The Conservative Case for Single Payer Health Reform

By Dr. Joe Jarvis for Utah Healthcare Initiative Blog

Recently, Charles Krauthammer, conservative Washington Post commentator and Fox News analyst, who is also a physician, spoke to an audience of mostly physicians in San Antonio (find coverage of the speech in the San Antonio press here). Excerpts:

If President Barack Obama’s health care reform act is fully implemented over the next two years, it will evolve into a Canadian-style single-payer system that will forever change the social contract between Americans and their government, a nationally syndicated columnist and physician predicts.

“It will change the country. If it is not repealed, we will be a different country when ‘Obamacare’ is fully implemented,” Krauthammer said in an interview after speaking Thursday to a receptive crowd of mostly physicians and other health care professionals at a breakfast sponsored by the San Antonio Medical Foundation.
The Affordable Care Act, which passed in March 2010 without Republican support, was touted as a way to extend coverage to most uninsured Americans, and to offer it at an affordable price to those who have trouble buying it now, such as the poor, the self-employed, and those with pre-existing medical conditions.

The centerpiece of the plan is a requirement for everyone without health coverage to buy a policy or pay a fine.
Krauthammer predicted that the U.S. Supreme Court, which is set to deliberate the constitutionality of the Affordable Care Act this month, will overturn the that provision of the law.

“The individual mandate (to buy health insurance) is a fairly radical step in the final expansion of the power of the federal government, which would then leave it in a position where it would be very hard to find any constitutional grounds — if you don’t overturn this — for ever denying the federal government the power to do anything it wants,” Krauthammer said.

“We’re spending perhaps $1 out of every $4 on unnecessary treatments, referrals and tests that everyone knows are unnecessary,” he said. “And Obamacare did nothing to reform it.”

In his speech, Krauthammer predicted the complexity of the law eventually would doom it to failure, which would lead to a single-payer system within a decade.
“This is a new reform that when it kicks in within a couple of years will make the practice of medicine a nightmare,” he said. “If it’s not repealed, I guarantee you that within a decade we will have a single-payer system. And if I had to choose between Obamacare and a Canadian or British system, I’d choose the single-payer system. At least it would be rational.”

My comment:

It’s clear from his comments that Dr. Krauthammer wishes that Obama-care would be repealed and that the nation would not go down the pathway towards single payer health system reform. However, he directly states that given a choice between Obama-care and single payer, he would choose single payer, because ‘at least it would be rational’. What does a conservative like Krauthammer see in single payer health system reform that is rational? I feel qualified to answer that question, since I am both a conservative (I received the Republican nomination twice for legislative races in Salt Lake City) and a long time support of single payer health system reform.

First, and foremost from a conservative viewpoint, single payer health system reform is fiscally responsible. Unlike the ‘Affordable’ Care Act, a single payer approach to health system financing is financially sustainable. Nearly all of the unfunded future debt due to entitlements currently stacked up against the federal government is medical debt. The last count for that debt which I have seen is $60 trillion, more than the present day value of all assets owned in the US. Single payer health system reform can reduce the cost of health care by $1 trillion/year, nearly all of which can go to relieving the tax burden. By the time today’s kindergartners are Medicare eligible, a single payer style payment mechanism for American health care would have eliminated the federal deficit.

Second, and integral to cost control, single payer health system reform has the capability to eliminate the poor quality care due to unnecessary treatments. Eliminating the multiple, confusing payment schemes for health services also eliminates the perverse incentives inherent in those schemes. The health insurance business model induces provider behaviors which are contrary to good patient care. In contrast, single payer health financing focuses providers on best practices for patient care. It is, as Krauthammer notes, the most rational method of paying for health care.

Third, single payer health system reform can (and should) be implemented at the state level, preserving the appropriate balance between national and local governing.

I disagree with Dr. Krauthammer. Obama-care does not make single payer health system reform inevitable. If we Americans want a health system that is optimal quality and therefore lowest cost, we will have to do the heavy political lifting necessary to intentionally rid our health system of corporate welfare, clearing the decks for a rational payment mechanism which cherishes patient care above profits. It’s the most conservative way forward for our health care system.


  1. Cheryl Liniman on March 22, 2012 at 5:03 pm

    Quite frankly, President Obama’s health care law does NOT go far enough. The public option should have been included. “Medicare for all” would have been ideal. A SINGLE-PAYER system is the ONLY way health care can work in America, otherwise the insurance and drug companies will rule over who gets health care and who does not. And health insurance for profit does NOT benefit the patients.

