Pushing the Single-Payer Solution

[kristopher]

http://www.alternet.org/healthwellness/83420/

Pushing the Single-Payer Solution
By Amy Goodman
King Features Syndicate

Thursday 24 April 2008

As the media coverage of the Democratic presidential race continues to focus on lapel pins and pastors, America is ailing. As I travel around the country, I find people are angry and motivated. Like Dr. Rocky White, a physician from a conservative, evangelical background who practices in rural Alamosa, Colo. A tall, gray-haired Westerner in black jeans, a crisp white shirt and a bolo tie, Dr. White is a leading advocate for single-payer health care. He wasn't always.

He told me in a recent interview: "Here I am, a Republican, thinking about nationalizing health care. It just went against the grain of everything that I stood for. But you have to remember: I didn't come to those conclusions with lofty ideals of social justice."

In the early 1990s, his medical group started falling apart. White, a keen student of economics and the business of medicine, determined that it wasn't just his practice but the system that was broken.

"You're seeing an ever-increasing number of people starting to support a national health program. In fact, 59 percent of practicing physicians today believe that we need to have a national health program. I mean, that's unheard of, even 10 years ago. It's amazing to see a new generation of physicians coming up who are disgusted with our current health-care system. You know, we're trained to be advocates of patients, we're trained to save lives, we're trained to practice medicine. And instead, what we're doing is we're practicing Wall Street economics."

Single-payer is not to be confused with universal coverage, which Hillary Clinton and Barack Obama both support. In fact, in a recent debate, when Clinton raised the issue of single-payer, the audience interrupted with applause. She immediately countered, "I know a lot of people favor , but for many reasons is difficult to achieve."

Why? One of the most powerful industries in the country opposes it -- the insurance industry. Under universal coverage, insurance profits are preserved. Under single-payer, they are not. Dr. Rocky White, who now sits on the board of the nonprofit Health Care for All Colorado, has switched his political affiliation. He also has updated and reissued Dr. Robert LeBow's book on single-payer called Health Care Meltdown: Confronting the Myths and Fixing Our Failing System.

He described possible solutions: "There are a lot of different types of single-payer systems -- you could have purely socialized medicine. That's kind of like what England has. The government owns the hospitals, the government owns the clinics, the government finances all the health care, and all the doctors work for the government. That is truly socialized medicine, as opposed to the Canadian system, where the financing comes through their Medicare program, but all the doctors are in private practice."

The economics are complex, but this plain-spoken country doctor explains it clearly:

"You know, this industry is a $2-trillion industry, and the profits in the for-profit insurance industry are so huge and it's so deeply entrenched into Wall Street ... but until we move to a single-payer system and get rid of the profit motive in financing of health care, we will not be able to fix the problems that we have."

What would it take? Dr. White has spent his life dealing with the high winds on the high plains, from Nebraska to Colorado, and describes the challenge the country faces in familiar terms:

"I think that our current presidential candidates understand that ideally single-payer would be the best, but they don't have the political will to move that forward. Their job is to feel which way the wind is blowing. Our job is to turn that wind."

[dkf]

1. Big humongous K&R!

I like Canada's version best.

Thanks for posting.

[nichomachus]

2. AMEN

but until we move to a single-payer system and get rid of the profit motive in financing of health care, we will not be able to fix the problems that we have."

This is why neither candidate's health care plans is worth anything. It's not even, as some supporters claim, "a first step."

The only thing that's certain is that McCain's system would make health care worse.

[kristopher]

3. I don't agree

Obama's is offering the prelude to single payer. He concentrates on two things: cost control in the delivery of medicine and the elimination of profit in distributing the costs of risks (function of insurance). The endpoint is a system dominated by a government program that offers all the benefits of single payer. This is parallel to a private system of insurers that serve large corporate clients. This is actually the best of both worlds. The undeniable curse of single payer is stagnation and inefficiency while the undeniable curse of the present system is the drive for growth inherent in unfettered application of the profit motive. This keeps the good in both, while providing checks on the 'curses'.

The blending of the two is seen in Japan, for example.

[nichomachus]

4. It's the exact opposite of what you imagine

undeniable curse of single payer is stagnation and inefficiency

Stagnation and inefficiency -- not to mention confusion -- comes from the multi-payer system.

In the US, 35 percent of health care cost goes to administration. In Canada, it's 10 percent.

I was in the pharmacy the other day and they had a sign bragging "We honor over 5,000 prescription drug plans." Five thousand??? Do you know what it costs to keep track of that? I found that hard to believe, but there is was on the sign.

[kristopher]

8. Thanks for the opinion but

You're incorrect. Forget for a moment the labels. Any monopolistic system is going to produce stagnation and inefficiency; it is built into the model and it has to be dealt with in some manner or you are going to go wrong at the opposite end of the spectrum from where we are now. The mixed model is a good approach to dealing with the worst of both systems. the only thing missing is a requirement that companies above X number of employees are required to provide health care for all their employees and are not eligible to do so under the government's system.

There are more models than the US and Canada.

[nichomachus]

10. Yes there are other models -- and almost all are single payer

[Prophet 451]

14. True but there are different ways of doing that

The French system, for example, takes 7.5% as part of income taxes and hits up employers for a larger sum. The NHS is funded purely from taxes (mainly tobacco taxes). Germany has a complicated system where the funding comes from both national and local taxes.

Of course, since the US is coming to this late, there's nothing to stop the US establish a committee to study the existing systems for, say, three months and then mix-and-matching parts from existing systems to come up with something ideal.

