Hillary Clinton and Donald Trump have spent very little time debating or even discussing on one of the most important issues facing Americans — their health care and what could happen if Obamacare (the Affordable Care Act, or ACA) goes belly-up.
During their raucous second debate, however, Clinton quickly glossed over the issue with a comment about “Medicare-for-all,” since she claims the government-run program is working well. But a closer look confirms Clinton’s solution is a form of single payer.
Single-payer health care systems are, in reality, what were once referred to as socialized medicine.
Here’s the truth: Many patients are no longer able to go to the doctor of their choice — and many doctors no longer participate in the Medicare program. Other than in an emergency, patients can only use providers who accept Medicare rules and payments — or they’re responsible for their own health care costs.
The increasing control of health care delivery by a barrage of federal mandates also makes it more onerous for doctors to care for their patients. Federal mandates control virtually all criteria for appropriate care through Medicare and which reimbursements will be made to health care providers and institutions.
And it’s all run through the pocketbook of the American taxpayer.
The authors of the original Affordable Care Act knew early on that if their legislation failed, moving to single payer would — in the short term — solve the loss of coverage concerns. However, the long-term concerns outweigh the short-term coverage benefits.
Single-payer health care systems are, in reality, what were once referred to as socialized medicine — where medical and hospital services are provided by the government and paid for by taxes.
Under a single-payer health care system, all people may be guaranteed health care services, but that care is dependent on the availability of the services and the providers who would render that care. One just has to look at the Canadian system: There, examinations, tests, and procedures are often put off for weeks or months — while patients’ morbidities drag on.
The complexities of reimbursement may be reduced under a single-payer system, but a care provider’s time for billing and coding, sometimes away from direct patient care, increases exponentially. And reimbursement levels usually decrease for doctors and institutions, resulting in potential compromise of the time that is devoted to that care.
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All patients have access to a defined package of health care benefits in a single-payer system. But they are also constrained from using their own funds to purchase more health care services if they have resources to purchase care, and if that care is available.
There is no question that this country’s modified fee-for-service approach has built the best health care delivery system in the world. Now, that system is under fire. If Hillary Clinton is elected to the presidency, there is very little chance she won’t continue to push for a single-payer system, since the Obamacare train is about to “run off the track.”
Robert Tenery, M.D., is a Dallas-based ophthalmologist and writer, and the third in three generations of physicians.