Should The U.S. Move To A Single-Payer Health Care System?

According to a new Gallup Survey, 53% favor replacing the Affordable Care Act with a single-payer, federally funded health-care plan.That kind of  health care system also has the backing of more than 2,000 physicians who have signed a "physicians' proposal" calling for major changes to our health care system.

Dr. Marcia Angell is one of the co-authors of the proposal. She’s a member of the faculty of Global Health and Social Medicine at Harvard Medical School, and former editor-in-chief of the New England Journal of Medicine.

Highlights of her interview included:

On why the U.S. should adopt a single-payer model:

It is much cheaper. On the first year alone, if we converted to a single-payer system, we would spend no more money than we are spending now. With time, since it’s the only way to control cost inflation, it would be much cheaper. I look at it not so much as an economic issue as a moral issue. This is an obligation of any decent society to provide health care to its residents. If every other country can do it with better results than we get in terms of health, while spending less than as much per person on it, we ought to be doing this. If you look at other services that decent societies provide their people—police protection, clean water, education, roads—why is this not considered one of them?

On how the lucrative health care industry in the U.S. influences policy:

[With] politicians, you have to look at who is pulling their strings. There are huge industries in health care in this country that don’t exist in other countries. Not only do they have variations of single-payer but they deliver health care in a largely non-profit system…Hospitals (even specialist positions) outpatient dialysis centers, imaging centers—they’re profit-oriented.

Even in a non-profit hospital—even at Partners, for example—they can use their operating expenses to expand, and the more they expand the more they become these great conglomerates and buy up physicians and buy up outpatient clinics, the more they can set their own prices. You can’t do that in other countries.

On whether switching to a single-payer model would create long waiting lists and less efficient service:

That’s simply not true. Very rich people, the sheik of Kuwait, may come here to the Cleveland Clinic when he gets his heart fixed, but it is not the best system in the world by any means. We have 30 million people, even with Obamacare, who are still uninsured. That’s just obscene. We distribute health care according to the ability to pay, not according to medical need. There’s a huge mismatch between the ability to pay and medical need. The people who most need health care [are] the people least able to pay. If you're well insured you can get all kinds of MRIs you don’t need, but if you’re not insured—good luck. 

Marcia Angell is a lecturer at the Harvard Medical School and the former editor-in-chief of the New England Journal of Medicine. To hear more from Angell, tune in to Boston Public Radio above.