By Howard Bauchner, MD
Under the Affordable Care Act, the number of individuals in the United States with insurance has increased by 20 million, yet its effect on cost and value remain unclear. Health care costs are again rising faster than the rate of inflation and the transition from volume to value has not yet occurred. In 2 Viewpoints published today in JAMA, Victor Fuchs, PhD, MA, of Stanford University and David Naylor MD, DPhil, of the University of Toronto discuss whether a single-payer system is the next appropriate policy response for the United States, and what such a system would accomplish.
Dr Fuchs suggests that a single-payer system would likely reduce administrative and drug costs but acknowledges its effect on patient outcomes is less certain. Dr Naylor discusses the fascination of many US experts with the Canadian single-payer system but argues it is unlikely to be successful in the United States, having been introduced at a far simpler time in a country with a very different culture. Instead, he points to systems that are more likely to be acceptable and effective in the United States and notes there is likely still much the country can learn from both the Canadian system and systems in Europe that do much better at controlling health care costs without sacrificing improvements in patient outcomes.
Whether more meaningful change is possible for the US health care system is unclear. The late, great Uwe Reinhardt, PhD, a health policy expert and JAMA editorial board member, was an adherent to shock doctrine theory: the premise that real change is possible only in moments of crisis. He said he regretted that the 2008 recession was not nearly bad enough. Had it been much worse, he imagined, more meaningful and lasting health reform would have been possible.
Read the Viewpoints here: