Dear Editor,

Dr. James Mitchiner wrote in ACEP News (August 2012) that he was committed to single payer Medicare model. I reject his proposal as impractical and bound to fail.

The new federal health care plan called the Affordable Care Act, admits it will leave 25 million uninsured, shift 700-plus billion from Medicare, but claims it will reduce costs and promote efficiencies? The cost of care for the uninsured is reported by Kaiser and Blue Cross research as less than 100 billion in a system that spends 2 trillion, but we should revamp a $2.3 trillion health care system to single payer?

Government mandates and politics have removed or suppressed free market health care, with the price and payment accountability and sensitivities, and created mandates and restrictions on competition. Third-party payment has reduced responsible consumer and provider conduct, creating excess mandated benefits and preventing market sensitive programs like Health Savings Accounts from working like they do in a very successful health care system in Singapore. State and federal government mandates in private insurance and Medicare and Medicaid have distorted the free market and caused increased nonsensical utilization and cost shifting. Could more Medicare and Medicaid solve a problem caused by Medicare and Medicaid? PPACA (Obamacare), or expanded Medicare, doubles down on a failed idea. Government mandates, lack of competition, and the perception of free care with no price or cost sensitivity destroy market forces that work.

More government and the increased perception of free care is not the answer. The promise of the latest reforms du jour, such as Accountable Care Organizations and Patient-Centered Medical Homes, just repeats the old failed and discredited programs of financial incentives and penalties that were part of managed care/HMOs.

Dr. Mitchner ignores the reality of Medicare and Medicaid failures and runaway costs. Obamacare does not solve the problems. Dr. Mitchner suggests that Obamacare is the choice of Americans, but visions of utopians fail because of the “Fatal Conceit,” described by Hayek and Sowell: overconfidence of well-meaning elites.

Dr. John Dale Dunn is board certified in emergency medicine and teaches emergency medicine at the Carl R. Darnall Army Medical Center, Fort Hood, Tex.