THE CASE FOR SINGLE-PAYER HEALTH INSURANCE

Our private health insurance system is not working. As I outlined in my previous post, there are three core problems with our private health insurance system:

  • By fragmenting the pool of insured people and allowing some to opt out, the basic theory and efficiency of insurance is undermined.
  • Private insurers have no financial incentive to maintain the long-term health of their customers because customers change insurers frequently.
  • Private insurers spend a large portion of their health insurance premiums on overhead, i.e., non-medical expenses (roughly 25%, which adds up to hundreds of billions of dollars each year).

An alternative that would address these major problems with the U.S. health insurance system is a Medicare-for-All, single-payer system. This type of a system is supported by a growing majority of Americans (62%), most Democrats in Congress, many doctors, and a growing number of public figures, such as former President Jimmy Carter [1] and former Vice President Al Gore. [2] Physicians for a National Health Program is one of a number of groups advocating for a single-payer system. An interview with its President, Dr. Carol Paris, on why the group supports single-payer health insurance is here. (She joins the newscast at 17 minutes 25 seconds into this 28-minute segment. The link starts 14.5 minutes into the newscast, when the topic turns to health care.)

A universal, single-payer system provides the most efficient health insurance for multiple reasons. First, it maintains a single, large pool of insurees who have differentiated risks and health care needs. A large, differentiated pool of insurees is what the basic theory and efficiency of insurance is predicated on.

Second, a single-payer insurance system has people as customers for life, thereby providing a strong incentive to invest in preventive care and the long-term health of its customers. A focus on preventive care and wellness produces the best health outcomes and does so at the lowest cost.

Third, switching to a single-payer, Medicare-for-All type health insurance system would save about $500 billion per year by eliminating the administrative overhead of our health insurance corporations. [3] In addition, health care providers would have only one set of forms, procedures, and paperwork to deal with, greatly simplifying the processing of billing the insurer for their services and reducing their costs and frustrations in doing so. [4]

A single-payer system is the only way to both improve quality and control costs, as Don Berwick (a doctor and former head of the Centers for Medicare and Medicaid Services (CMS), the federal agency that oversees those public health insurance programs) has stated. An example he cites to illustrate this point is an action he took when he was the head of CMS. Data was showing that senior care facilities were using drugs to sedate patients whose behavior was challenging at times, rather than taking the time and energy to handle their behavior more appropriately. Given that Medicare and Medicaid pay for much of the care these facilities provide, he had the leverage to tell the facilities’ managers that they should address this problem or that he would develop regulations to deal with it. The result was that the facility managers reduced drug use and costs, and also provided better care to their patients. Berwick could do this because he had leverage as the primary payer (although not quite the only or single payer) for these services. [5]

Bills have been introduced in Congress to create a single-payer, Medicare-for-All health insurance system. Over half of the Democrats in the House, over 100 Representatives, have endorsed H.R. 676, The Expanded and Improved Medicare for All Act, sponsored by Rep. Conyers. Senator Bernie Sanders will introduce a similar bill in the Senate.

I don’t understand why Democrats in Congress haven’t been making more of a push for a single-payer health insurance as an alternative to the Affordable Care Act repeal-and-replace legislation that the Republicans have been promoting. [6] I am disappointed that our mainstream, corporate media haven’t provided more coverage of this as an option, although at some level I’m not surprised as it would make significant changes for the health insurers and drug companies that provide them significant advertising income. [7]

I urge you to contact your US Representative and Senators to ask them to support a single-payer, Medicare-for-All health insurance system. Every other economically advanced country has a universal, single-payer health service system that covers everyone at far lower costs than our current privatized system and produces better health outcomes with longer lifespans. [8]

There has been a concerted effort in the U.S. to discredit other countries’ universal, single-payer health care systems, particularly Canada’s, often with inaccurate information. An excerpt from a recent Congressional hearing where a Canadian doctor very effectively rebuts attacks on the Canadian health care system can be viewed here. (It’s just under 7 minutes.) Or you can watch or listen to a Canadian businessman rebut attacks on the Canadian health care system here (a short, less than 3-minute YouTube video).

I encourage you to engage, however you can, in the movement to make universal, single-payer health insurance a reality in the U.S. We need to pressure our elected officials to adopt this solution to our failing health insurance system. If you need further convincing that this is the way we need to go, please watch or listen to the interview with Dr. Carol Paris referenced above. (She joins the newscast at 17 minutes 25 seconds into this 28-minute segment. The link starts 14.5 minutes into the newscast, when the topic turns to health care.)

[1]    Nichols, J., 7/27/17, “Jimmy Carter calls for single payer,” The Nation (https://www.thenation.com/article/jimmy-carter-calls-for-single-payer/)

[2]      Johnson, J., 7/21/17, “Message to Democrats: Get on board with Medicare for All or go home,” Common Dreams (https://www.commondreams.org/news/2017/07/21/message-democrats-get-board-medicare-all-or-go-home)

[3]      Goodman, A., & Moynihan, D., 6/30/17, “Medicare for All: It’s a matter of life and death,” Common Dreams (https://www.commondreams.org/views/2017/06/30/medicare-all-its-matter-life-and-death)

[4]      Ready, T., 9/20/16, “Donald Berwick calls for ‘moral’ approach to healthcare,” Health Leaders Media (http://www.healthleadersmedia.com/quality/qa-donald-berwick-calls-moral-approach-healthcare) See in particular page 2 of the article.

[5]      Ready, T., 9/20/16, see above. See in particular page 3 of the article.

[6]      Cho, J., 6/30/17, “The cynical opposition of some Democrats to universal health care,” Common Dreams (https://www.commondreams.org/views/2017/06/30/cynical-opposition-some-democrats-universal-health-care)

[7]      Goodman, A., & Moynihan, D., 6/30/17, see above

[8]      Cho, J., 6/30/17, see above

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