A single payer does not equate with socialized medicine; it just doesn’t. But, if not properly structured and written into legislation such that that structure remains authoritative, then it can have its functioning mired in the worst and most feared aspect of a socialized medicine system. What is this aspect? It is the payer directing the practice of medicine by interfering with, pressuring, or leveraging the doctor patient relationship like our public and private 3rd party payers currently do.
The figure above is a simple outline of what I believe constitutes a properly structured single payer system. The foundation, upon which the entire structure rests, is the American people, who must fund the system. This financing, I suggest, would be a federal sales tax, which dollars accumulate in a single payer fund.
The single payer fund has several notable characteristics:
- untouchable by politicians,
- used for paying the medical bills of the American people,
- no deductibles, co-pays, coinsurance, or bills sent to the patient,
- also used for paying its own overhead including a fraud investigation department.
The single payer functions to pay the medical bills of the American people. That’s what it does. The price paid to specific health care businesses for service and product is and will be a major source of contention. The ethos of my single payer is that the health care businesses be paid for service and product in such amounts that they earn genuinely healthy profit enabling the growth of the business which can be documented to have occurred or not occurred.
To accomplish the goals set forth by this grand ethos requires tough knowledgeable negotiation between the single payer and the business. The negotiators for the single payer must not be Washington, DC bureaucrats with an ax to grind but rather seasoned business people who have labored in specific health care business arenas for many years, even to the point of retirement. These people will immediately know the difference between the needs of the business for genuine profitable growth and excess manipulation which amounts to greed. I want these negotiators to work for the single payer with an accurately intuitive grasp of the balance between proper financing of the business and affordable dollar flow from the payer. The job requires in-depth knowledge of and hands-on experience in the specific business and tough yet sincere negotiation. The businesses are not the enemy and indeed, they need to be kept profitable for the welfare of the country and its people. The lead negotiator of each business section might be appointed by the President or perhaps his/her Secretary of Health and Human Services.
This simple concept of a properly structured single payer seems right to me.
Note that health insurance companies and the burden of employer provided health benefits are not part of it. And one other thing: You don’t see the doctor patient relationship in the figure. That’s because this equilibrium of trust between the doctor and the patient must remain free of influence, pressure, and demands from the single payer or any health care business. Indeed, the single payer and all the health care businesses exist to serve and support the existence of and access to sound, ongoing, non-conflicted, spontaneously functioning doctor patient relationships for everyone living in America.
R. Garth Kirkwood, MD