As long as demand for medical care is greater than the supply of providers and facilities (it always will), rationing is inevitable. One suggestion to combat this, as this is the chief complaint of a single-payer system, is to enforce a policy of transparency. All payers must completely disclose levels of coverage and price, giving consumers the ability to choose. This aligns with the current policy in privatized health care, which exists alongside a single-payer system. In this way, no one is “forced” to accept the inherently long wait times associated with a single-payer system. Cost is the key factor with this suggestion. The VA offers low-cost care. This transparency plan would require all payers to price their policies competitively, otherwise many individuals will go uninsured.
Another approach would be to improve the existing single-payer system, extending coverage to all Americans. The current health care budget would be utilized. Infusing the total budget into one system as opposed to many would likely improve outcomes. Competition would exist among hospitals and providers, as each individual would have the liberty to choose where he or she wants to receive care. Choice appears to be a leading reason that people oppose a nationalized health care system. To address this, a more provider-friendly reimbursement system would be adopted. Emphasizing performance on key metrics, including wait time and patient satisfaction, could motivate providers to provide a higher quality of care and reward them for meeting these metrics. Thus, a more welcoming environment for patients would be created. Also, dollars from businesses could be used elsewhere. Perhaps to provide other benefits to their employees. This option would also call for transparency among hospitals and providers for billing, which would increase competition and incite competitive pricing for services. Finally, this option would offset the risk assumed by the government due to a larger number of members.
The two main complaints about a single-payer system are lack of choice and long wait times. Evidence should be obtained that supports the claims that a single-payer system would increase choice and improve or leave wait times unchanged. Currently, there is no evidence that the VA’s wait times are any longer than non-VA wait times. The average wait time in major metropolitan areas for non-VA hospitals is 20 days (Klein, 2014). In areas like Boston and Los Angeles, wait times are about 60 days on average. Current and trending data on wait times needs to be obtained by both the VA and non-VA hospitals to determine how the single-payer system performs in this regard. Also, a common set of metrics should be developed to accurately compare the performance of the single-payer system to the multi-payer system in the U.S.
Based on the information provided, it can be concluded that the VA Health System is a model for a single-payer health system in the U.S. The VA Health System satisfies each of the criteria in Berwick, et. al’s Triple Aim. The VA Health System offers a high quality of care and improves on it, as evidenced by patient satisfaction surveys and self-reported metrics. The VA, although it is experiencing a shortage on the supply-side, is increasing population health among veterans by expanding access to care and carefully coordinating that care. Finally, the VA offers low to no-cost care to all its members. It meets the Triple Aim to the best of its ability and, therefore, serves as a model of what a single-payer system in the U.S. could be with more support, staff, and funding.
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