Tuesday, September 4, 2007

Single-Payer Health Coverage: Scary Boogey Man or Super Process-Improvement Force in Health Care Reform?

Health care is an essential safeguard of human life and dignity and there is an obligation for society to ensure that every person be able to realize this right. Joseph Cardinal Bernardin, Chicago Archdiocese

So what have you heard about Single-Payer?

A single-payer, national health insurance program equates to socialist, government-controlled, ineffective health care. And Michael Moore's SiCKO exaggerated the negative outcomes of Americans who may, or may not, have health insurance coverage. Finally, it may sound good, but we can't afford it.

But I disagree...

My understanding is that the United States health care system is comprised of both public and private systems; public examples being Medicare, FEHBP; private examples being everybody else in the insurance industry. In the private sector, there exist a plethora of insurance coverage options (group, non-group, self-insured, association plans, guaranteed issue, risk pools, underwritten, employer-sponsored, high deductible, managed care, indemnity, individual, family, etc.), accompanied by equally thick layers of regulations at local, state, and federal levels.

The result of this multiplicity being inequality of access, coverage, and affordability, abundant bureaucracies, excess layers of administration, profit-motivated corporations, and the general third-payer choke-hold of our current US health care system.

Establishing universal health care in this country is not a new idea. The Consumers Union, the parent of Consumer Reports, has lobbied for universal health care for most of its 70-year history. In May 2001, Kaiser Family Foundation published Physicians' Working Group on Single-Payer National Health Insurance, A Proposal for Health Care Reform.

Many of the 2008 presidential candidates are calling for universal health care in their campaign platforms, but most of these proposals are still bound by the choke-hold of the profit-driven, financially-powerful, free-market (so called), private insurance industry and its monopolies.

In February 2003, Dr. Marcia Angell, Harvard Medical School, introduced The United States National Health Insurance Act, H.R.676 which would establish a single-payer system for health care in America. For complete text - read here.

So far, only one presidential candidate publicly endorses H.R.676, Rep. Dennis Kucinich (D-OH) who is one of the originators of the bill.

What IS Single-Payer Health Coverage -- What is it NOT!!!

What is Single-Payer?

The term single-payer describes the method by which some countries provide its citizens with health insurance. The name comes from the fact that doctors, hospitals, pharmacists, and other health care providers, are paid by ONE organization. In a single-payer national health insurance system, as demonstrated by Canada, Denmark, Norway, and Sweden, health insurance is publicly administered and most physicians are in private practice. (OECD)

Single-payer saves lives.

In a single-payer health system, everyone has health insurance. Lacking health insurance in the U.S., 18,000 people die each year -- at the rate of two per hour -- according to the Institute of Medicine. The US has higher infant mortality levels compared to most other democratic countries. Babies would be healthier if all pregnant women could get access to a doctor while they're pregnant. Or think of how much less-crowded emergency rooms would be if people could see a primary care doctor when they were sick, instead of only going to an ER when they become sicker.

To be without health insurance in this country means to be without access to medical care. But health is not a luxury, nor should it be the sole possession of a privileged few. We are all created b’tzelem elohim — in the image of God — and this makes each human life as precious as the next. By ‘pricing out’ a portion of this country’s population from health care coverage, we mock the image of God and destroy the vessels of God’s work. Rabbi Alexander Schindler, Past President, Union of American Hebrew Congregations [1992]

Single-payer saves time.

Imagine if all doctors and hospitals in the US had a uniform claim form to submit for payment; if all patients had the same insurance card; and if patients had health insurance by virtue of being US citizens.

Ever hear the business saying? Time is Money.

Consider the savings in time and money by eliminating wasteful paper-pushing. Doctors would have more time to care for patients; patients would have fewer headaches waiting to talk to their HMO to prove their coverage; nurses would be able to focus on nursing instead of spending 40%-60% of their time dealing with paperwork (AHIC, 03/13/07, meeting notes)

Single-payer saves money.

By streamlining the administration of the health care system, the paper-pushing is greatly decreased in frequency, duplication, and cost. A greater percentage of each health care dollar could be used to care for people's health, instead of going to managers and forms. Even advocates for private health insurance report that 56 cents of every health care dollar goes to the administrative costs of insurance companies, doctors and hospitals.

"The insurance system is a mess," said Greg Scandlen, the founder of Consumers for Health Care Choices, which advocates for private health insurance. "That's why we support health savings accounts," he said. With health savings accounts, insurance companies, doctors and hospitals can save on administrative costs and pass those savings on to consumers, Scandlen explained. These costs take 56 percent of every health care dollar, he said. — Steven Reinberg, HealthDay News, 08/07/07

By eliminating the bulk of paperwork duplication, a single-payer system could potentially save hundreds of BILLIONS (that's 100,000 million) of dollars. As it is right now, American businesses are at an economic disadvantage, because their health costs are so much higher than in other countries. The Canadian branches of Ford, GM, and Daimler-Chrysler all publicly support Canada's health care system, because it saves them an enormous amount of money, compared to their counterparts in the US.

