Public Option for Health Insurance or Change to Single Payer?

My wife showed me an article about something called a “Public Option” for health insurance. I recalled reading something about that on the Physicians for a National Health Program (PNHP) QnA web page.

This just makes me even more interested in seeing a serious mainstream debate about single payer systems across all major TV news networks. In fact, even though PNHP leaders have promoted Single Payer on CNN, you probably wouldn’t see a similar program on Fox News offer the same kind of opportunity to debate the pros and cons of the issue for the express purpose of educating the American people.

I think part of the reason is that certain TV news media stations frankly have reporting agendas that lean either to the conservative or liberal side, as one partly tongue-in-cheek cartoon graph suggests:

I think it would be much more helpful to Americans if journalists could try dropping this habit, at least temporarily, and do something more open-minded.

I believe many doctors and medical students are pretty idealistic about health care-related issues and Single Payer is one of them. I teach medical students and residents every day and as I enter phased retirement, I often reflect on one of the greatest rewards of my career–the opportunity to witness and foster the idealism of the next generation of doctors and their hope for a better future for medicine and for humanity.

I admit it; I’ve been called a “liberal wingnut.” Sticks and stones may break my bones… Let’s stop calling each other names and focus on the problem for the benefit of the people. Here’s an approach by the Harvard Negotiation Project that might work and that I’ve mentioned before in a recent post (based on the book “Getting to Yes: Negotiating Agreement Without Giving In.”):

Separate the people from the problem–You don’t have to be a conservative or a liberal to love or hate the health insurance debacle whether you consider Single Payer, the Affordable Care Act, or the American Health Care Act. The issue is how do doctors and patients engage genuinely in honest, fair-minded reflection on the pros and cons of differing options for health care reform?

Focus on interests, not positions–How do we keep in front of us our mutual interests include how to make sure we’re paying attention to the devil in the details of helping doctors help health policy makers and legislators help patients heal and thrive?

Generate options for mutual gain–Would it make sense to to vet and validate alternative methods for providing funding for and provision of health care for all, including Single Payer, for Americans, so that patients and the next generation of doctors and other health care professionals acting as a team of empathic, humanistic clinicians can have confidence in the country’s leaders?

Agree on using objective criteria–What would be acceptable to patients, doctors, and regulatory boards to use as objective markers for successful application in the real world of various means of restructuring and funding health care reform alternatives as studied in the health policy literature?

As the health care reform debate evolves, I hope for the best, partly because I’m headed for Medicare myself, and partly for the good of the country. Things change slowly and not according to my timetable. But change happens.

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  1. Jim,

    Liberal “wing-nut” or not – most people don’t even consider the basic arithmetic. This is what happens if the USA adopted the next most expensive model of health care from the Swiss – about 1 trillion in savings:

    Combine that with Warren Buffet’s recent comments about how the financial problems for businesses in this country come down to health care costs and not taxes. Throw in the fact that health care administration in this country is a disaster and lacks both intelligence and creativity.

    The only solution is single payer. The only reason it has not happened is that we have a Congress propping up a failed managed care business model with the money of every American.

    Without it – you and I will end up paying $30K/year for rationed Medicare benefits. Keep that palliative care doc away from me – I’m just here for a blood pressure check!


    George Dawson, MD, DFAPA

    Liked by 1 person

    • Thanks for the link to your blog post, George. I’m going to recommend it to my trainees. It’s hard to pick a favorite quote from it because I think the entire post is excellent. But I especially like this one below the graph at the beginning:

      “A minimum of $300 billion dollars saved. That is what I thought could be achieved by eliminating insurance companies from the American health care system. It turns out the savings are a lot bigger than that. Just looking at countries where the per capita health care costs are at least $2500 and comparing the USA to Switzerland – the country with the next highest per capita health care costs we get the following equation:

      $2640 (the difference) x 320 million (current population the the US) = $844.8 billion

      That is what converting the US health care system to single payer would involve. No more managed care companies (MCOs) pretending to be efficient. No more pharmaceutical benefit managers (PBMs) rationing medications in order to make profits. No more outrageous Obamacare premiums that seem to be rising with no end in sight. No more MCOs, and PBMs making your doctor’s life miserable and burning him or her out. The writing should be on the wall by now for all Americans. The US Congress and their healthcare lobbyists fully intend to continue the unsustainable health care bureaucracy to every American until the last possible moment. That is as true for Republicans as it was for Democrats.”–Dr. George Dawson, Real Psychiatry: The reality of psychiatry rather than the perception; Americans Can’t Do The Basic Health Care Arithmetic, Jan 3, 2017.


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