Single Payer Hurts the Poor

There is a very sad column in today’s SF Chronicle that details the trials and travails of a terminally ill woman who became homeless because she couldn’t work and was denied SSI benefits. I have no doubt the physician who wrote the piece meant for us to conclude we need to increase benefits for the poor and make them easier to obtain. From “Recession Makes Dying Too Expensive for the Poor” (behind pay-wall until Monday AM):

Rita’s problem, the clinic’s social worker explained, is that, like most young people who are ill, Rita is dying too young to have paid significantly into Social Security. This meant Rita would receive “Supplemental Security Income” (SSI), $830 a month, and California’s Medi-Cal insurance. Initially, Rita thought she could stretch these funds...But the politics of budget cuts stifled her plans.

More than 65 percent of SSI claims were denied last year, a record. A series of interviewers from the Social Security Administration interrogated Rita, and one without any medical training misinterpreted her medical chart. Despite the fact that Rita had “pulmonary arterial hypertension” — severely increased pressure in her lungs — he wrote that Rita suffered from run-of-the-mill high blood pressure. Rita was denied. The clinic’s social workers tried to intervene. They were told that Rita would have to wait for an “appeals hearing” after 90 days — possibly longer than she had left to live. She would be without income for her last months of life.

Yet, we are often told, “Government is the solution!” And yes, SSI has to be a government program. But healthcare doesn’t. Indeed, as anyone who has ever appealed a Veteran’s Administration adverse ruling knows, government can be very cold, callous, and slooooowwww.

Indeed, the moral of the story I saw in Rita’s tale is the potential cruelty of single payer healthcare:

Due to new state budget cuts, Rita’s Medi-Cal coverage was limited to six medications. Her doctors had to decide which pills they could take away without suffocating her immediately — a deadly guessing game because there is not enough research to guide doctors in forecasting a regimen. When clinic workers discussed the dilemma, Rita joked: “I should have been a banker instead of an ordinary taxpayer. Then I could have been bailed out.”

Were Rita covered by private insurance, even if paid by the state, the company couldn’t change the goalposts in that way, and if it tried, there would be some potential remedies. But as I wrote in more detail in the Weekly Standard, only government can cruelly and unilaterally cut health benefits when time gets tough—but unlike a private company cutting corners, there’s nothing anyone can do about it.  That is one reason why I changed my mind on single payer health care.  It both opens the door to rationing and often hurts the very people it is supposed to help through budget cutting.

By the way, despite her being homeless because Rita still had help at the end:

Finally, her doctors persuaded her to check in to the hospital. In the hospital, Rita was stoic. Her face had assumed the tough sheen of ceramic. When a social worker asked her whether she would be willing to modify her plans, let the clinic find her a hospice bed, Rita said she had written it all down. Because of her shortness of breath, she couldn’t discuss her thoughts aloud. And besides, going over her problems would only make her cry. And crying made it difficult to breathe.

The article doesn’t state whether she went into hospice. I hope so.  But clearly, Rita was not abandoned by those who cared for her, even if she was let down by “the system.”