Most single-payer systems save a ton of money by buying prescription drugs for its patients in huge bulk quantities. Consider the money you save by buying in bulk at Costco or Sam's Club? Now imagine applying that concept to buying prescription drugs for America's 290 million people.

Single-payer creates financial security.

A single-payer system would mean fewer personal bankruptcies due to medical bills--and an end to patients actually receiving bills. Medical bankruptcies account for 55% of all bankruptcies filed in the US. In most countries with a single-payer system, patients never see a bill. The billing process doesn't even involve patients. (This saves money, too--think of how much work goes into itemizing each bill, sending it to each patient, following up on the bill if there's been an error... and on, and on.)

"Four out of 10 Americans can't count on having health insurance when they need it," said senior project editor Nancy Metcalf, [Consumer Reports]. "This includes people who don't have health insurance, but also the 3-in-10 people whose health insurance is so bad or so costly to them that [they] are having trouble accessing and paying for medical care."Steven Reinberg, HealthDay News, 08/07/07

Single-payer saves choice.

Americans love choices and being presented with options. With a single-payer system, patients could go to any doctor they preferred. You could see the doctor that's closest to you, the one that all your friends recommend, or even choose one of your same religion, ethnicity, or race. A much different experience than being limited to the preferred providers of your HMO, if you don't want to pay an arm and a leg for it.

With a single-payer system, people would not be shackled to their current job solely for the health insurance it provides. People would be liberated to find jobs they're happier with or even consider starting their own businesses. Employers would be freed from the constraints of providing health benefits and could be more confident their happier-healthier workers were a good fit for their jobs.

"In 2005, we passed a milestone that no country should be proud of, which is that the average cost of a family plan in a workplace-based policy was more than a full-time employee making minimum wage gets in a year," Metcalf said. "Employers, too, are feeling the strain of rising costs. In 2000, the average employer contribution for a family plan was $135 a month; by 2006, the cost was $248," Metcalf said.

[PERSONAL NOTE: In 2007, an individual (non-group, not employer-based), PPO (managed care), underwritten (pre-existing conditions excluded), private insurance policy for a 39-year old single female living outside Washington, D.C., costs $274 each month, while providing limited $1500 drug coverage. In 2000, the monthly cost was $151 with the same $1500 limited drug coverage.

In 2006, uncovered medical expenses exceeded $31,000, in addition to health insurance premiums, for the treatment of Multiple Sclerosis. Fragmented assistance received for obtaining necessary medication came as: 50% award from pharmaceutical company=$9000; county Coordinated Services grant=$900; local charity=$200; donated medications from doctors' offices=$6000+; 'We Care' donation from D.C. Musicians' Union=$2000. Earnings 2006: $19,421.]

What isn't single-payer?

There's a great deal of incorrect information out there about health care reform. It's time to set the record straight--and if you want more information, you can always dig deeper.

Single-payer isn't socialized medicine... it's socialized insurance.

What's the difference?

Socialized medicine is the system in the Britain where the government owns the hospitals and employs the doctors--truly a government-run health care system.

Socialized insurance is the system in Canada where the government pays the hospitals and pays the doctors. An important difference is that hospitals and doctors remain part of the private sector in the single-payer system.

Single-payer isn't government bureaucracy... it's actually government efficiency.

Admittedly, some parts of the government are inefficient. Some waste your time; but so do HMOs and other corporations that keep you on hold for hours. In fact, the Medicare system is much more efficient than any HMO. About 4 cents of every dollar goes to administration in Medicare, but it's anywhere from 10 to 30 cents of every dollar in HMOs--the average being 11 cents.

Single-payer is health care rationing... but not the type you think.
Currently, health care is rationed by ability to pay. If you have insurance, you get health care; if you don't have insurance, you generally don't get health care. Basically a no pay-no play system which costs us all more.

Single-payer rations care by health care need. There would be no more "pre-existing conditions" limiting insurance availability, no more hassles to see a doctor of your choosing, no more denied applications for prescription assistance, no more demoralizing cling to a disintegrating safety-net system, no more delaying medical attention for inability to pay. Every American can receive necessary health care attention regardless of ability to pay.

Single-payer isn't free care... but it's certainly less expensive.

Money would come from employers and employees. Most of the necessary money is already in the system--currently going to HMOs instead of to a single-payer organization. Studies by the Congressional Budget Office, the General Accounting Office (GAO), the Lewin Group, Boston University, and numerous other reports, have done the math and come to the conclusion that single-payer would save enough money to cover the cost of insuring all the 45 million uninsured in the United States today.

