In the current debate on health care reform in Washington, the chance of a single payer system emerging seems to be very small. I think that's fine. Three years ago, I made this point, citing a portion of the book Redefining Health Care, by Michael Porter and Elizabeth Teisberg.
Now, Clayton Christensen and his co-authors reinforce this view in The Innovator's Prescription. They note (on pages 400-401) that "almost every government with nationalized health care has been forced to ration access to advanced care in one way or another. . . . As a result, most countries with national health systems have had to develop alternative market-based channels for coverage as well -- so people can choose for themselves whether to pay for certain services, rather than leaving that choice to bureaucrats."
They further note, "Because of governments' tight control on caregivers' salaries, in many nations the best physicians establish themselves in private practice, where they can earn higher incomes by serving the wealthy. This is another paradox of national health system: while the intent is to assure universal access, often it is the elite who see the elite, while the rest see the rest.... We ... urge America's political leaders not to view further government control as a vehicle for solving our problems."
I have made similar comments based on my trips abroad, in Iceland, the UK, and elsewhere. When we look at the complexities and flaws of the US system, it is easy to think the grass is greener elsewhere, but it really is not in many respects. But, where we can certainly learn from those countries is the importance of putting greater emphasis on primary care. Interestingly, Medicare could do that tomorrow by changing reimbursement rates for primary care evaluation, diagnosis, and disease management types of services. But, as Brian Klepper noted some time ago, this is viewed as a zero-sum game by the specialists, and so those proposals do not make progress. (Thanks to Charlie Baker for linking to Brian's post over a year ago.)