Topics: Obamacare

Veterans Affairs scandal is a look at future of Obamacare

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If Obamacare isn't repealed, we know what the future of health care will look like, thanks to the Veterans Affairs scandal.

It will mean long delays to see a doctor, ridiculous hurdles to obtain basic tests, demoralized doctors and hospital waiting lists. These are all inevitable byproducts of a single-payer system.

Obamacare didn't adopt a single-payer system. It instead relied on private insurance, burdening insurers with massive new regulatory demands that have made insurance much more expensive.

Understandably, young, healthy people are fleeing the mandate, opting to pay the tax instead. This has initiated a "death spiral" of ever-sicker insureds and ever-increasing premiums.

Combined with massive mismanagement of a simple website, Obamacare — and with it, private insurance — is headed for disaster. As this train wreck unfolds, the Left predictably will increase their cries for a single-payer system.

Many well-meaning people may begin to believe single-payer is the only way out of the Obamacare mess. But what would U.S. single payer look like? Answer: the VA, which is a classic single-payer system.

With VA, the government is the provider, insurer, administrator and payer all rolled into one. Its doctors aren't independent; they're salaried employees.

There's no independent private insurer scrutinizing the quality of care or selecting only the best doctors and hospitals for its network. There's no independent administration; administrators are "the boss" of the medical staff, empowering them to second-guess medical judgment.

Single-payer obliterates these independent functions, merging them into a single, monolithic entity like the VA.

This isn't to say that single-payer systems don't achieve some efficiency by combining these roles. But, as the VA debacle shows, these efficiencies come at a high cost, in terms of lost provider independence and productivity, lower incentives to quality, and growth of a powerful, unaccountable bureaucratic administration.

Single-payer systems can nonetheless achieve cost savings if the citizenry is willing to accept explicit forms of rationing.

In single-payer systems such as those found in Canada and the United Kingdom, for example, citizens accept explicit waiting times, coverage limits, age cut-offs, and even blanket denials for expensive procedures.

The UK's National Health Service, for example, won't cover In-Vitro Fertilization for any woman over age 42. In Canada, about half of Manitobans have to wait over 16 weeks for simple cataract surgery and over 70 days for life-saving, diagnostic MRIs.

And Canadians needing knee or hip replacement face frustratingly, notoriously long waits. Canadians and Brits trapped in single-payer queues can escape only with a lot of money or medical tourism.

Would Americans accept these single-payer consequences? Unlikely. Americans are spoiled with a variety of choices and nearly instantaneous access to high quality care.

Even Medicaid patients generally have a choice of insurers from which to choose and have access to MRIs, joint replacement and other urgent care that's indistinguishable from those with private insurance.

Uninsured individuals get state-of-the-art emergency care, too, thanks to a Reagan-era law called EMTALA.

Indeed, Americans' aversion to explicit rationing is so strong that, in creating the Independent Payment Advisory Board -- the so-called Obamacare "death panel" charged with slashing Medicare spending -- Congress commanded that it "shall not ... ration health care."

Yet in the same breath, the law declares that IPAB cannot "raise revenues or Medicare beneficiary premiums ... increase Medicare beneficiary cost-sharing ... or otherwise restrict benefits or modify eligibility criteria."

In other words, IPAB cannot explicitly ration care by restricting benefits or raising cost-sharing. But IPAB can—and indeed must—reduce Medicare spending by deeply cutting doctor and hospital payments.

As reimbursements to providers decline, fewer providers will be willing to see Medicare patients. The result is drastically increased waiting times for care.

And as VA administrators know, increasing waiting times is a potent, albeit clandestine, way to ration. This sort of covert rationing — VA-style — is even more pernicious because it's adopted by bureaucrats, never publicized, unevenly imposed, and patients aren't even aware that something's amiss until it's too late.

Unless or until Americans are willing to accept explicit rationing such as that of Canada or the UK, single-payer health care in the U.S. would be akin to adopting "VA health care for all." And we know how well that works.

Elizabeth Price Foley is a professor of health care and constitutional law at Florida International University. She is the author of "The Law of Life & Death," (Harvard 2011).
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