As the global economic crisis deepens, our broken health care system continues to neglect an increasing number of uninsured Americans, which will top 50 million this year. Tens of millions more who have health insurance still cannot afford the care they need. The resulting illness from inadequate health coverage will lead to missed days of work and lost jobs, making it harder for us to recover from the recession.
Two weeks ago, the House passed President Obama's economic stimulus plan, which includes $127 billion in federal funding to expand Medicaid and subsidize health insurance for the unemployed. Most of this has been retained in the Senate version of the bill as well.
These measures are a prelude to Obama's proposal for comprehensive health care reform, which will likely boil down to increased regulation of the private insurance industry and subsidies for the poor and middle-class to purchase coverage. Some Democrats will fight to include a competing public plan. However, a weak public plan in our current system could easily become a dumping ground for patients with costly and unprofitable illness who are already shunned by private insurers.
There is a better solution that will expand health care access to all Americans and also help our struggling economy: eliminate private health insurance and create a single-payer system that automatically covers everyone under one national health insurance plan. A single-payer system would be funded by progressive income taxation, rather than unaffordable premiums or employer contributions that distort labor markets and leave workers tied to undesirable jobs. It would also address the fundamental problem of costs.
Private health insurers drive up health care spending with unnecessary overhead - high executive salaries, decreased cost-efficiency from smaller insured groups, and profit. They also increase administrative costs for hospitals and physicians who must deal with hundreds of different insurance plans. As a result, Americans spend 31 cents of every health care dollar on administrative costs, by far the highest rate in the world and much higher than the 17 cents spent in Canada.
Further driving up costs is the unrestricted use of expensive and unproven technology and medications. Such waste is best controlled with a centralized system of payment, as has been done successfully by the Veterans Health Administration. A single-payer system would eliminate enough excess spending to provide every American with the same high-quality coverage, without spending more money than we already do.
China recently announced plans to spend $123 billion to provide universal health care for its 1.3 billion citizens. Two decades after free-market reforms dismantled their system of non-profit rural-based care, drugs and visits with physicians are now unaffordable for most of the poor, who often incur crippling debts to pay for care. Chinese economists argue that providing government funding for universal coverage is important for productivity. Also, not having to worry about catastrophic health care costs encourages people to consume rather than save, providing a direct boost to the economy. These same arguments apply to the United States, where half of all personal bankruptcies and home foreclosures are caused by medical bills.
Many politicians agree that a single-payer system is the best way to eliminate wasteful spending and provide health care to every American, but argue that we cannot win a battle with the narrow interests that defend our broken system. To quote President Obama during his inauguration speech: "Stale political arguments that have consumed us for so long no longer apply." The economic recession and hundreds of billions of dollars in corporate bailouts and stimulus spending have changed everything. It is finally time for us to move to a single-payer system.
James Floyd, M.D., is an internist and health researcher with Public
Citizen.
Each of us needs to work in his or her own way.
As a family practitioner I have decided that my way is to advocate for change as a central aspect of primary care:
I register my patients to vote.
Any patient whose circumstances evoke a defect in our health care system which could be remedied by a single payer system gets sent an email with essentially the following text:
" As I told you at the time of our visit, in addition to my usual "doctoring" I have been working to transform the health care system through creation of a single-payer "Medicare for All".
I support this concept in many ways. One way is that I recently held a health care discussion with patients about this in our office. I have posted on YouTube a ten minute video which captures the essence of the important thoughts offered by the people who attended the meeting. It can be seen at at http://www.youtube.com/watch?v=_WukOIsG5dA I have also blogged about this issue as it relates to my patients at http://www.dailykos.com/user/doctoraaron/diary.
Help me create change. Contact our Congresswoman and Senators. We can make it happen!"
In America we socialize failure all the time, most recently with the ongoing bailout of the financial industry which is forcing all of us to contribute to the greedy and bad decisions of the very few. This type of socialism also happens with superfund sites all across our land. Rich and greedy corporations break laws, pollute our environment and put us all at risk and when it comes time to clean up the mess they made it falls upon the taxpayer instead of the few who took advantage of our combined goodwill.
Why wouldn't we want to share the burden of healthcare which would benefit all of us when we share the burden of failure which benefits the very few at the expense of the rest of us?
In the current system, who is the customer? Not the patient, he is paying only a part of the bill, and is in no position to negotiate. Companies foot much of it and they negotiate coverage with the insurers they offer their employees. This system pushes care the wrong way.
