Single-Payer Cocktail Party Talking Points

With the surprisingly strong showing of presidential candidate Bernie Sanders, it's no longer Miller Time, it's Single Payer Time. Moving faster than a cute puppy video on YouTube, people will be chewing on Sanders’ popularization of the single-payer concept for many, many months.

When the topic rears its ugly head at the water cooler or drinks after work today, here are a few things to consider:

1. Using the VA or the US Post Office as the model of the sick-care system of the future is not accurate. The VA is funded and mostly staffed by government employees.

2. Care in a single payer system would most likely be delivered by non-government employees. There are distinct combinations of who pays for care and who actually delivers the care around the world.

3. There are many different forms of single-payer systems throughout the world. Most have shadow private-pay systems that can create perverse incentives and maintain outcome disparities.

4. Those systems with private insurance do not have for-profit insurance companies. They look more like utilities to provide a public service deemed essential.

5. There is no sick-care system that has been able to optimize cost, outcomes, access, and experience anywhere in the world. Doctors in the UK recently went on strike. The NHS is staring at significant budget deficits.

6. Every system is a trade-off. Which factor is emphasized, in my opinion, is a reflection of the political mood and the values of any given country. Comparing one country to the next is often comparing apples to oranges.

7. The US sick-care workforce does not have the same appetite for unionization and negotiation with a single payer as those in other countries.

8. Overturning a $3 trillion industry is a herculean task, representing 20% of the largest economy in the world, and will probably require generations of persistence in the face of oscillating political winds. Change, if any, will have global repercussions.

9. A de facto oligopayer system has already happened. Expanding Medicaid to children and others is another scenario aimed at the same result

10. Pretty soon you run out of other people's money.

Like the US Constitution, there is something in single payer for everyone and it’s subject to interpretation. In addition, you should probably have the same skepticism about single payer opinions as you would talking to someone about their money or their sex lives. When all else fails, just fake it, like talking about a book you've never read at book club.

The potential value or damage is in the eye of the beholder and no one has strong enough lenses to predict the outcome when and if it comes to your neighborhood. Just ask that doctor who protested Medicare as "socialized medicine" in 1965 and is now driving that Maserati.

Photo by Phil Roeder/Creative Commons License.