The Conservative Case for Single-Payer Health Reform

By Joe Jarvis
Utah Healthcare Initiative blog, March 10, 2012

Recently, Charles Krauthammer, conservative Washington Post commentator and Fox News analyst, who is also a physician, spoke to an audience of mostly physicians in San Antonio (find coverage of the speech in the San Antonio press here).

Excerpts from the article:

If President Barack Obama's health care reform act is fully implemented over the next two years, it will evolve into a Canadian-style single-payer system that will forever change the social contract between Americans and their government, a nationally syndicated columnist and physician predicts.

“It will change the country. If it is not repealed, we will be a different country when ‘Obamacare' is fully implemented,” Krauthammer said in an interview after speaking Thursday to a receptive crowd of mostly physicians and other health care professionals at a breakfast sponsored by the San Antonio Medical Foundation.

The Affordable Care Act, which passed in March 2010 without Republican support, was touted as a way to extend coverage to most uninsured Americans, and to offer it at an affordable price to those who have trouble buying it now, such as the poor, the self-employed, and those with pre-existing medical conditions.

The centerpiece of the plan is a requirement for everyone without health coverage to buy a policy or pay a fine. Krauthammer predicted that the U.S. Supreme Court, which is set to deliberate the constitutionality of the Affordable Care Act this month, will overturn the that provision of the law.

“The individual mandate (to buy health insurance) is a fairly radical step in the final expansion of the power of the federal government, which would then leave it in a position where it would be very hard to find any constitutional grounds — if you don't overturn this — for ever denying the federal government the power to do anything it wants,” Krauthammer said.

“We're spending perhaps $1 out of every $4 on unnecessary treatments, referrals and tests that everyone knows are unnecessary,” he said. “And Obamacare did nothing to reform it.”

In his speech, Krauthammer predicted the complexity of the law eventually would doom it to failure, which would lead to a single-payer system within a decade.

“This is a new reform that when it kicks in within a couple of years will make the practice of medicine a nightmare,” he said. “If it's not repealed, I guarantee you that within a decade we will have a single-payer system. And if I had to choose between Obamacare and a Canadian or British system, I'd choose the single-payer system. At least it would be rational.”

My comment:

It's clear from his comments that Dr. Krauthammer wishes that Obamacare would be repealed and that the nation would not go down the pathway towards single-payer health system reform. However, he directly states that given a choice between Obamacare and single payer, he would choose single payer, because "at least it would be rational."

What does a conservative like Krauthammer see in single-payer health system reform that is rational? I feel qualified to answer that question, since I am both a conservative (I received the Republican nomination twice for legislative races in Salt Lake City) and a longtime support of single-payer health system reform.

First, and foremost from a conservative viewpoint, single-payer health system reform is fiscally responsible. Unlike the 'Affordable' Care Act, a single-payer approach to health system financing is financially sustainable. Nearly all of the unfunded future debt due to entitlements currently stacked up against the federal government is medical debt. The last count for that debt which I have seen is $60 trillion, more than the present day value of all assets owned in the U.S. Single-payer health system reform can reduce the cost of health care by $1 trillion/year, nearly all of which can go to relieving the tax burden. By the time today's kindergartners are Medicare eligible, a single-payer-style payment mechanism for American health care would have eliminated the federal deficit.

Second, and integral to cost control, single-payer health system reform has the capability to eliminate the poor quality care due to unnecessary treatments. Eliminating the multiple, confusing payment schemes for health services also eliminates the perverse incentives inherent in those schemes. The health insurance business model induces provider behaviors which are contrary to good patient care. In contrast, single-payer health financing focuses providers on best practices for patient care. It is, as Krauthammer notes, the most rational method of paying for health care.

Third, single-payer health system reform can (and should) be implemented at the state level, preserving the appropriate balance between national and local governing.

I disagree with Dr. Krauthammer. Obamacare does not make single-payer health system reform inevitable. If we Americans want a health system that is optimal quality and therefore lowest cost, we will have to do the heavy political lifting necessary to intentionally rid our health system of corporate welfare, clearing the decks for a rational payment mechanism which cherishes patient care above profits. It's the most conservative way forward for our health care system.