First, although the placement of a single payer for American healthcare service and product under the sponsorship of the federal government, which seems to be a natural course of events, might seem to fulfill the economic-political policy definition of socialized medicine (that the government owns and operates both the financing of health care and its delivery, http://economix.blogs.nytimes.com/2009/05/08/what-is-socialized-medicine-a-taxonomy-of-health-care-systems/), I don’t think it does because I don’t see a change in ownership of anything but rather, just a change in which organization administers payment of the bill. Nor does it follow that this change must fulfill the effective meaning of socialized medicine, which is to control the functioning of the doctorpatient relationship in an effort to control health care expenditure, i.e., to control the practice of medicine to reduce cost. Fulfilling the effective meaning of socialized medicine, which the current British, Canadian, and American systems so capably do, adds a major conflict of interest on top of the mutual trust, which is the doctorpatient relationship and from which sound, ongoing, non-conflicted health care is supposed to ensue. And this dollar based conflict of interest is every bit as damaging as a doctor, who performs procedure after procedure or test after test just for self-enrichment.
So, does a single payer system have to fulfill this effective meaning and fear of socialized medicine? The answer is, Of Course Not, IF IT IS STRUCTURED PROPERLY.
Well then, how can we create a single payer system under the sponsorship of the federal government without subjecting it to the cunning, scheming, unscrupulous, and disastrous manipulations, which our Washington, DC politicians, the federal government, have unleashed upon our healthcare system for the last many years up to and including the ideological farce, the Affordable Care Act, (ACA)?
I believe the answer is to create a separate, independent paymaster similar in structure to the Ken Feinberg–BP Oil Spill Escrow Fund Payout System, which administers claims payments related to that event. Independent is a key feature. The paymaster of my single payer system would not be beholden to the government nor to any healthcare business or corporation, including hospitals, health insurance carriers, and drug companies. The paymaster and his/her team of healthcare-business-experienced negotiators would have the same authority and isolation as the Supreme Court of the USA. In other words, their decisions regarding payment for services and product would be final and only changed by themselves or their future members. Notably, they would have NO INFLUENCE over how medicine is practiced, i.e., no influence over the functioning of the doctorpatient relationship. Cost control would be accomplished by straightforward, transparent NEGOTIATION between the individual healthcare business, including individual hospitals, and healthcare-business-career-experienced members of the paymaster’s team. These negotiations would not be punitive in attitude nor with an attitude that good, decent profit is a bad thing. Quite the contrary, they would have to be conducted with an attitude that good profit over and above clear assessment of absolutely necessary overhead is vital for our wonderful healthcare businesses and corporations. The definition of absolutely necessary is a major part of the negotiating process. Also note that the paymaster’s negotiating teams would consist of experienced healthcare business people, who worked many years in the domain of the companies, hospitals, or corporations with which they are negotiating the prices to be paid by the single payer for their services and product.
My effort in this discussion is to try to describe an administrative mechanism, which frees up the doctorpatient relationship to do what it is supposed to do, while also ascertaining agreed-upon negotiated profit margins with our healthcare businesses. Greed would be removed, national healthcare expenditure could be controlled, and the mutual trust, which is the doctorpatient relationship, could blossom. Also, it should be noted that the business practices of doctors will be part of these price negotiations, which are completely separate from the sound, ongoing, non-conflicted functioning of the doctorpatient relationship. In other words, the single payer is not negotiating with the doctor regarding how he/she practices medicine but rather only what the doctor will be paid for same. And the price a doctor, hospital, or other service is paid is the same regardless of the financial status of the patient. There will be no more bad debt and these dollar amounts will not be penurious but rather reflect the esteem, which people in general should have for the wonderful doctors and hospitals in the USA.
This can work wonderfully for our healthcare system if transparency, sound healthcare business experience, and good will are at play. This requires that the ethos of the single payer is removal of the greed within and the political power over our healthcare system. Sound, ongoing, non-conflicted functioning of the doctorpatient relationship must flourish as the primary goal, which healthcare business concerns (including doctors’ practices’ business mechanisms) must function to support, while making their own profit seeking a secondary goal, yet a goal, which is guaranteed in a good, negotiated, agreed-upon measure.
R. Garth Kirkwood, MD