Logo

Log In Sign Up |  An official publication of: American College of Emergency Physicians
Navigation
  • Home
  • Multimedia
    • Podcasts
    • Videos
  • Clinical
    • Airway Managment
    • Case Reports
    • Critical Care
    • Guidelines
    • Imaging & Ultrasound
    • Pain & Palliative Care
    • Pediatrics
    • Resuscitation
    • Trauma & Injury
  • Resource Centers
    • mTBI Resource Center
  • Career
    • Practice Management
      • Benchmarking
      • Reimbursement & Coding
      • Care Team
      • Legal
      • Operations
      • Quality & Safety
    • Awards
    • Certification
    • Compensation
    • Early Career
    • Education
    • Leadership
    • Profiles
    • Retirement
    • Work-Life Balance
  • Columns
    • ACEP4U
    • Airway
    • Benchmarking
    • Brief19
    • By the Numbers
    • Coding Wizard
    • EM Cases
    • End of the Rainbow
    • Equity Equation
    • FACEPs in the Crowd
    • Forensic Facts
    • From the College
    • Images in EM
    • Kids Korner
    • Medicolegal Mind
    • Opinion
      • Break Room
      • New Spin
      • Pro-Con
    • Pearls From EM Literature
    • Policy Rx
    • Practice Changers
    • Problem Solvers
    • Residency Spotlight
    • Resident Voice
    • Skeptics’ Guide to Emergency Medicine
    • Sound Advice
    • Special OPs
    • Toxicology Q&A
    • WorldTravelERs
  • Resources
    • ACEP.org
    • ACEP Knowledge Quiz
    • Issue Archives
    • CME Now
    • Annual Scientific Assembly
      • ACEP14
      • ACEP15
      • ACEP16
      • ACEP17
      • ACEP18
      • ACEP19
    • Annals of Emergency Medicine
    • JACEP Open
    • Emergency Medicine Foundation
  • About
    • Our Mission
    • Medical Editor in Chief
    • Editorial Advisory Board
    • Awards
    • Authors
    • Article Submission
    • Contact Us
    • Advertise
    • Subscribe
    • Privacy Policy
    • Copyright Information

Opinion: Single Payer Health Care Would Be Detrimental to Emergency Physicians

By Todd B. Taylor, MD, FACEP | on October 21, 2019 | 0 Comment
Features
  • Tweet
  • Email
Print-Friendly Version
ILLUSTRATION: Chris Whissen & Shutterstock.com
ILLUSTRATION: Chris Whissen & Shutterstock.com
With election season in full swing, the debate over the future of the United States health care system is a hot topic. Would single-payer health care be an economic disaster, as Todd B. Taylor, MD, FACEP, argues here? Or, is it time for the United States to adopt a single-payer system, as James C. Mitchiner, MD, MPH, FACEP, suggests? What do you think? Send your comments to acepnow@acep.org.

If you think health care is expensive now, wait till it’s free.”

You Might Also Like
  • Opinion: Single Payer Health Care’s Time Has Come
  • Single Payer System, Universal Health Coverage Not Synonymous Health Care Terminology
  • Vermont to Launch All-Payer Accountable Care Organization Model for Financing Health Care
Explore This Issue
ACEP Now: Vol 38 – No 10 – October 2019

―P.J. O’Rourke

By the common definition, America currently has “universal health care.” Health care services are largely available to almost all Americans via a combination of publicly and privately funded systems based on individual demographics. However, not all Americans choose to avail themselves of the options for health insurance to pay for these services and protect their assets.

Prior to the Affordable Care Act (ACA), or Obamacare, about 83 percent of Americans had some form of health insurance. Of the remaining 17 percent, half could have had coverage if they had chosen to pay a modest monthly premium (eg, to add family coverage at work) or simply applied for Medicaid. After ACA, the uninsured rate dropped to about 10 percent, largely due to expansion of Medicaid.1 As before ACA, perhaps another 5 percent could be covered if they choose.

With these facts in mind, the current discussion on health care is really about how to fund it and not about universal coverage. This brings us to the crux of the issue. How you fund health care directly determines what health care you get (or is even available). Nationalization of the health care system in America (eg, via “single-payer”) will be much different than our current private health insurance market. And much of this simply comes down to choice.

In a single-payer system (government funded, regulated, managed, and defined), politicians largely determine health care services and their costs. This is a “regulated monopsony.” In a market-based approach (even one that is highly regulated), individuals (or groups of individuals, eg, employers) largely determine services, and to some extent, the laws of supply and demand determine prices. Individuals have choices regarding insurance benefits or whether it is even worth the cost to purchase insurance.

Common Sense Analysis of Single-Payer Health Care

It is impossible to read, let alone analyze, everything that has been written about single-payer health care. Further, while various other countries are used as examples, the largest such country by GDP with single-payer is Japan, whose health care system (by total spend) is only about 9 percent of that of the United States. England is about 3 percent. We cannot be so naive as to believe a country the size of the United States can simply wholesale adopt a system that works for countries a fraction of our size. Even by population, the United States ranks third, and neither the first (China) nor second (India) most populous country has universal health care. There is simply no way to assume we can know the impact of adopting single-payer health care in the United States, and not just on health care but the entire economy and U.S. way of life.

The fact is, America has already largely achieved universal health care as defined as “available access to health care services.” Some simply choose not to avail themselves of readily available health insurance to protect against financial ruin due to an unexpected health care crisis. Failing to buy health insurance is like owning a car and failing to buy auto insurance. Then when you get into an accident, you complain about not having a car and suffering financial ruin after being sued by the other driver you hit.

Rather, the challenge with health care today is finding affordable insurance and/or care, a problem which largely stems from the ACA’s comprehensive coverage mandates and a lack of an efficient health care services market. Pharmaceuticals remain artificially expensive due to various federal policies.2,3 Direct hospital services are artificially expensive due to government price controls (cost shifting) and predatory pricing from some health plans.4 In fact, all of health care is artificially expensive due to a lack of a true market. Imagine how expensive anything might be if you could not comparison-shop because you did not know the price until after the goods and services were delivered. Amazon and eBay have revolutionized commerce, but health care has failed to keep pace. Nevertheless, a market-based approach will eventually prevail in virtually all aspects (including cost) if left alone to follow market forces. As noted, ACA mandates severely influence the upward trend in the cost of health insurance.4

Pages: 1 2 3 4 | Single Page

Topics: health reformInsuranceMedicaidMedicareMedicare for Allsingle-payer health care

Related

  • Medicare’s Reimbursement Updates for 2024

    January 13, 2024 - 0 Comment
  • What Is ACEP Fighting for in 2023?

    March 6, 2023 - 0 Comment
  • ACEP Calls for UnitedHealthcare to Abandon Retroactive ED Coverage Denials Policy

    July 21, 2021 - 0 Comment

Current Issue

ACEP Now May 03

Read More

No Responses to “Opinion: Single Payer Health Care Would Be Detrimental to Emergency Physicians”

Leave a Reply Cancel Reply

Your email address will not be published. Required fields are marked *


*
*

Wiley
  • Home
  • About Us
  • Contact Us
  • Privacy
  • Terms of Use
  • Advertise
  • Cookie Preferences
Copyright © 2025 by John Wiley & Sons, Inc. All rights reserved, including rights for text and data mining and training of artificial technologies or similar technologies. ISSN 2333-2603