By “Hannah” – Single-Payer Health Care System Limits Patient Choice and Outcomes

(Editor’s Note:  The writer lives in Canada, and is writing from her experience with their government-funded “single-payer” health system.  Many Canadians like their system and can’t understand the U.S. system of “the best health care a person’s money can buy.”

Many in the United States, who favor health insurance reform,  feel single-payer health care, where individual practitioners, clinics, and hospitals would be paid by the government, would be better.  Some Canadians and Britons, who have single-payer health care, aren’t so sure.)

What Would TV's Marcus Welby, MD, Think of Single-Payer Health Care?

What Would TV's Marcus Welby, MD, Think of Single-Payer Health Care?

I figure this is heresy, but I’m starting to feel that society would be better if health services were purchased through a free market based on consumer choice — not through a single-payer system, whether managed by government or big insurance companies.

We in Canada already have a system where most of the services are provided by private for-profit businesses, whether they be doctors’ practices, clinics or hospitals.
 Our dirty little secret is that only some of these health care businesses are covered by our single-payer health system, with huge gaps in coverage of essential services.
In effect, Canada already has a two-tiered single-payer health care system, whether or not we admit it to our neighbours.  And most of the decent, useful services I’ve gotten have been things I had to pay for out of pocket, in a free market, not the single-payer health system.

Free Market Health Providers Would Be Accountable

If you went to a mechanic and your car wasn’t fixed, you would want that mechanic held accountable.  In a free market, people would take their dollars elsewhere, and he would go out of business.
 But people who work in government-funded, single-payer health and welfare bureaucracies collect their paychecks, and are not held accountable for their clients’ outcomes.

And when you see, say, social workers who come and chat with people for months or years, never leading them to gainful employment, you have to ask why society keeps paying these people to make nothing happen. Could the answer simply be no accountability?

I wonder if it relates to the presence of bureaucracy, and the fact that the workers in the bureaucracy are working for their paycheck, but not personally accountable for the success or failure of the enterprise.

Free Market and Single-Payer Health Both Have Limits

There are necessary services that are far too expensive for an individual to pay for.  Some means of paying for these as a society makes sense, though I think we need to look more critically at some of the expenditures in systems that go towards unnecessary or harmful products, procedures, medications, etc.

But a lot of services aren’t that expensive, but aren’t covered by our single-payer health system, even though they’re medically necessary. And the services that health care does cover are often inappropriate and inadequate.

You can go to your family doctor for years with a problem and never get resolution, when what you really need is something not provided by our single-payer health system — in my case athletic therapy. Not an expensive therapy in the scheme of things, but the government does not pay for it, while wasting money on things that aren’t helpful.
Trips to specialists probably cost more than my AT, and never gave me resolution at all, or even any clues. I spent years going to my doctor and specialists until I found an athletic therapist, almost by accident. I got so much more benefit from her than I ever got from the so-called “free” hospital physiotherapy.
Those hospital physiotherapists are getting paid by the government no matter how poor their outcomes are, but my athletic therapist could not stay in business if people were not getting better from her services.

Government Is Often Wasteful and Harmful

Ironically, the lack of accountability in the public system means that a lot of money is spent on things that don’t work, which fuels huge industries that sell questionable products — that harm the environment and human health — while limiting people’s choices.

Now this doesn’t mean I don’t think people should encourage each other, and work together, but this pose about the “system” really helping is just that, often — a pose.

My Experience on Government Welfare

I’ve been in it, and I’ve seen it. I’ve been on welfare.

The rates are so ridiculously low you have no security, yet they claw back so tight that they disincentivize work.   You’re treated like crap and end up feeling crappy about yourself.

The only way to move on with your life is to get out of that system, as impossible as that may seem. You’re not going to get anywhere with the “help” of the social worker who chats with you, but at the end of the day just walks away with their decent middle-class income.

Capitalism Might Be Better If….

These criticisms don’t just apply to publicly administered bureaucracies.  They also apply to big, impersonal, profit-making corporations. Neither socialism or corporate capitalism is the problem or the solution.

Well, socialism is giving me some pause right now as a system.

Capitalism might work better if we had an economy of independent producers, and a good flow of materials and services through this economy, coupled with high participation encouraged by a culture of encouragement and optimism.

It’s problematic if the alternative to markets is bureaucrats deciding what people should be able to have and do — whether the bureaucrats work for the government or a giant insurance company.  At least in a small business, where owner-workers have a stake, they have reasons for making good decisions.

If prices reflected all the real costs (e.g. air pollution), we could have a system where being thrifty also translates into helping the planet.

 Let Patients Vote With Their Dollars

It would be better to give patients the power to spend their health care dollars on whoever is actually helping them, even if the health care dollars are entirely from taxes.

Give patients a certain amount they can allocate, based on the amount that the current system already spends per person – and if someone has greater needs that require a higher amount of money, e.g. for a surgery, find ways to apportion that.

That way, bad care would no longer be rewarded, and patients would effectively be voting with their dollars. We deserve better.

Government Welfare for Doctors

Right now we’re engaging in a kind of welfare for doctors. They have professional associations, and power in society, so that whatever they define as an acceptable standard of care is what happens, the patient be damned.

The government just forks over money, simply because they have medical degrees, not because they have proven results.

Additional Thoughts

1.  If patients were actually choosing where the health care dollars were going (kind of equivalent to spending their own money), things might correct themselves. In my case, almost none of my healthcare dollars would go to doctors.

2.  The way in which medicine is taught and practiced in this country is really problematic, in my opinion. You hear so many horror stories, and you can’t help thinking that if Joe the mechanic can’t get away with returning cars that are still broken, how come high-paid MDs can essentially get away with doing that to people’s health?

3.   I think doctors should get paid based on results. Maybe eventually the incompetent ones would just stop practicing medicine. And if that happens to be a large portion of them, so be it. They haven’t earned the privilege.

Why is free market or single-payer health care better for you?

 

Wordworks Blog Author: Hannah Cohen

Hannah Cohen writes under a pseudonym to avoid discrimination for her psychiatric history. She lives in Canada, where she was forcibly hospitalized and drugged for years, fighting against being labeled. In 2006, she was locked up so long and drugged so much that the system broke her will and convinced her she was disabled for life. After years on welfare and disability, she started working again and clawing her way back into a full and satisfying life. She is now weaning off psychiatric drugs and rediscovering her own mind and heart.

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