Wednesday, March 11, 2009

Obama Can't Ignore Single-Payer Health

Lions and tigers and single-payer health, OH MY! Yes, we're trying to find the wizard who will cure us of our health-care woes -- provide it to everyone at an affordable cost. Is the man behind the curtain President Obama?

The way it stands now, probably not, since he's never mentioned single-payer health and his spokesman says he's not interested. My Bloomberg column today discussed this shut-out at length:

The bottom line is that the insurance and pharmaceutical industry see single-payer as the anti-christ. Insurers offer no value and are making health-care decisions for us every day. Yes, folks, they are RATIONING care by simply refusing to pay for some treatments or making premiums exorbitant if we are paying through individual policies or high-deductible plans. if you are sick, suffer from a chronic disease or have had any number of (dozens) of "pre-existing" conditions, you will not get an affordable rate outside of a group plan.

So those who whine about the more than 45 million who are uninsured "choosing not to get insurance," get a grip. These folks are priced out of the market simply because their health isn't good. Insurers only want people who aren't going to cost them money, "losses" in their jargon.

Enter the single-payer concept. Doctors are not employed by the government. Hospitals will not be taken over by Homeland Security. Drugs will still be available. One buyer purchases all of these services, monitors care and gets the lowest price. The health-care combine despises this idea because it will hurt their profits and may even drive them out of business they will have to compete with this system in a free market, which is anything but open right now.

There are several versions of single-payer. One is an expanded Medicare, which is not to be confused with a pure single-payer system that simply acts as a big purchasing agent.

The single-payer system in England, which is not what I'm advocating, actually owns clinics and hospitals.

Then there are various other European models, which most single-payers decry as "socialist." Yes, they are not perfect and yes they cost taxpayers more money. But they don't have people going bankrupt or losing their homes in Europe, Canada or Australia because they are hounded by medical bill collectors.

Here's an enlightening Q&A provided by my friend Dr. Ida Hellander at Physicians for a National Health Care Plan (, one of the most vocal advocates of single-payer programs:

Q and A with PNHP co-founders Drs. David Himmelstein and Steffie Woolhandler

*Question: Should PNHP support a public Medicare-like option in a
market of private plans? PNHP should tell the truth: The "public plan option" won't work to fix
the health care system for 2 reasons.*

1- It foregoes at least 84% of the administrative savings available
through single payer. The public plan option would do nothing to
streamline the administrative tasks (and costs) of hospitals, physicians
offices, and nursing homes, which would still contend with multiple
payers, and hence still need the complex cost tracking and billing
apparatus that drives administrative costs. These unnecessary provider
administrative costs account for the vast majority of bureaucratic
waste. Hence, even 95% of Americans who are currently privately insured
were to join the public plan (and it had overhead costs at current
Medicare levels), the savings on insurance overhead would amount to only
16% of the roughly $400 billion annually achievable through single payer
- not enough to make reform affordable.

2- A quarter century of experience with public/private competition in
the Medicare program demonstrates that the private plans will not allow
a level playing field. Despite strict regulation, private insurers have
successfully cherry picked healthier seniors, and have exploited
regional health spending differences to their advantage. They have
progressively undermined the public plan - which started as the single
payer for seniors and has now become a funding mechanism for HMOs - and
a place to dump the unprofitably ill. A public plan option does not lead
toward single payer, but toward the segregation of patients; with
profitable ones in private plans and unprofitable ones in the public plan.
Question: Would a public plan option stabilize the health care system,
or even be a major step forward? *

Answer: The evidence is strong that such reform would have at best a
modest and temporary positive impact - a view that seems widely shared.
Indeed, we remain concerned that a public plan option as an element of
reform might well be shaped in a manner to effectively subsidize private
insurers by requiring patients to purchase coverage while relieving them
of the highest risk individuals, stabilizing private insurers for some
time and reinforcing their control of the health care system.
Question: Given the above, is it advisable to spend significant effort
advocating for inclusion of such reform? No, for 2 reasons.*

1 - We are doctors, not politicians. We are obligated to tell the truth
(see above), and must answer for the veracity of our stance to our
patients and colleagues over many years - a very different time horizon
and set of responsibilities than politicians'. Falling in line with a
consensus that attempts to mislead the public may gain us a seat at the
debate table, but abdicates our ethical obligations.

2- The best way to gain a half a pie is to demand the whole thing.

*Question: Is fundamental reform possible? *

We remain optimistic that real reform is quite possible, but only if we
and our many allies continue to insist on it.

The above was submitted by doctors who want reform, so they know much more about the system and how to fix it than anyone in the insurance industry or in Washington.

Tell your elected representatives to give single-payer a chance.

If you believe, as I do, that health care is a fundamental human right (I would protect it by a constitutional amendment), then join the battle. Even with Obama in office, our odds are long and we need to be organized.

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