Wednesday, May 4, 2016

qotd: James Burdick: “Talking About Single Payer”

Near Horizons Publishing
May 5, 2016
Talking About Single Payer
By Dr. James F. Burdick

From the Introduction

Fifteen years ago, when the Clinton health reform plan failed, I began to feel that something was missing, something so fundamental that it seemed hard to understand why almost no one mentioned it: The doctors were missing from the design.

This book corrects that error. It describes a powerful role for doctors in the novel national structure that I propose to allow us to move beyond the incomplete successes of the Patient Protection and Affordable Care Act (ACA). Opinions from a variety of authorities are quoted to provide rich independent sources of understanding about the complex realities and difficult choices we face. Much of this is relevant to any systematic improvement in the U.S. health care system, but out of it emerges in particular a compelling argument in favor of a national single payer system giving access to care for everyone.

These convictions issue in part from my career as an active clinician and health care administrator. I have seen problems from the inside which has given me a clear vision of the power that only doctors can bring to saving our health care system.

One of the most important reasons that single-payer health plans have failed to take hold in American politics is the fear that government-sponsored health care will put decisions in the hands of government bureaucrats, leading to rationing, red-tape, and cost overruns. My plan removes these obstacles by putting decision-making powers in the hands of trusted medical professionals, backed by empirical research and a robust electronic medical records system. Doctors can unite behind my plan to help ensure passage of a single-payer plan that will provide quality, affordable health care to all Americans. Most single payer health plan proposals include some sort of decision-making board. The difference, in the case of the Health Security Board in my proposal, is its private character.

Health care and its delivery involve a complex of issues and all must be considered for such a major restructuring. Costs, issues regarding doctors and hospitals, drugs, devices, diagnostic tests, electronic medical records, professional involvement and the general social challenges in our country are all part of the single payer system talked about in this book. The final structure proposed in the last chapter is my vision for how best to serve patients through a synthesis of all of these topics.

The ideas here are not just my opinions - far from it. I have gathered disparate views from knowledgeable individuals through a series of interviews and researched the literature extensively to underscore a variety of important perspectives.

James F. Burdick is a Professor of Surgery at the Johns Hopkins School of Medicine, Past President of UNOS, the Organ Procurement and Transplant Network contractor, and prior Director of the Division of Transplantation in the Healthcare Systems Bureau of the Health Resources Services Administration.

The Table of Contents and the first 20 pages can be previewed at the following link:


Comment by Don McCanne

Oh no, not another book on single payer! No, this is not "just another" single payer book. It is complementary to books that have already been published on the topic.

Professor Burdick not only is very well informed on health policy in general and single payer more specifically, he also is dedicated to the cause of health care justice which certainly helps him to sort out good and bad policy. His extensive background as a transplant surgeon and as a health care administrator also provides him with the adroitness to apply effective health policy principles to our health care system. For this book he also interviewed numerous well qualified individuals who provide a broad spectrum of views that are helpful in understanding single payer - even learning the "how not to" from the few expressing negative views.

Burdick does present some new ideas - maybe not entirely new but placing a new emphasis on them. Most significantly, he proposes a Health Security Board composed of qualified professionals rather than government bureaucrats. This board would have a much greater role than the Patient-Centered Outcomes Research Institute (PCORI) established by the Affordable Care Act or the United Kingdom's National Institute for Health and Care Excellence (NICE). Such concepts along with others should be considered when moving forward in developing the definitive design of a single payer national health program.

Burdick does have some relatively minor differences with some of the opinions expressed on the website of Physicians for a National Health Program, though none of them are compelling enough to motivate fundamental change in the standard single payer model of reform. In fact, tomorrow an updated version of the Physicians' Proposal will be released, reflecting six years under the Affordable Care Act. It is still the golden standard of single payer.

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