"To hear the various supporters of universal access, single payer, or whatever is the current euphemism for socialized medcine describe it, proclaiming universal coverage is going to solve not only the cost problems of American medicine but also those of access. It’s as if the Obamas and Clintons of the world believe that there exists vast underground reservoirs of medical care which only have to be tapped to provide Americans with all the medical care they can eat. But, as anybody who has waited in our department or cannot get a timely appointment to see his doctor can tell you, we are operating pretty much at capacity right now and not only is there no reserve to tap but medical care is not a tappable commodity anyway, at least not like that. The only extra capacity will come from eliminating waste and unnecessary uses of medical services, something which will not happen when medical care is free because, unless there is some direct cost to the consumer, there is no incentive not to go to the doctor for every little thing.
In fact, everything about “Single Payer” is going to make medical care an even scarcer commodity. Just an increase in demand, that is, giving the Holy 47-million-uninsured (PBUTHN) sudden and equal access with no possibilty of increasing the supply of medical care, by itself will lead to a relative scarcity. That’s just simple math. Additionally, after an initial bonanza of insurance money to mollify the various short-sighted medical societies pushing single payer (including, unfortunately, my own) the pressure on reimbursements in the absence of any competition will be down, and down, and further down until at some point there will be so little incentive to see more patients for the government dime that we will stop working so hard and adopt a more European approach to a full waiting room or a long list of patients needing elective surgery. Try getting a doctor in the VA to see patients in the late afternoon for a preview. I mean, if we’re going to be government employees (de facto or otherwise) we may as well get all of the perqs including all the usual holidays, coffee breaks, lunch breaks, and the sure knowledge that we can never be fired. Remember, doctors in the German Federal Republic work around forty hours a week. The baby-boomer armies who will shortly pillage and burn their way down our medical Danube are going to need a lot more hours of our time than that to collect their booty of knees, hips, colonoscopies, and other plunder.
The correct play is to make going to the doctor cost something for everyone (no matter the income level) to discourage frivoulous use of services, enact national tort reform to begin to give physicians some cover behind which to start to exercise more common sense, to frankly eliminate most government involvement in primary care letting the market decide how much patients will pay for a doctor, and if we must provide free health care, limit it to the extremely poor and to government backed major medical insurance for which all but, again, the very poorest should contribute something. We might also start asking the elderly who have assets to kick in a little more for their own medical costs. I wouldn’t want to bankrupt anybody but would it kill many of the elderly if Medicare was means tested just a little? The idea is to set the stage for a little more patient and family involvement in real medical decision making, not the pretend decision making we have today where the answer is usually, “Do everything that someone else’s money can buy.”
Integral to this would be to start implementing EMTALA like it was intended, that is, to offer only a free screening exam and if no emergency medical condition is discovered, to allow the hospital the option of sending the patient home to follow up with his own doctor for whom they can pay if they want to. This would remove the “out” that people currently have to avoid taking money out of their tatoo budget to pay their minor, primary care-type medical bills. I’d also get rid of the Childrens Hospital (I)nrichement Program, also know as “CHIP.” Almost a complete waste of money as, again, most children just need a little low-cost primary care. I don’t think it would bankrupt us to pay for major medical expenses of children because, and hold onto your hats, most children, even the children of the Holy Underserved, are fairly healthy. Just pay for their necessary major medical care directly out of tax money and stop trying to comprehensively insure a population that doesn’t really need it.
The idea is to decrease the federal obligation, money that we don’t have and the borrowing of which is going to bankrupt our nation. Better to have a low tax economy where people are free to spend their own money how they like. If they decide to get that bitchin’ nose ring instead of their antibiotics, well, that’s just freedom, baby!"
- The Great Panda Bear, M.D.