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Q: Why isn't single payer an option?

"Why isn't single payer an option?" This question was posted in a forum I perused after reading The New York Times article from my previous post. Single payer doesn't work because it makes the fundamental assumption that a third party – be it government, private company, neighbor down the street – knows the best medical option for a patient.

In other words, when you have a patient (A) and a provider (B), the single-payer system says that rando (C) gets to make a health care decision for A and B in an "effort to decrease costs" and "stretch our resources."

How does that make sense?

Yes, having C dictate the price (and treatment plan) between A and B is a great way to keep costs down but only if we're all in the same risk pool. I don't know about you, but I don't want to be in a risk pool with the jerk that cuts me off in traffic. Or the inconsiderate lady who talks loudly on their cell phone in the coffee shop. Or that millenial who makes fiscally questionable decisions to buy only organic cologne.

A single payer (C) codifies all of "us" into a single entity and then dictates what health care should be. I think that's a fundamentally flawed way of approaching a very personal aspect of our society.

That's why I purport that health care is an "A & B conversation" and we can "C our way out." A single payer doesn't promote personal accountability for the foods you eat, the exercise you don't do, and the risks you take. In fact, a single payer incentivizes the individual to shirk their personal responsibility because their decisions will be diluted in the "risk pool."

Subsequently, poor outcomes get covered by others in the risk pool – some that live mindfully and try to mitigate their risks. Others may not be mindful but don't deserve to be pushed into worsening debt when they're simply trying to make ends meet.

It's time to get out of the pool.

P.S.Y.C.H. provides a general waterpark for preventative care because it provides funding and opportunity to access care once a year, for life. For sick visits, you get to choose which pool you jump into (by your lifestyle choices). And for those sick visits that are due to no fault of your own, the pool is available for you to get into without fear of bankruptcy, judgment, or drama.

Wow, that was a lot of analogies for one post, but I think you get my drift. A single payer (like the Canadian system and our Medicare system) is not the best idea for true health care reform.

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