Resolved: The US should implement a single-payer healthcare system

October 26, 2015

Affirmative: Dr. Prajwal Ciryam

Main points:

  • Current system offers inadequate quality of care
  • Single-payer system allows more choice and streamlines process
  • Lower administrative costs

Negative: Max Rowe

Main points:

  • Ideal system would be market based
  • Lack of competition is problem in status quo but not addressed by single-payer system
  • Average wait time in socialized healthcare systems is three times as long as US
  • Lower wages for doctors will disincentivize them and exacerbate shortage

General points of discussion

  • What system keeps costs down and how?
  • Does a single-payer system disincentivize people from becoming doctors?

Initial vote: 10 affirmative, 4 negative, 7 abstain

Final vote: 16 affirmative, 4 negative, 4 abstain

The Northwestern Political Union welcomed Dr. Prajwal Ciryam for a discussion of a topic that lights many political fires but confounds due to its complexity. Dr. Ciryam began with an anecdote about a patient who had gastric cancer but faced insufficient care. He criticized the complexities of navigating the current system and the anticompetitive behavior of large companies; to that end, he suggested that a single-payer system would allow more choice and transparency through government involvement. He added that single-payer systems were associated with lower administrative costs.

Max Rowe agreed with Dr. Ciryam that the current system was anticompetitive but established that his job was not to defend the status quo; rather, it was to show that the single-payer system was not the solution. Mr. Rowe put forward an entirely market-based system as his ideal choice, which he argued would create the necessary competitive behavior. He finished with two criticisms of single-payer systems: that they had longer wait times and lower wages for doctors (which in turn would exacerbate an already existing shortage of doctors).

The first topic brought up was costs. One commenter noted that many of the current costs were structural and expressed doubt over how a single-payer system would reduce them. Mr. Rowe argued that a government-granted monopoly (as he suggested a single-payer system would be) would do little to curb costs. Dr. Ciryam explained that anticompetitive behavior occurred because medical procedures are priced à la carte; the actual bill is the product of negotiations between the provider and the insurance company. This process makes it hard to pinpoint the source of specific costs and thus difficult to compare different insurance plans. By contrast, Dr. Ciryam’s vision of a single-payer system would eliminate such negotiations by placing cost control in the hands of a single entity (the government). While he conceded that a completely free-market system would create the necessary transparency, he suggested that it would drive costs extraordinarily high. Dr. Ciryam added that the gains from switching to a single-payer system would take time.

Other concerns were raised: how would single-payer systems prevent a death spiral (a situation in which rates are raised due to the presence of high-risk people in the risk pool, leading healthier people to drop coverage and thus raise rates even further to cover for the company’s loss of revenue from healthier people) and continue to incentivize people to become doctors and researchers (a question that Mr. Rowe echoed)?

Dr. Ciryam responded that risk-incurring behavior was hard to change, especially for those in socioeconomically disadvantaged locations (as many high-risk people are); it would thus be unfair to charge higher rates to such people. He continued that a form of the death spiral was already occurring when companies refuse to insure older people (who carry higher risk of needing health services), who were funneled into Medicare. He concluded that eliminating the threat of a death spiral would require putting all people into the same risk pool and averaging out their risk.

With regards to incentives for medical careers, Dr. Ciryam first posited that wages would not fall to the point where medicine was no longer seen as a lucrative career; he pointed out that the current shortage in doctors is not due to lack of demand but lack of supply – while many people want to become doctors, medical school provides a formidable barrier. And researchers are already paid little and receive their wages from the government anyway.

Dr. Ciryam also answered questions on empirical examples (he explained that Vermont was not an appropriate example due to its small size and lack of poor people and that Ben Carson’s health plan was faulty) and pointed out that excessive drugs and tests were not always good, as all procedures carry risks.

In his closing statement, Dr. Ciryam noted polls showing support for a single-payer system and that any costs of a single-payer system were already being borne by society; he argued that such a switch would reduce the costs. Mr. Rowe again emphasized the importance of choice and his belief that a socialized healthcare system was contrary to such ideals. Political Union members also took the ability to choose to heart and by a resounding majority passed the resolution.

Dr. Prajwal Ciryam is an alumnus of Northwestern University and the Political Union. He completed his BA in biological sciences and PhD in neuroscience at Northwestern and PhD in chemistry at the University of Cambridge as a Fulbright scholar. He has written on medical ethics and healthcare policy and published scientific research. He is currently completing his MD at Northwestern.