Universal Health Care: Is Medicare Really a Single-Payer Success?

One doctor's opinion

“If you want an example of a successful single-payer system, just look at Medicare,” many say.

I say, not really.

A single-payer system is the form of universal health care Canada and Great Britain use. Several groups are advocating for it. People on the right tend to view it as socialized medicine at its worst. Many on the left think it’s ideal. President Obama has tried to distance himself—and his plan—from it, frustrating some Democrats.

With Medicare, the government is the single payer. And it’s worked so well, some say, why not just extend it to all?

The problem is, Medicare is not working well. The reason it’s been somewhat successful is that it has been subsidized, in an indirect way, by private insurers.

How Medicare really works

Medicare pays such low fees that many primary care physicians would have trouble making ends meet and staying in practice with those payments alone. Instead, health care providers, including doctors and hospitals, have been able to make up the difference by charging the private insurance companies more.

Some doctors don’t even take Medicare. It’s not worth it to them, especially after taking into consideration the extra personnel they have to hire just to go through the red tape to get paid. If you don’t cross all the T’s and dot all the I’s (and keep up with when they change the rules right out from under you), the claim may be denied and the office has to start all over again.

I don’t tell this to whine and gripe. Most doctors get along just fine. We don’t need pity. I just don’t want the system to fail.

What I worry about is when I retire. I’m getting older and will be on Medicare soon. I want quality care. Medicare for all is not the answer. It won’t hold up. Not without a major overhaul of Medicare itself.

What do you think?

By James Hubbard, MD, MPH
My Family Doctor Blog

[Originally posted August 5, 2009, James Hubbard’s My Family Doctor Web site.]