By Alicia Ault for Medscape

As many of the newly elected and newly empowered Democrats in Congress are vowing to push for what they are calling “Medicare for all,” a majority of US healthcare professionals recently surveyed said they support a single-payer system, according to a Medscape Medical News reader poll.

Sixty-eight percent said they supported — with 52% strongly supporting — the United States moving to single-payer healthcare, while 21% said they strongly opposed such a move.

More than two thirds of the 2503 US respondents who participated in the Medscape poll were older than 55, but the support for single-payer care came from respondents of all ages. Nurses and advanced practice nurses made up the majority of respondents, followed by physicians and administrators.

Sixty-six percent of physicians who responded said they favored a single-payer system, compared to 68% of administrators and 69% of nurses. About a quarter of respondents among those three professions opposed single-payer healthcare.

Overall, almost two thirds of respondents said they believed that support for single-payer care had increased during the past decade. Physicians (78%) most often believed so, followed by administrators (69%) and nurses and advanced practice nurses (59%). Consonant with that increasing popularity, only 9% of respondents said they thought that support had decreased in the past 10 years.

In Favor

The poll generated spirited debate. Many who commented argued that, given increasing costs and what appears to be worse health outcomes in the United States, it was time for America to move to a single-payer system similar to that in Canada or many European countries.

“We have the most expensive system in the world, and the current model cannot be sustained,” said Mark Kaliher, RN. “We need to stop kicking the can down the road. For-profit insurance companies are not your friends, they are in it for the money and that is all. Illness needs to stop being a profit-making adventure.”

“Socialized healthcare systems in nearly all developed world countries outperform US health systems and at half the cost,” claimed Tristan Mueck, MD. He said the United States is the only country in the Organization for Cooperation and Economic Development (OECD) “with rising maternal mortality.”

Added Mueck, “These other socialized countries have lower maternal mortality than us and also a declining mortality rate.”

US men and women have the lowest life expectancy at birth in comparison with similarly developed nations, according to OECD data analyzed by the Peterson Center on Health Care and the Kaiser Family Foundation. America also has the lowest number of insured citizens in comparison with those countries, according to Peterson and Kaiser.

M. Pinsker, MD, said the nation already has a single payer — the US taxpayer, who foots the bill for uncompensated care and covers healthcare for individuals who are enrolled in Medicare or Medicaid or are treated through military hospitals and the VA hospital system.

“We have never had a free medical market in my 76 years of life,” Pinsker said. “We can’t return to what never existed. It is past time to join the rest of the developed world, rather than insisting that everyone is out of step but me.”

Not in Favor

Others warned of what they saw as the pitfalls of “socialized medicine” and the dangers of letting the government be in charge of healthcare.

“We are already enslaved enough as it is,” said rheumatologist Emilio Gonzalez, MD. “I cannot imagine what it would be like with a single payer system, hard-working physicians quickly becoming more like peons of a system where bureaucrats are in control; what a nightmare!”

Mitchel Galishoff, MD, said, “There may be nothing inherently wrong with a single payer system in theory but in practice — oy.”

He said government has a “lousy track record” when it comes to managing healthcare dollars because of the influence of lobbying. “Place all that money in one large kitty where the people with the most influence can determine how it is spent — well, you get waste and badness,” said Galishoff.

Maureen Coppotelli, who did not identify her profession, said she had worked in California hospitals, where she said she saw Canadians who had come to the United States for cardiac procedures because of long waiting lists at home. “Single payer could never work in the US because the demands and expectation of care are so much higher,” said Coppotelli, who added, “The US Congress cannot manage a budget and the country would be broke in no time.”

Some commenters said that stories about long waits in countries with single-payer systems were overblown.

“No one waits for a CABG or Stents here in Australia if they need it,” said a commenter who identified themself as HH. The commenter noted that there are waiting lists for nonurgent procedures, “but these lists are constantly reviewed and cost-effective strategies and innovation in teamwork see these lists kept well under control.”

Kerry Rodgers, RN, agreed that waits for emergency and urgent procedures or cancer surgery, for instance, do not exist in Australia. If a patient presents to the emergency department for emergency care, not only will they never know the cost, but “they receive world class emergency treatment, ICU care if required, rehab, etc. and will not pay a cent,” said Rodgers.

She also noted that the government doesn’t get involved in care decisions. “Ordinary people are not bankrupted by their need to access treatment,” she said. “Our system is not perfect – not near enough spent on preventative healthcare, universal dental coverage, people living in rural/remote areas may have to travel to access specialised care, indigenous health outcomes, etc., but no one dies because they can’t afford to pay,” said Rodgers.

Australians can also access private insurance for elective and cosmetic surgeries, she said.

Australian nurse midwife Fay Nilsen said her countrymen get top care, paid for by “a small medicare levy through the taxation system each year, but anyone can access care without worrying about being bankrupted.” Brain surgery — including a stay in an ICU — cost her nothing, as did the follow-up care and MRIs, said Nilsen.

“I live in Canada and I don’t know why you would think the government has any say in our health care,” said Jodi Libralesso. “I can assure you that if I need care, my doctor makes sure I get it. And what we pay in taxes based on income is less than what you pay in insurance premiums. The best part is, everyone is covered,” said Libralesso.

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