Single-payer system is the way to go

Ray Bellamy
Tallahassee Democrat
My View
November 14, 2008

Millions of families are struggling with economic hardship. Health-care costs are weighing on more Americans, contributing to about a million bankruptcies a year, and are a major factor in many home foreclosures.

Distressed companies are struggling with the rising costs of providing health coverage for their employees, and there is evidence of poorer health outcomes for the uninsured. More deaths occur from lack of insurance than because of auto accidents, leading to more deaths from cancer and chronic diseases and worse outcomes from emergency care.

One in three families is now distressed by medical costs. Yet health-care costs continue to rise faster than inflation and squeeze both families and businesses.

We pay an estimated $50 billion for health care for the uninsured and an additional estimated $180 billion in lost productivity due to employee health problems. Yet with more than $10 trillion in national debt, but assets rated at only $1.5 trillion, how can we afford to reform this dysfunctional system?

Let me show how we must undertake this task.

For-profit insurance companies must go. Their mission is to make money, and they do this best by enrolling only people who are healthy and unlikely to need care. Then, when medical expenditures are called for, the health insurers benefit by denying tests or treatments. Enormous profits for their 1,500 companies and investors are possible in this way, but at highly expensive administrative effort and waste.

Since 1970, the number of administrative personnel in the health-care industry has increased 2,500 percent, while the number of physicians has only doubled. Some health-care CEOs have reaped salary and benefits of more than $1 billion a year. Profit and overhead in the U.S. health-care industry is now 31 percent, compared with less than half of that in most other industrialized countries.

Eliminating the insurance companies and replacing them with a single-payer system such as HR 676 proposes would save our country an estimated $350 billion a year, enough to provide comprehensive health care for all of us, including dental coverage, long-term care, full pharmacy and mental-health benefits — all with no co-pays or deductibles and at no additional cost to our country beyond what we now spend on health care.

The so-called mandate plans, of which the Barack Obama campaign proposal is representative, have been tried in a number of states and have never been sustainable or successful at covering the uninsured or controlling costs.

All were plagued by soaring cost increases and failed in just a few years.

Insurance works best when the largest possible number of individuals is covered in the same risk pool, so that the healthy individuals share in the cost of paying for treatment of the sick.

Any dividing up of the risk pool by for-profit insurance companies leaves those in sicker risk pools with rising costs, whether those pools are Medicaid or other insurers.

Currently, individuals tend to switch insurance plans an average of every two years, and continuity with one’s physicians gets disrupted. So there are no incentives for the insurer to practice preventive medicine, which, because of cost reduction, tends to pay off in the long run.

HR 676 is not socialized medicine, and it is not government-run medicine. Care would be provided by private physicians, and hospitals would continue to be private. Guidance for the single-payer plan would be through health planning boards on a regional basis, appointed by state legislators and advised by medical experts. Huge savings would be realized by having only one not-for-profit insurer for everyone.

Benefits beyond the financial would be realized by having a readily accessed database on what kind of health care works and levels of utilization on a national basis. Pilot programs like HR 676 have been hugely successful. A fine example is the national health insurance in Taiwan, with an overhead of less than 2 percent, functioning well since 1995 and covering 99 percent of the Taiwanese at less than half the per-capita health-care costs of the U.S. system. Medical bankruptcy is unheard of in those countries with national health insurance.

Our organization, Physicians for a National Health Program (www.PNHP.org) represents more than 15,000 physicians and many nonphysicians who are advocating for passage of HR 676.

Several additional members of Congress were elected on Nov. 4 who advocate for this position, including one U.S. senator, Tom Udall of New Mexico. Surveys indicate about two-thirds of the public wants some form of national health insurance, and 59 percent of physicians favor this also, as well as more than half of our surveyed members of the Capital Medical Society who responded. Since it is the only comprehensive program that is affordable, can we get on about the business of passing HR 676 and let go of the idea that a private market of for-profit health insurers, with their exorbitant profits and administrative expenses, is in some way compatible with our interest?