Single Payer May Mean No Service, No Choice

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The momentum for “single payer,” “Medicare for All,” or “Medicare Extra” is building at both the state and national levels, especially after the narrow primary election victory of young democratic socialist Alexandra Ocasio-Cortez in New York, observes the Association of American Physicians and Surgeons (AAPS). The sky-high premiums, huge deductibles, and complexities of ObamaCare make the promises of single payer more appealing.

The biggest hurdle in the states has been cost, estimated to be as high as $400 billion a year in California.

“Americans need to understand that ‘single’ payer means no other payers are allowed,” explained AAPS executive director Jane M. Orient, M.D. “If you don’t like your government health plan, you have to keep it anyway.”

Few places in the world have a true single payer outside of North Korea and Canada, she noted. There is a parallel private pay system, and private insurance, although everybody has to pay for the government system whether receiving care or not. Canada is beginning to allow some private payment because of long waits.

Democratic socialists promise free choice of provider. “But that means choice of someone who is on the list or in the network and doesn’t already have a full panel,” Dr. Orient cautioned.

“More than 71 percent of Medicaid patients are in managed care. Managed care means narrow networks, pre-authorizations, waiting periods, and denials.”

Like Medicare, Medicare Extra will surely be administered by private carriers. UnitedHealth Group—or one of its rivals, or a consortium—might be the de facto single payer.

“When anything is ‘free,’ demand is guaranteed to rise steeply. Without a competitive free market, services are rationed by the queue and bureaucratic fiat,” Dr. Orient states.

“As this issue is likely to be a major issue in the midterms, people need to learn what they are asking for, as they might get it. They can start with the AAPS Single Payer IQ Test, with questions such as: Who is the single payer? Does single payer guarantee a right to health care? Under single payer, who will do the work?

The Association of American Physicians and Surgeons (AAPS) is a national organization representing physicians in all specialties, founded in 1943.

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