THE SINGLE PAYER CONCEPT #1: What Is It? Can It Be Abused?

What does single payer mean, when used in the context of the American health care system? A single payer is an administrative organization, which would collect our money into a large pool and then administer payment, from that pool of our money, for our healthcare services and product. This contrasts with our current healthcare system’s administration of payment, which consists of multiple payers including the federal government, health insurance companies, and us, when we pay cash out of pocket.

Can a single payer system be abused? By abused I mean, Can a single payer system be worked to a great financial and political advantage for some (THOSE, WHO ARE IN A POSITION TO CONTROL IT) and to the great disadvantage of others (US, WHO PAY THE MONEY INTO THE LARGE POOL WITH THE EXPECTATION THAT THE PEOPLE, WHO WORK IN THE SINGLE PAYER ADMINISTRATION, FUNCTION TRANSPARENTLY, HONESTLY, AND IN OUR BEST INTEREST)? The answer is YES, IT CAN BE ABUSED. Look at the single payer systems in Britain and Canada with their long waiting lists for surgeries and specialty consultations.

However, look at our American multiple payer system. Look at the revenues of our health insurance companies, our hospitals, the vast majority of which are not-for-profit, and the money spent on lobbying politicians. Don’t waste your time looking at reported profits. A good CFO can place the profit numbers wherever the board tells him/her to place them. The revenues for all our hospitals were over 707 billion dollars in the Economic Census of 2007. The revenues for the top health insurance and managed care companies ranged from 19 billion dollars to 81 billion dollars in the Fortune 500 2009 Top Performers list. So far, it doesn’t seem like the American healthcare system abuses us with long waiting lists, save for those, who, unable to afford being part of the system yet not entitled, have a waiting period of forever. No, our American healthcare system abuses those of us, who pay taxes and/or who buy health insurance individually or via employer as part of our wages, by sucking the financial life out of us to enhance their own prosperity. I believe that most of us recognize that no service or product in America is going to be free and that companies and organizations must function with a good, annual profit after all overhead is paid. But the business empires, which have developed in our healthcare economic marketplace including our hospitals, which are independent business fiefdoms whether for-profit or not-for-profit, have changed sensible capitalism into an all out game of GREED, while placing our individual health care as a very distant secondary goal in their business plans, which fact they disguise by their false mantra of how important their social missions are to them.

Thus, in the above analysis, I do not believe that any of the mentioned healthcare systems offers a sound, ongoing, non-conflicted path, which will lead us to a plateau, where our healthcare system functions primarily in our individual healthcare interests, while placing the dollar bill as an important but definitely secondary goal.


I will discuss this ideal system in the next few posts on this blog.

R. Garth Kirkwood, MD

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