A single-payer health care system? A flawed treatment

AMA Leader Commentary. By Donald J. Palmisano, MD, Sept. 15, 2003.

AMA LEADER COMMENTARY

A few words about current events in medical practice

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A message to all physicians from AMA President Donald J. Palmisano, MD:

I was surprised recently to read an article in the Aug. 13 Journal of the American Medical Association written by a small number of physicians and medical students who advocate a single-payer national health system.

It wasn't that the article ran in JAMA -- the journal is editorially independent from the AMA, and is free to publish articles at odds with AMA policy. My surprise was directed at the authors of this article who don't want market competition, but instead seek a rigid, coercive, government-controlled system.

The AMA has long-standing policy in support of pluralism, and against a single-payer system because it would create long lines for services, is slow to adopt new technologies and maintain facilities, and generally is less adaptive, less responsive, more bureaucratic. Such a system is bad for patient care because it invariably leads to rationing.

Just this past July, I attended a meeting of the British Medical Assn., where Dr. Ian G. Bogle, BMA's chair of council, characterized his nation's single-payer health care system as "the stifling of innovation by excessive, intrusive audit ... the shackling of doctors by prescribing guidelines, referral guidelines and protocols ... the suffocation of professional responsibility by target-setting and production-line values that leave little room for the professional judgment of individual doctors or the need of individual patients." His words come from long experience with a single-payer health system that has increasingly been criticized for not keeping up with the needs of its patients.

Unlike the United Kingdom system where private insurance can co-exist, Canada's single-payer model forbids the existence of competing private insurance. No wonder I recently heard a delegate speaking on the house floor at the Canadian Medical Assn. annual meeting state that her patients are "suffering and dying on wait lists," and the only escape for them is to go to the United States.