Long-time HCFA-WA supporter and recently retired RN Cris Currie, who spent the last 13 years of his career in home health serving mostly Medicare and Medicaid patients, addresses a common objection to universal/single payer healthcare: Centralization would leave us worse off than the status quo and take away choice.
Private insurance companies have added incentive to reduce or not extend coverage to keep profits high
A state Republican legislative aide recently commented to me that the dangers of over-centralization in healthcare may pose more risk to Americans than the status quo, since people won’t have the option of switching to a competitor if they don’t like the government’s decisions. I would argue that the status quo offers no advantage for several reasons.
With regard to essential coverage decisions, private insurance companies generally follow Medicare’s lead anyway, but they have the added incentive to reduce or not extend coverage whenever possible to keep profits high. Unlike in the public sector, these decisions are made secretly, and attempts by the public to expose and change corporate policy are largely fruitless.
Public and private bureaucracies can be equally frustrating, but fiscal conservatives tend to think that many government services, including Medicare, should be privatized because private enterprise is more efficient, innovative, and responsive than government. While this might be true in the context of manufacturing or technical services, it is not generally true when basic human needs and rights are involved such as in healthcare.
Over the last 200 years, Americans have concluded (often through costly trials and errors) that services everyone needs such as law enforcement, fire fighting, basic education, sanitation, safe drinking water, courts, defense, etc., are best provided by a single, nonprofit, centralized government entity - not by multiple, competing, profit-oriented organizations. I would argue that healthcare financing should be added to that list because of the continuous escalation of costs, which has caused rationing to only those who can afford it; because everyone needs it; and because profit making and competition only complicate the ability of individuals to efficiently access essential services.
Healthcare, unlike commodities, is typically not purchased until conditions require it. This urgency greatly limits options and makes consumers more vulnerable to those for whom profit is the prime motivator. It is therefore essential that professional healthcare providers, dedicated to service rather than profits, maintain their ability to make appropriate care decisions together with their patients - not continue to allow faceless insurance companies to make those decisions on a case-by-case basis.
Certainly, problems can develop when government run services are not funded adequately, such as is often the case for the British National Health Service or the Veteran’s Health Administration in the U.S. However, when the health services are privately managed and only the financing is government controlled, as is the case in most of the developed world, services tend to be quite stable. Plus, preventive services are much more likely to be sought under a single payer system, since in the absence of high deductibles, co-insurance, and co-pays, people are more likely to seek attention earlier.
What do you think? Join the discussion in the comment section below.