How single-payer would affect all the health care players...


Single-payer national health insurance would provide health insurance coverage for everyone in the United States which currently has about 45 million uninsured. Patients would have access to all medically necessary care, including doctor visits, hospital care, prescriptions, mental health services, nursing home care, rehab, home care, eye care and dental care. (Sorry, "medically-necessary" doesn't cover cosmetic surgery or botox injections.) Patients would have their complete choice of doctors, cheaper prescription drugs, and no bills for health care.


Doctors would have less paperwork and fewer administrative headaches, while given more freedom and choices, too. Because there would be "one form" for doctors to file and less time spent figuring out a patient's insurance status and coverage limitations (and therefore more time to spend helping patients), doctors would be able to return to the reason they entered medicine--to help care for patients.

Most primary care physician doctors' incomes would stay about the same (when Canada passed its health care reform, salaries actually went up). Specialists' incomes would decrease, but doctors' own costs would be decreased, too: they could spend less on office staff and employees that work on insurance claims, as well as the health insurance for those workers.


Nurses' salaries increased greatly in Canada after passage of its health system reform. More nurses would be trained and hired to work in departments where nurses have been cut to save costs (and to work in nursing, where there is already a shortage.) This would decrease stress levels, and give nurses more time to spend caring for each individual patient.

Medical Students

Medical students would graduate with significantly less medical debt, if the single-payer plan mimicked the Canadian system. Many students cite debt (currently averaging around $90,000) as a reason they do not enter the field they truly want to enter.


Researchers would still have their research funded like it currently is--through the National Institutes of Health, the main entity in the United States that provides research grants to professors and scientists working on science-related research.


All hospitals would be converted to non-profit status, after a one-time payment to investors (several of the largest for-profit hospital chains have paid billions of dollars for defrauding Medicare.) Hospital billing would be virtually eliminated. Instead, hospitals would receive an annual lump-sum payment from the single-payer to cover its expenses—a "global budget." A separate budget would cover such expenses as hospital expansion, the purchase of technology, marketing, etc. Hospitals would no longer close because of unpaid bills.


Businesses would see the single-payer system decrease their health costs and remove the burden of administering health insurance for their employees. They would gain the competitive advantage that Canada and other countries have from decreased health costs per worker, and wouldn't need to worry about health care cost increases every year--the single-payer system helps control costs much better than the current system does.

Health Insurance Industry

The health insurance industry would be mostly eliminated--only organizations that actually employed doctors (like Kaiser Permanente in California) would be allowed to continue to operate. One proposed single-payer bill would provide one percent of funding for retraining displaced insurance workers during its first few years of implementation.

What would single-payer look like in the US?

The Single-Payer(s)

Okay. You got me. Multiple single-payer groups. Most blueprints suggest that the US would have regional payers--so, maybe a Western, Mountain, South, Midwest, South, and Northeast payer. Each would be responsible for a certain number of states, and each would still work with the others, so that if you live in California and take a trip to Atlanta, you're still covered. These payers would handle their states' paperwork and payments, and would get their money from the federal government, who would collect all the money to begin with.

The Doctor's Office

You go to see a new doctor. You give them your health card, they scan it, and you're in their system. You fill out the paperwork about your health for your doctor, and see him or her. The doctor either treats you or sends you to a specialist, and you don't see a bill or invoice. The doctor simply bills the regional payer electronically for the treatment or care he or she provided, and within 30 days, the doctor is paid.

When integrated with Health Information Technology, a single-payer system would created a unified, compatible, secure, system for receiving health care services, maintaining transparency, increasing quality, and ensuring confidence in evidence-based medicine.

How would we pay for all this?

"That's all fine and dandy," you say, but you want to know how we're going to pay for it all. A reasonable question. And for it, a reasonable solution.
Luckily there's already plenty of money in the health care system. The US spends double what most other countries spend on health care, and Americans still have shorter lifespans, and 45 million people still go uninsured every year. Many financing schemes exist. Hundreds of billions of dollars could potentially be saved in administrative costs, which would far exceed the amount needed to insure everyone in the United States. Put most simply, the money that businesses currently pay for health care would go to the single-payer; this would make up most of the money needed.

A wealth of other questions answered...

Special thanks to Graham from whom I 'borrowed' a great deal of material and inspiration regarding single-payer health care system.

More information is available at:

http://www.pnhp.org/ - Physicians for a National Healthcare Program

http://www.results.org/ - RESULTS

http://www.consumeraffairs.com/ - Consumer Affairs

www.grahamazon.com/sp - Single-payer info by Graham, med-student

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