Oncologists Make the Case for Single Payer System

When a patient receives the diagnosis of cancer, regardless of stage or severity of the disease, one of the many questions asked is how to pay for the treatment. And while the diagnosis is arguably the single most catastrophic health care event in an individual’s life, the burden of cost on the patient and their family only adds to the stress of the situation.

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Oncologists are in the unenviable position of advising a treatment scheme that the patient can afford, paving the way to consider a single-payer system, writes Ray E. Drasga, MD, and Lawrence H. Einhorn, MD, in the of the Journal of Oncology Practice. Drasga is a community oncologist who founded a free clinic in Crown Point, IN, and Einhorn is a professor of Medicine at Indiana University Hospital in Indianapolis.

Single-payer systems are systems in which a single public or quasi-public agency handles all health care financing. Delivery of care may remain in public or private hands, depending on the particular system.

Drasga and Einhorn make the case for a regional single-payer system similar to Medicare that would provide universal, comprehensive coverage with free choice of providers. “All medical care would be covered, including provider visits, hospital care, prescription drugs, and rehabilitation. Copayments, deductibles, insurance premiums, and out-of-pocket expenses would be eliminated,” they write.

With the Affordable Care Act (ACA) now firmly established and private insurers firmly at its center, the authors foresee the trend of more high-deductible health plans, underinsurance, and greater cost shifting to patients. In addition, Drasga and Einhorn point out that the ACA does not include any cost-control measures, but rather relies on accountable care organizations, a revised version of the health maintenance organization. The authors write, “There’s no evidence ACOs will be any more effective than HMOs were in containing costs.”

Faced with the crisis of uncontrolled costs and inequitable access to care, Drasga and Einhorn call for a “streamlined, efficient, nonprofit system based on human needs to provide high-quality care to every person,” and ask that their fellow oncologists and their society, ASCO, endorse a single-payer system of national health care insurance.