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Health care in America: On single-payer systems

Debates about policy approaches to health care continue. With the rise to prominence of Sen. Bernie Sanders as a candidate for president, politicos and citizens alike have rekindled discussions concerning the adoption of a “Medicare-for-all,” single-payer health system. Among the goals of such a system, the most salient is guaranteed health care for everyone.

A 2013-2014 American Community Survey showed New Mexico with an uninsured rate roughly 4 percent above the national level. New Mexico continues to face a critical health insurance problem.

Single-payer health systems, while capable of eliminating the problem of the uninsured, remain controversial for two primary reasons: the resultant expansion of government and the perception of diminished point-of-care service.

Regarding the first, government administration of the health care system would necessitate an expansion of oversight and the conversion of quasi-private markets to those controlled by bureaucrats.

Regarding the second, much of the discussion is informed by political ideology. Yet the actual, real-life experience of receiving health care within a single-payer system provides a nice contrast to such an ideological perspective.

To the ideologue, many stereotypes exist, including notions of long waits and impersonal care. Such stereotypes, however, were never verified in my experience within Scotland’s single-payer National Health Service.

While a graduate student at the University of Edinburgh, I’ve had roughly a half dozen experiences with NHS Scotland.

Most followed a standard procedure. At 8:30 a.m., I would call the local NHS clinic and arrange to be seen during that day’s “open surgery” – a time when patients, without an appointment, met with doctors.

Check-in at 10 a.m. was quick and required only name and date of birth; co-pays didn’t exist. I was always seen within 25 minutes of check-in and met with a doctor each time.

If a prescription was ordered, I would immediately take the script to my local pharmacist, and within 10 minutes, and without charge, it would be filled.

Even in acute or more complex situations, service was equally as efficient and effective. In fact, my first NHS Scotland experience was just that – occurring on a Saturday shortly before a first lunch date with a young Scottish woman.

To my dismay, I awoke that morning with a fever. I contacted the 24-hour NHS telephone operator. After answering several questions, I was patched through to a doctor, and an appointment was scheduled for that afternoon at the Royal Infirmary.

Knowing that I’d be seen that day, I nonetheless met my date and, upon arriving, half-jokingly uttered, “I have the most romantic thing to tell you – I have to go to the hospital at 3 o’clock.” I was in luck, as my date had a car and drove me to the hospital after lunch. Unfortunately, however, not even the prompt and excellent health service was able to ensure a second date.

Similarly, upon returning to Edinburgh from Italy with an ailment necessitating a chest X-ray, I found the process to be very straightforward.

After meeting with the doctor at my local clinic, she handed me a single-page print-out with my medical details and the location of the nearest X-ray clinic. The wait for the X-ray was merely half an hour.

The procedure took only a few moments, and within a couple of days, my local clinic had my “boringly normal” X-ray results. All free of cost and hassle.

Obviously, my point-of-care experiences within NHS Scotland are not predictive of the potential experiences of individuals within a single-payer health system in America. They do, however, serve to challenge the stereotypes we’ve attached to such systems.

Given this, when reflecting on improvements to our health care system, it’s essential to approach such with impartial understanding of single-payer systems, as opposed to one blinded by ideological predispositions.

Bryce Zedalis holds an MBA from the University of New Mexico and is a Ph.D. candidate in Social Policy at the University of Edinburgh.


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