U.S. Must Avoid a Single-Payer Health Care System That Stresses Doctors to the Breaking Point

COMMENTARY Health Care Reform

U.S. Must Avoid a Single-Payer Health Care System That Stresses Doctors to the Breaking Point

Jul 25th, 2018 3 min read

Commentary By

Kevin Pham, M.D.

Graduate Fellow in health policy at The Heritage Foundation

Robert E. Moffit, Ph.D.

Senior Fellow

Whatever direction lawmakers choose, the consequences will be profound for both doctors and patients. wutwhanfoto/Getty Images

Key Takeaways

One leads toward a market-based system, based on consumer choice and competition; the other, toward a government-controlled, single-payer system.

More than 60 percent of American physicians said they were pessimistic about the future of medicine, a 10 percent increase over just a two-year period.

The experience of the British National Health Service indicates that Americans could look forward to burned-out and overburdened doctors under a similar system.

Washington policymakers increasingly face a crossroad in American health policy between two broad and vastly different directions. One leads toward a market-based system, based on consumer choice and competition; the other, toward a government-controlled, single-payer system, like that of United Kingdom, where health care financing and delivery is implemented through the British National Health Service.

Whatever direction lawmakers choose, the consequences will be profound for both doctors and patients.

Champions of a single-payer system often claim that a government-controlled health system, run by Washington officials, would provide an efficient practicing environment for physicians. The British NHS experience, however, suggests otherwise.

The National Health Service burdens physicians with a suffocating practice environment that strips them of their professional autonomy and sometimes forces them to put the interests of the British government above that of their patients. As a result, British doctors are leaving medical practice at an unprecedented rate.

The British Medical Association's latest surveys find more than 60 percent of their physicians report increased stress over the past year. Half have reported feeling unwell due to work-related stress.

Nearly half of their physicians report low or very low morale. While low morale extends across all medical branches, it is most prevalent among British general practitioners. The number of general practitioners choosing to retire early has increased threefold, despite growing demand for their services.

Earlier this year, the British Medical Journal published a study of GPs who have left practice or are planning to leave. The most commonly cited reasons were the lack of professional autonomy, administrative challenges and increasingly unmanageable workloads. Notably, British general practitioners report no longer feeling satisfied practicing as physicians. As one of the respondents remarked, "to survive in today's NHS, you have to be comfortable taking risks and cutting corners."

In the National Health Service, bureaucrats set treatment targets and guidelines. Often, physicians find themselves compelled to practice in ways that will meet legal and regulatory requirements rather than meet the needs of their patients.

The surveys reveal that British GPs often feel the pressure of an unrealistic workload. British physicians complain that the system forces them to take clinical shortcuts, spending less time and attention on each patient. As a result, they also felt increasingly vulnerable to medical litigation.

The impact of low morale among highly trained medical professionals is pernicious and immediate. What drives most people to go into medicine in the first place is the profound satisfaction of restoring a person's health. Encumber that impetus to heal, and you will start to lose doctors. And when there are not enough doctors, widespread coverage does very little for the health of patients.

The specter of this British dynamic already exists in American health care. The American Association of Medical Colleges projects a shortage of up to 120,000 physicians (measured in terms of full-time equivalent positions) by 2030. A 2016 Physician's Foundation's survey found that approximately 50 percent of American doctors reported low morale or persistent feelings of burnout.

More than 60 percent of American physicians said they were pessimistic about the future of medicine, a 10 percent increase over just a two-year period. During that time, Washington had saddled physicians with additional third-party reporting requirements, especially in Medicare.

Up to 80 percent of surveyed physicians feel they are at or beyond their capacity to care properly for their patients, and 72 percent feel administrative requirements detract from the quality of their care. In America today, the top two physician complaints are the growing regulatory burden and the erosion of clinical autonomy.

These complaints are serious. Nearly half of American doctors now plan to accelerate their retirements.

Sen. Bernie Sanders, I-Vt., and others in Congress favor a federal takeover of American health care. This would be disastrous. Nationalizing American health care would only exacerbate administrative and patient workloads, further eroding physicians' ability to practice.

The experience of the British National Health Service, the most prominent single-payer system in the industrialized world, indicates that Americans could look forward to increasingly burned-out and overburdened doctors under a similar system.

Washington's policymakers must correct the features of the current system, not bear down harder on its overburdened providers.

This piece originally appeared in Dallas News

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