No. It’s exactly the opposite. It’s precisely and literally the other way around.
That fact has frequently been noted by the eminent health care economist Uwe Reinhardt, and has come to be known as Reinhardt’s Law, or sometimes Reinhardt’s irony or paradox. Simply stated, in single payer systems or their functional equivalent, cost control is achieved up front through a negotiated, uniform, and transparent fee schedule, and there is explicitly no meddling at the clinical level between doctor and patient. Whereas with private insurance, every claim is individually adjudicated, so meddling with the doctor’s clinical discretion is inherently baked into the system; the intrusion of insurance bureaucracy into clinical decision-making is pretty much the hallmark of US health care. The irony is that physicians opposed to “government involvement” in health care have pretty much brought this situation on themselves; by insisting on their economic freedom from single-payer regulation of their fees, they have sacrificed their clinical freedom to insurance bureaucrats.
From a paper on physician autonomy [PDF]:
It is Reinhardt’s assertion that the absence in the United States of an overall program of budgetary control over medical expenditures, as is characteristic of the prominent European systems, results in unparalleled micro-management at the clinical level to achieve cost control unattainable on a larger scale. He writes that “…if the bureaucrats cannot somehow impose upon the healers an overall budget constraint ex ante, then they will sooner or later be driven to control their outlays on an ongoing basis, by monitoring each and every transaction for which they pay – that is, by second guessing both the providers’ clinical and pricing decisions” (Reinhardt, 1988). This appropriation of the clinical dimension of autonomy would be regarded as intolerable by physicians in other medical care systems. He suggests that “European and Canadian physicians would be appalled at the numerous intrusions into clinical decisions now routinely made by these external monitors in the United States. They probably would rise up in arms over that loss in clinical autonomy” (Reinhardt, 1988).
It seems problematic that physicians in the United States would willingly and knowingly sacrifice the clinical element of autonomy that Freidson considered to be the more consequential element of his two-part definition of autonomy. Clinical autonomy, after all, constitutes the primacy of the physician in the health care division of labor and is the basis on which arguments for political and economic autonomy are formed. Reinhardt’s answer to this seeming paradox is that physicians in the United States have traded off clinical autonomy “in their tenacious fight to preserve the individual physician’s right to price his or her services as they see fit” (Reinhard~ 1988). This observation has been distilled into a formula referred to as Reinhardt’s “Law” or “Irony.” Reinhardt has summarized his law as follows: “In modern health care systems, the preservation of the healers’ economic freedom appears to come at the price of their clinical freedom” (Reinhardt, 1988). The application of Reinhardt’s Law to the late-20th-century United States scene would appear to indicate a priority on the part of physicians to pursue economic betterment at the expense of clinical autonomy.