The Doctor Is In

Q:How would single-payer healthcare work in the Palisades?

First off, this seemingly very simple question has no simple answer. Almost everyone in town, including myself, believes that all of us in Pacific Palisades should have health insurance and be able to get basic medical care for a reasonable cost.

But how we, as a society, implement this is the tricky part. Universal coverage is the term for everyone having access to care … how that is paid for is an entirely different issue.

When I see an older, retired resident in my office with high blood pressure, arthritis and diabetes, she will often complain to me that she cannot afford all of her medications. She cannot walk as well as she used to, but is holding off on knee replacement surgery because she is scared about going to a nursing home after the procedure. She needs more help around the house, but often has to choose between getting a caregiver and taking all of her medications.

Just last week, I also saw several younger working residents of our town who struggled to pay their bills because they thought their employer-sponsored plan covered all their health costs and were astonished that they still had high copays and deductibles that were not covered by their plan.

This is happening in our upscale community? Yes, in fact, it is. I see this, and similar scenarios, every day. There are many holes in our current system that affect our local Palisadians. But the solution is far from clear.

Single-payer healthcare is a healthcare system financed by taxes that covers the costs of essential healthcare for all residents with these costs covered by a single public system. In other words, we pay higher taxes and the government pays all of the providers and hospitals the same amount to take care of everyone. This system would have one set of rules for services offered, reimbursement rates, drug prices and minimum standards for required services.

On one hand, this could lower drug prices and help many in town on fixed incomes. On the other hand, not everyone in the Palisades would be pleased with the limits that could be placed on them for how fast that they could get access to care.

With a pure, single-payer system, there would have to be limits set on when a resident can see the doctor, and what tests and medicines can be used to treat a certain condition. There would be no paying extra to get ahead of the line.

Many Palisadians in my practice want to be seen right away, have immediate access to the doctor for any problem and want to get their MRI at the first sign of joint pain. This would be difficult to do under a single-payer plan.

In addition, most doctors in town that I have spoken to feel that they didn’t go to all that school and into major debt just to come out and be told what to do by the government.

Of course, there could be variations on the single-payer model, but then it really isn’t single-payer at all. The Palisades community is extremely varied in its demographic, and just like our country in general, all would have to give up a little for the greater good for this concept to work.

Most of us want universal coverage, and this is indeed improving. We have to look long and hard about how we pay for this and what we are willing to settle for. Our collective health as a community and a society is at stake.