THE SINGLE PAYER CONCEPT #3: Does It Increase the Involvment of the Government in Our Medical Care?

The answer to this question comes in two parts:

First, a central single payer, federal level, should eliminate state governments’ participation in our healthcare system. That would mean 50 less sets of politicians and their games and dealmaking to contend with. Wow! FIFTY less sets of politicians! I am starting to feel lighter already. Beyond that there would be hundreds, maybe thousands, less sets of city, county, town, and village politicians and their local cronies to deal with.

Suppose all healthcare construction had to undergo and pass a certificate of need examination (from the central single payer) as opposed to having hospital boards of directors and entrepreneurs in conjunction with local officials decide that new construction was warranted and then issuing bonds for same. What am I trying to accomplish? I am trying to alleviate the American people from bearing the financial burden of local and state politicians’ dealmaking with healthcare businesses. Entrepreneurship in the business of medicine, for example to build medical palaces, does not translate to better medical care. The work and decision making of the doctorpatient relationship conducted in a non-conflicted manner, coupled with the conscientious work of nurses; technicians; doctors’ office staff; other administrative personnel; and patients’ family members to effectuate that decision making, is responsible for the quality of care, not the building within which that care is delivered. Yet, every neighborhood seems to need a new cancer therapy center, or an MRI center, or an extension of a downtown hospital or a specialty type hospital.

What I am saying is the less local and state politicial-business interaction there is to deal with, the less the American healthcare expenditure will be and the less our income will be eaten up by the cost of health care. Yes, I am trying to stifle entrepreneurship in the business of medicine, when its primary goal is to make a fortune off the backs of the American people.

So, this first part of the answer says that there can and should be a lot less government-political-business interaction within our healthcare system, and a properly structured single payer could bring this about.

Second, will the federal government per se become directly involved with our health care, i.e., be put in a position to control it, ration it? The answer is NO, if the central payer is structured properly. If the doctorpatient relationship is left alone to develop free of external pressure and control from the payer, then there will not be rationing from that payer. This is the key. The central payer must control the prices paid for service and product, i.e., must control the business of medicine and not make attempts to control the medicine of medicine. This control of the business of medicine begins at the doctors’ practices’ billing mechanism and continues through every business, which becomes involved as a consequence of the decision making, which occurs within doctorpatient relationships. One could say that this would be ‘socializing’, i.e., controlling or putting a bridle on, business functioning. That would be a correct view, and it would be in direct opposition to the current business functioning of unbridled capitalism, aka, GREED. But, in my view, more importantly, this would unsocialize, free up, the doctorpatient relationship so that it could develop to the full potential of its mutual trust. Cost control would come at the business level not at the doctorpatient relationship level. The single payer would not be influencing how medicine would be practiced, for example, by restricting access to surgical procedures and specialty consultations, which is the game plan of the British and Canadian systems and which is becoming more and more prominent in America. Note the medical home concept and the emphasis placed on primary care services by both private and government payers in America. This is disguised rationing, which, in effect, becomes a primary care holding pen, into which people can be herded like cattle.

This cost control for the business of medicine would come through a process of serious, transparent negotiation as described in the previous post. Why have cost control at the business level? So that the central pool of funds (the collective monies given by all people living in America to pay the entire bill for their healthcare services and product) is enough to guarantee clear and equal access to sound, ongoing, non-conflicted doctorpatient relationships for everyone.

Well, what about the last 2 to 4 weeks of terminally ill patients’ lives, where so much futile expenditure occurs? I will discuss this in a future post regarding the use of Advanced Care Directives within the context of the doctorpatient relationship.


Do you think the politicians, whom we elected last November, have the will and courage to make this happen? It is not about a single payer system per se, but rather, about the individual politicians, who have the power to structure that type of system. The previous Congress didn’t do so well with The Affordable Care Act, did they: Increasing insurance premiums, increasing entitlement populations, increasing our taxes for same, no public option? Do you think, if the ACA is repealed at the Supreme Court level, that the Republicans and Democrats will actually work together to create a healthcare system that controls the business of medicine as opposed to trying to control the practice of medicine, i.e., the functioning of the doctorpatient relationship, which is exactly what the government payers in Britain and Canada and the government and private payers in America are doing at present?

Make no mistake, the American healthcare system is already fulfilling my definition of the effective meaning of socialized medicine. This is what must change if we are serious about true healthcare reform.

R. Garth Kirkwood, MD