Where execs, clinicians, payers, purchasers stand on single-payer

The idea of a national, single-payer healthcare system is as divisive as ever to people within the industry, according to a new survey from cloud-based researcher company Reaction Data. Surprisingly, some leaders among payers and health plans are in favor of such a change, even though single-pay may cause their companies to disappear.

The survey collected responses from 198 executives among providers (63 percent of respondents), payers (13 percent) and benefit managers at employers (24 percent). Thirty percent of the respondents hold the title of CEO, 16 percent are chief medical officers (CMO) and shares of 15 percent each among benefits managers and CFOs.

Overall, none of the three broad categories had a majority saying they “strongly agree” on supporting a single-payer system:

  • Providers: 41 percent strongly disagree vs. 38 percent strongly agree.
  • Payers: 46 percent strongly disagree vs. 31 percent strongly agree.
  • Employers: 44 percent strongly disagree vs. 20 percent strongly agree.

Among providers, the survey saw an “extreme” inverted bell curve between clinicians and non-clinicians. On scale of 1 to 7, with 1 being “strongly disagree” with single-payer and 7 being “strongly agree,” 48 percent of non-clinician respondents choose either a 1 or a 2, indicting they’re opposed to such as system. On the other end of the curve, 49 percent of clinicians choose either a 6 or a 7, showing stronger support for single-payer.

For both sides, there were a sizeable number of responses going against their peers. 27 percent of clinicians were on the strongly disagree side, while 33 percent of non-clinicians were more in favor of single-payer.

“The non-value adding loading of utilization management has made our nation’s health delivery system the most expensive in the world,” said one CEO. One COO against single-payer argued it would increase costs, saying, “It guarantees inefficiency, ine­ffectiveness, loss of personal choice and inhibition of innovation at every level.”

Support for single-payer was smaller among payers, though the survey authors said they “appreciate the honesty in light of what would be an insurmountable competitive force (government takeover) to the organizations they represent.” For benefits managers, support was the weakest, which the authors guessed could be attributed to single-payer making their jobs unnecessary. The sample of responses from benefits leaders included several who argued regulators are already too involved in healthcare.

“Government intervention is the cancer,” said one benefits manager. “Treatment should be a true free market of direct primary care and individuals buying individual health insurance policies to insure their health risks. Prohibiting (pre-existing condition) exclusions ensures losses and the eventual collapse of the current system providing the excuse to fully implement a single-payer. Doctors and charities would still treat the sick and poor.”

When respondents were asked to rank coverage options and delivery models on a 1 to 5 scale, however, most didn’t argue for such a deregulated system. Providers, payers and benefits managers all said some sort of universal healthcare mechanism which guarantees coverage but preserves both private and public options would be the most efficient and sustainable option. When asked about the most effective delivery models, respondents were most favorable to a mix of private and state-run provider organizations, followed closely by a federal/private mix.

While most respondents want continued involvement of private companies in the delivery of care, some favored more “radical restructuring.”

“Medicine is a business-for-profit at present and too many people are making too much money for this model to continue. People will not willingly give up their ability to earn large rewards,” said one vice president of medical affairs.