[Enthusiast]

22. Nothing except,

"Of course, since the US is coming to this late, there's nothing to stop the US establish a committee to study the existing systems for, say, three months and then mix-and-matching parts from existing systems to come up with something ideal"

Yeah, there is nothing to stop the US from making a study of existing systems except for the insurance lobby. And they are all powerful. There will be NO single payer! This country is fascist, game, set, match. It's too late!

[depakid]

15. Forget the dogma and look at the outcomes

America pays nearly twice as much per capita on health care (billions of which don't "produce health," but perversely promote the opposite). America also lags well behind other western nations on just about every aggregate health outcome measure.

Not only that- but the system places the burden of these gross inefficiencies on American businesses- both in the form of exorbitant premiums that rise at double the rate of inflation (and we're talking real, not "nominal inflation) and in the form of internal human resources costs.

A so called mixed model does little to address those problems and will probably exacerbate others in the form of adverse selection among the risk pools (as opposed to gaining efficiency, economies of scale and bargaining power through a single risk pool).

[kristopher]

17. A recounting of current problems

Do you really think everyone else is so uninformed?

A recounting of our current problems does nothing to substantiate your conclusion regarding the mix of the two systems. The downside of our present system isn't just costly medical care due to high management costs. It also involves a deficit of informations due to high information costs for individuals. Large corporations do not face that obstacle, they are in a position to negotiate from both financial strength and knowledge. If the costs of an outside agency managing their risks becomes too high, they have the option of self insuring. At the same time, they are in a position of having a financial motive to push the health care delivery system for improved services and efficiency.

I think Obama's plan heads us in this direction and I find that acceptable. Another plus for it is that it doesn't directly confront insurance companies. It simply shrinks their pool of insured; thereby avoiding the war cry of over-interference in private business by government. Lots of people have had to sacrifice for the 'improvements' of globalization, the people are going to feel little empathy for insurance companies facing tougher times and having to be more competitive. They might (I think would), however, reject direct move to strip the insurers of all access to the market.

[eridani]

5. Get real. Neither Obama or Clinton can get us single payer

However, either could be PUSHED into going along with it. That depends entirely on pressure from below. WE are the ones we have been waiting for!

[Prophet 451]

7. "The undeniable curse of single payer is stagnation and inefficiency "

Huh? Admin costs for private health insurance are 20-30%. Admin costs for the Canadian system are around 10%, the admin costs of the NHS are 5-8% and that includes pensions for the career civil servants who administer the system quietly, efficiently and with the minimum of fuss.

[kristopher]

9. Both Canada and NHS have people who are not happy with the level of service

What do they complain about? I mean, really, not the right wing talking points.

Those types of institutional complaints are what I'm referring to, and over time they can corrupt a system just as surely and completely as the perverse incentives of capitalism. Government oversight is only as good as the benchmarks the overseers are using to judge by. The combined system gives both sides benchmarks to meet.

[nichomachus]

11. I know a lot of Canadians and

not one has every told me they want to trade their system for ours. Are there complaints? Sure. No system is perfect and people will always have complaints. Hell, there are people who would complain if you gave them free stuff. Some people just like to complain.

[Prophet 451]

13. what do they complain about?

Interesting thing: the actual things they complain about are rarely the ones touted by the right. Discounting the truly bizzare, the ones I hear most often are:
- "My doctor is rude/surly"
- "My appointment doesn't start on time" (i.e. ab appointment for, say, 1pm might not start until 1.15)
- Overuse of locums and substitute doctors (a problem in some urban areas)
- Poor out-of-hours service (there is supposed to be a doctor available for home calls at night, sometimes they don't show)
- Complaints about the £7 contribution to drug cost (young, old and poor are exempt)

Britain is a nation which is really good at grumbling. We moan about everything. Hell, we made complaining about the weather into a national pasttime but whenever some MP suggests privatising the NHS, they're shouted down and voted out of office.

[Prophet 451]

6. K&R and hurrah!

I'm English, I live under that socialised healthcare and, with the exception of dental (where some loopholes have caused a huge mess), it works pretty well and only costs around $2000 a year out of my taxes to cover me for absolutely everything with barely any out-of-pocket expenses.

There's a lot of different ways of doing single-payer medical coverage. Since the US is very late in thinking about setting this up, the US can just study the existing systems and mix-and-match the best parts from them.

[depakid]

16. You might remind Americans how much you pay for prescription drugs

That never fails to astonish them.

[Prophet 451]

18. £7

Seven pound contribution to the cost (roughly $15 and the young, old and poor are exempt). The rest is covered by taxes.

[Skittles]

20. my neighbor just paid $450 bucks

please remind your countrymen of that next time you hear them boo-hooing about how much we pay for gas :(

[Prophet 451]

23. Ouch! Done, happily. n/t

[OneBlueSky]

12. "It's time for the candidates to . . . get behind a single-payer system" . . .

yes, it is . . . but in order to do that, the candidates have to do the one thing that will make a single payer system feasible . . . and that is to remove the insurance/HMO industry from the healthcare equation . . . they contribute nothing to the provision of healthcare services other than rationing them for short-term profits, and every dollar that they skim off the system is one less dollar that goes for patient care . . .

so unless a president is willing to stand up to the insurance industry and say "NO MORE!," the chances of achieving real healthcare reform are slim and none . . . and since both Democratic candidates receive substantial campaign contributions from that very industry, the chances of a single-payer system happening in either a Clinton or an Obama administration are equally slim and none . . .

bottom line: unless we can get the insurance industry out of the healthcare business and stop paying for their corporate salaries, perks, and obscene profits with our healthcare dollars, nothing will ever really change . . .

[atjrpsych]

19. How many insurance companies sit on the stock exchange?

So much for HMO's and saving money. They don't even try to hide that they gain their profits by denying health care to those in need.

[undeterred]

21. Fuck the insurance industry. People are dying.