From the desk of the EMD: Single payer system – a rebuttal

October 2, 2017

My column on single payer system got the following response that I want to share with you.

I also want to make clear that all my past and future columns are my opinion solely, and do not represent the views of the College or its leadership.

Let’s keep the dialogue going. Happy to share my column space with any College member, as we all learn from hearing the opinions of others. Thanks Warner.


Michael,

I have spent the last week thinking about what you wrote with regards to a single payer system in the U.S.  

Personally, I am opposed to the entire concept of single payer. I am an Army veteran and go to the VA as my primary care. I personally can't believe the horrible care I get and that it is actually legal in the U.S. I almost died of an adverse reaction to anesthesia. While begging them to stop, I was restrained, and they proceeded. I then went unconscious and, thank God, when I came around I realized what had happened to me. I almost died. During the entire time, and to this day, I never saw an attending physician. I filed a congressional complaint and basically just got a formal apology from the VA. Beyond that, nothing has changed. I ultimately had to go out of the system and pay cash. Classic example of how a single payer system will for sure create class warfare.  

Since you, Michael, have taken a stance on a single payer system, perhaps we can have some discussion around the subject. I know with certainty that a huge amount of our membership does not want a single payer system, and we should listen to and represent all of our members. At least have a conversation with them.

I also don't feel the Australian model is a good comparison. They have less than one-tenth of our population and have subsidized care. When I was there as an invited lecturer traveling all over the country, I was told it was a four to six month wait to see an "allergist." They have no formal allergy and clinical immunology fellowship programs like we have in the U.S. It is hard to imagine how the ACAAI in one sentence asks for more money to preserve allergy training programs, then in another comment endorses a system that does not include allergy training programs. It seems contradictory.

I totally understand costs need to come down, but having a monopoly will not bring the costs down. There are laws to prevent monopolies in the private sector, so why should we give it to the government when they have already shown they can't do the job?

Looking just at drug prices, in the U.S., it is against the law to purchase bulk medications at a reduced rate – thus driving costs up. Pharma is global. They get their drugs approved in other countries at a very low cost and then, to keep profits up, the U.S. absorbs a seven- to ten-fold mark-up. You and I both know this, having worked with pharma. I was personally told this when helping to get medications approved in other countries like Canada, Australia and the U.K. Basically, they get a huge price cut, and the U.S. pays all the extra to bolster the profit margins. A better approach would be to have the same price for all of us or allow us to purchase from Canada or the U.K. Then we get the same price. In the end, the U.S. subsidizes the costs of these medications for other countries, and then we get compared to those countries with regards to the cost of health care. Clearly that is not a good comparison.

Didn't want to make this so long but it is obviously a hot topic, and perhaps something that we should all discuss. I totally respect your views presented and appreciate your leadership. I would say a healthy debate on the subject with membership involvement may be a very useful exercise for the ACAAI.  

Warner W. Carr, MD, FACAAI