• Christine Mann

Why Single Payer?

Thoughts From 18 Years in the System

"You're born, you get Medicare. The end." --Jim Hightower, at Saturday's Healthcare Rally

I've had a number of people ask me why I support Single Payer over other forms of Universal Coverage. The answer encompasses both practical and ideological reasons.

First, let's clear something up: Single Payer =/= socialized medicine. There are forms of Single Payer that are socialized (the VA and the British system are socialized--doctors are employed by the government and facilities are owned by the government.), and forms that are not socialized (Medicare and the Canadian system are not socialized; I participate in Medicare as an independent provider and I bill Medicare for my services). There is nothing wrong with a socialized system, btw! But you need to understand the differences when you are having these discussions for when people call you a commie.

My preference would be for a non-socialized Single Payer system. Single Payer just means that I send all my bills to one payer for all of the services I provide, and every doctor, lab, hospital, physical therapist, etc would do the same. All doctors and all facilities would be participants, and all citizens would be covered, regardless of age, job status, or place of residence.

So back to the question: why Single Payer?

Imagine I have called you into my office and told you that there is a suspicious mass on your CT scan, most likely cancer. Which would you rather hear?

A. I can send you to whichever specialist you'd like, and you can choose who is best for you.


B. I'll need to spend some time figuring out which specialist is covered by the insurance plan you picked. You will have to go to the specialists, radiologists, labs, etc. that your insurance company has chosen. It may take my staff a day or two to access the list and call the people on the list to make sure they are still on your plan. (In addition to this, doctors change their Insurance contracts all the time, so you might find out in a few months that the doctor you've been going to is no longer on the plan).

Getting a serious diagnosis is one of the most stressful things that can happen in life. Patients should be spending their time focused on their treatment, not on navigating their insurance plans. Doctors and their staff should be spending time helping patients understanding their illness, not figuring out what limitations their insurance companies will impose. The problems with multiple payers for healthcare impact every office and every patient, not just those with serious illnesses.

Behind the scenes, doctors and staff spend large amounts of time dealing with paperwork and such related to various insurance company requirements.

Some tasks we do behind the scenes instead of providing care:

1. Searching for which specialists/labs/facilities/pharmacies are covered by each patient coming into the office.

2. Determining which medications are on formulary.

3. Filling out credentialing/recredentialing paperwork for every insurance company (sometimes they are combined in groups, which is a bit easier) several times a year.

4. Figuring out if a patient's insurance is still in force (we have to do this every time you come in and for every patient).

5. Update patient insurance information every time patients change insurance companies. This can be several times a year in some cases, as people marry/move/change jobs, etc.

6. Making sure we are sending invoices to the correct sub-group for many insurance companies.

7. Chasing down claim denials, fixing them, and rebilling.

8. Providing different documentation regarding diagnoses and treatments to meet the requirements of multiple different insurance companies.

These are a few examples of the most common paperwork issues that keep your doctor from spending more time with you or seeing additional patients. Some estimates say that up to 20 hours per week are spent by a doctor and her staff on these paperwork tasks. So from my perspective, I'd much rather spend my time and energy with you, not with your insurance company.

From an ideological stand point, there are some things that should not be for-profit. Healthcare is one of those things. As long as insurance companies are involved in any capacity, there will be a motive to cut corners and make a profit to pass onto shareholders. This is immoral.

In my opinion, an ideal Single Payer system would be written by front-line doctors, those of us who are tired of watching our patients suffer and die from lack of care, and would be a non-socialized system.

A final note: although I strongly prefer a Single Payer system, I would accept Universal Coverage in any form. My patients need to be covered right now, and can't afford to wait for an ideal system. But Single Payer is the ultimate goal, and Democrats should be talking about it. We can build support if we find the courage to say the words "Single Payer" and back those words with reasons why we are in favor of Single Payer.



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