offer their takes on a single-payer health care system.
Dr. Albertsen“To me personally, single-payer makes much more sense. I’ve seen single-payer in various forms: I’ve seen how the UK system works and the Swedish system. In Canada, it’s provincially based but is essentially single-payer by province. I’ve seen how the Swiss do it, the Germans do it.
The Swiss use a private health care payer system, but it’s not this noise that you get out here-all this competing. Why do we have competing medical records systems? Our institutions are spending millions of dollars on electronic medical records. You have to ask how that is benefiting anyone, yet you can’t use it for the epidemiology and public health measures. I look at how the Swedes organize their health care system and all the public health stuff they can do out of the single-payer system; it really tells you what’s going on.
The UK is a nice system. People can be against it because it doesn’t cover their pet project. But at the end of the day, they have a much better handle on a much smoother operating system. They fund theirs to just a third of what we fund our system, but I’m sure they could go wild if they just doubled what they were spending. They spend only a third of what we spend yet get much better value for the money.”
Peter C. Albertsen, MD
Next: “Competition is what makes this country great; you have to have competition."
Dr. Verni“Competition is what makes this country great; you have to have competition. A single-payer health system would eliminate that. The Affordable Care Act is a failed proposition; I’ve seen that as the patient and as a doctor.
Health care costs money, and with the ACA, there’s not enough of it. There aren’t enough people who can afford it, so what the ACA does is limit access to care. People who have this insurance can get in to see specialists and primary care doctors because there aren’t too many people on the plan. A lot of plans across the country have failed. One failed in Nevada; it went bankrupt. I was part of the Nevada Health Co-Op as a physician and as a patient, so I got a double whammy. That’s what the ACA does.
Can you imagine having a single-payer system so that access to care was even more limited? The most successful single-payer system right now is Medicare, which only covers about 40% of the population. There are other avenues for people to get insurance, but with the single-payer we won’t have competition, and competition is healthy. You have to do better than the next guy to get the business; both the insurance company and the physician have to work more efficiently to do a better job for patients. That’s just my opinion. I have to see some more profound evidence that that would be better.”
Michael Verni, MD
Next: "The single-payer system or the Affordable Care Act do not seem to be working, and they need to look at a different way."
Dr. Jones“I actually supported a one-payer system-I’m from Canada-but I think America has to do it differently than its current approach. The single-payer system or the Affordable Care Act do not seem to be working, and they need to look at a different way.
Medicare is OK, but Medicaid does not pay that well. I’m in a situation where we take everybody where I work-a small hospital in a rural area where a lot of physicians don’t take Medicaid-so we’re swamped with Medicaid patients. We have a much higher percentage, like 40% to 50% Medicaid, compared to my colleagues in private practice. We take the financial hit for that in order to deliver excellent care. So in order to work in this system, we get paid less than someone in private practice.
I believe in service and I believe in taking care of people; that’s why I went into medicine. But there are financial discrepancies that need to be addressed. We won’t have anyone taking care of people who are on Medicaid unless they’re willing to take a financial hit.
Reimbursement needs to increase; something like single-payer Medicare-for-all would probably do it for me, but I don’t know how that would work in a bigger city or for doctors who have a different payer mix than I do.
It would certainly simplify our billing. We wouldn’t have to put so much financial effort into the billing if there was just one payer and one set of rules for everybody, and fairness in reimbursement whether the physician sees patients in Appalachia or New York; the comparison should be apples to apples.”
Nicolette Jones, MD
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