Pharma companies spend much more on advertising directly to patients than they spend on research. Can we re-instate the ban on direct marketing of drugs? That should reduce the cost of drugs immediately while maintaining research funding.
Why does the US pay much higher prices for drugs and advanced medical care? Are we really the only nation conducting research is these areas, and it is up to us to fund it all? I hope not, on both counts, but then why do we pay more?
This requires more than a buzz-phrase like "single-payer." What does that mean? How will it work? Who pays for what through the entire system, from pure research to hospice care?
To better explain single-payer, it means public financing (one payer, the government) to pay for all care, but private delivery of care, as currently exists. Public financing would occur through progressive income taxation and payroll taxes (like we have for Medicare and Social Security). Doctors, nurses, and hospitals would continue to operate autonomously, separate from the government. A single-payer system would cover all necessary care, including drugs, long-term care (nursing homes), and hospice, because these services are crucial to a well-functioning health care system.
It would not necessarily affect the way research if funded, which is through a mix of public (NIH) and private institutions (foundations, pharmaceutical companies).
Agreed. The proper link, so it seems to me, is between the citizen and medical necessity.
"To better explain single-payer, it means public financing (one payer, the government)"
Or: one payer... all of us _for_ each of us.
"A single-payer system would cover all necessary care..."
Hopefully you would also have dental included with that, though I rarely see it included in the discussion... and the way that has been treated in this country, particularly for eligible Medicaid recipients, is a scandal.
Think Medicare. It does not tell doctors how to practice medicine. Now think eliminating the required 65 year old age limit and allowing everyone to buy into that system at an affordable fee. Medicare administration costs are 3 - 4% as compared to the 31% costs of the private system. A huge savings right there. Go to the websites linked in the article and read about it.
There is not a single major insurance company that has 31% admin cost. Carriers make 6% margin on their premium. Check Yahoo finance for Anthem, United Health or any others.
Medicare does not have 3-4% admin, that is what they pay just for the intermediaries. You are exclusing the cost of CMS, congress, and a dozen other governmental entities that run the program.
Medicare does tell doctors how to pratice medicine, in fact most private insurers base their coverages on medicare guidelines.
You buthered every statment you made.
You might have to wait for elective or non-emergency surgery. That is called triage. But if you need treatment and urgently you do not wait. I have had pesonnal experince with this in Australia. I had pnumonia and when I arrived at the emergency room it was empty of people waiting, I was seen within 10 minutes. I was then triaged to a cubicle for observation and the beginning of treatment. Once it was determined that I could take care of myself I was assigned to a room. This took all of 6 hours but at least I was not sitting in a chair in a waiting room crowded with uninsured sick people and getting sicker.
Your arguments reflect the same flawed arguments that all those who support single payer health care make. That of the fact that those of us who are elderly, disabled or chronically ill will be reduced to cost analysis statistics. You talk about "driving up costs is the unrestricted use of expensive and unproven technology and medications." and, yet, it is those "unrestricted and (yet) unproven technology and medications" (stem cell research, umbilical cord blood banking, etc) that may save many of our lives, unless, as you desire, these medications and technologies are simply dropped from the research and development side of the Health Care debate because they do not currently fit within your model.
The problem is, we need to reframe the argument. Stop discussing Health Cost and calling it health care. You get what you pay for, and frankly, I as a disabled, terminally ill patient know that we need to pay for the fast advancement of potentially beneficial medical procedures, if there is going to be any reason at all to consider health. Otherwise, we might as well just euthanize those of us elderly or disabled, who will not benefit by the restructuring of costs, because we will be left behind by those who do not see us as valuable as the 30 year old ex-football player with the MBA.
From what I have read about Conyers HR 676 bill [which is a single-payer plan], no one would be denied coverage, and I cannot imagine that the deeply ingrained mindset to cut costs by cutting services would carryover into that system from the current medical insurance system.
You call my arguments flawed but do not explain which ones you are referring to or how. My data on administrative spending comes from the most comprehensive study on administrative spending in the U.S. and Canada, which shows a near doubling of costs. This is consistent with the very large and disproportionate amount we spend on health care administration, rather than real care, and accounts for the dramatic cost savings that would be achieved with single-payer. This is money that would go towards treating the millions of Americans who currently do not have access to health care providers or the treatments they need.