  2. Joseph De Miranda on March 22, 2012 at 5:22 pm

    Health Care in America is very expensive, and there are a number of factors contributing for that, for example, when a person without insurance receives care in a hospital, that bill is paid by insurances through inflated prices. But the main reason for it to be so expensive and inaccessible to a large and growing part of the lower income Americans, is the fact that it isn’t considered a common and necessary welfare. This is a wrong outlook, certainly health care is as important as education, police, firefighters and the military are, and it works that they are all given equally to all citizens through our income taxes, and yet, if you are wealth enough, you cans send your children to private school, hire a body guard, and install a good fire system. So as a principle, health care should be available (through income taxes ) for every citizen, anything else goes against the Constitution …”every citizen has the right to pursue happiness”… And I ask, who can pursue happiness in sickness? Who can pursue happiness going broke over medical bills? It is a shame that educated people can’t see the burden and pain his fellow citizens are facing for not being able to afford health care, and do not address this matter responsibly and humanly, resolving it once and for all. They can’t even see that resolving this problem would significantly lower their health insurance costs. (Hospitals overcharging Insurance Companies)

    • Theresa Welsh on March 22, 2012 at 9:29 pm

      I am tired of reading that, as Mr DeMaranda alleges, the bills of uninsured hospital patients are paid by other peoples’ insurance. For your information, when you receive hospital services (inpatient or ER), THEY SEND YOU A BILL! And you are expected to pay it. And they will refer you to a collection agency if you don’t pay it.

      I will certainly agree that many uninsured people are unable to pay their hospital bill, but I am tired of this kind of assumption that every uninsured patient does not pay anythng on their medical bills. Furthermore, uninsured people often simply do not get any care. the idea that uninsured people run up the cost of health care for others is false. What about people with those “Cadillac Plans” who have coverage for everything and receive lots of treatment and services they don’t actually need, but get because of their fabulous insurance coverage? Don’t THEY run up the cost for everyone?

      Please do not pick on the uninsured. Life is tough enough for those, like myself for many years and my daughter right now, who lack health insurance!!!@!

  3. Michael Mooney on March 22, 2012 at 7:38 pm

    True conservatives know that a single payer system is the most cost-conservative system, while also providing a means to reduce the federal deficit over time.

    Take note: Faux conservatives speak against the single payer system. Either they are not able to do the math or they aren’t real conservatives.

  4. Grover Syck on March 22, 2012 at 10:38 pm

    Obama tried to get a strong public option, but the conservatives blocked it. He wanted a single payer system, but the conservatives blocked it.

    The far fight will obstruct everything Obama tries to do. They are only intersted in getting back into power, reguardless of what it may do to the nation.

  5. Stan Nuremburg on March 23, 2012 at 9:35 am

    Dr. Krauthammer says, “We’re spending perhaps $1 out of every $4 on unnecessary treatments, referrals and tests that everyone knows are unnecessary. And Obamacare did nothing to reform it.”

    The Dems tried to, but Dr. K’s buddies the R’s called this effort “death panels” and put the kaibash on it; I call his position “blame the victim.”

  6. Ron Christensen on March 23, 2012 at 11:28 am

    Obama and the Democratic leadership (Harry Reid, Nancy Pelosi, et al) clearly stated when the health care legislation was first being formulated: “Single Payer is off the table!” Obviously they didn’t want to create waves or rock the insurance industry boat.

  7. Sebastian VanVechten on March 23, 2012 at 3:36 pm

    As a hospital-based BSN with more than a decade in healthcare, I have seen countless examples of inefficency of the “market approach” which in practice appears to mean lobbyists writing legislation to protect a profit margin. I am pleased to see bona-fide conservatives making the same economic argument I’ve put forth, and am disappointed in the “Christian” conservatives who seem content to watch hard-working citizens lose a home to medical bills. I usually make a money point first, then talk about my personal(Christian) conviction regarding care for the least of us, which could be almost anyone, except of course all our reps in the Houses. I haven’t heard a word about all the new blood in the House and Senate declining the coverage on grounds of personal conviction, either. They just ask for disaster relief, unaware that they voted it away.

  8. sean on March 23, 2012 at 6:05 pm

    Something I never hear discussed: if a corporation or individual writes off health insurance premiums on their taxes, doesn’t that mean the federal government is paying for virtually all health insurance? So we really have a single payer finance system for healthcare, it is just very indirect, disorganized, and inefficient. I don’t care if the single payer system includes insurance companies, but those insurance companies need to provide coverage from cradle to grave — they cannot take profits and when someone becomes 65 let the federal government assume healthcare risk directly.

  9. Asher Cohen on March 27, 2012 at 10:48 am

    Obama did not advocate for a single payer system. He barely advocated for a public option. The reason being, in my perception, that the health insurance industry owns him. Otherwise we would have a debate on whether a single payer system is the right approach an make a determination based on rationality.

  10. Carolyn Heinz on April 5, 2012 at 9:56 am

    “by the time today’s kindergartners are Medicare eligible, a single payer style payment mechanism for American health care would have eliminated the federal deficit”. Does Dr. Jarvis not mean the federal debt??? If our medical costs were the same as the other counties with a single payer program we could eliminate the deficit THIS year and federal, state and local debt (unfunded mandates for health care) in the years to come.

  11. Mike on January 4, 2014 at 3:43 am

    A single payer system would never have passed because the health insurance and pharmaceutical lobbies would never have allowed it.

  12. Mike on January 4, 2014 at 3:49 am

    All members of congress should give up their government funded health care and shop for coverage in the market place. Maybe then they would have some perspective on health insurance industry abuses.