Friday, March 13, 2009

Single-Payer Health, The People Speak

My Wednesday Bloomberg column "No Reason to Demonize Single-Payer Health" triggered an avalanche of emails -- the most I've ever received in 8 years of writing the column.

The message was pretty consistent: President Obama and Congress should consider a single-payer health plan in its reform agenda. It may be the best solution out there, but it isn't even on the table (as far as I know).

I heard from doctors, other health professionals and ordinary folks. No one can understand why we should keep such a wasteful, inefficient and expensive system that denies more than 60 million (I include the 25 million underinsured) affordable, universal care.

In my piece, I called health care a fundamental human right. Of course, I heard from folks who thought that people don't have this right. I know it's not written in the U.S. Constitution, but I think it should be an amendment. It shouldn't be a luxury. If we can build nuclear weapons, invade countries for the flimsiest of reasons, export our dollars for oil and get the Chinese to finance tax cuts, warmaking and stimulus measures, we can certainly come up with a health-care program that covers everyone.

Single-payer makes sense for just about everybody because our system is so splintered. Doctors and other providers waste time, resources and money filling out forms for thousands of different insurers. That takes away from direct care and costs everyone. Those who can't afford policies end up in emergency rooms. That costs taxpayers money. Those who don't get preventive or chronic health management also end up costing the system more than is necessary.

Will single-payer demand some changes and sacrifices? Of course it will. Will it mean higher taxes? Possibly, but not if the waste is wrung out of the system and discounts are obtained for all services and drugs. A Wal-Mart style purchasing model makes much more sense than each company contracting with middlemen for PPOs, drug plans, etc. It makes no economic logic to force employers to dance around all of these issues, add to their cost of doing business and make them less competitive with global competitors.

At the very least, single-payer should be the model that's studied first. There's plenty to examine from Europe, Japan and Australia. While I don't think that we will end up with what the UK or Canada have, we should stop the crazy rhetoric that shuts down the debate. I don't think anyone truly believes that we will become like Europe any time soon. Let's grow up and start talking like we want to help everyone.

Here's a sampling of what I received:

Hello from Paris, where I've had direct experience with single payer health care.

The key thing to get across is that single payer is not the same as single provider. It is a tribute to the power of functional illiteracy that Americans can't get that straight despite having Medicare, which is single payer and endlessly multiple providers!

It is further incomprehensible that physicians moan about paperwork, yet a majority are against single payer. You may already know this, but I'll write in anyway. In France, a doctor's paperwork now usually consists of swiping a patient's health card, typing in treatment codes and hitting the SEND button. The doctors I know here have a receptionist or several doctors share one. They just don't have the same needs or expenses.

This one was from a doctor:

Could you please address the cost savings if defensive medicine was
stopped? How much would health care resources be freed up if health care
providers did not order tests and treatment to protect themselves from
malpractice suits. Obama never mentions how much of the health care dollar
is spent by the health care industry on malpractice insurance, defense and

Redirect the money that is spent because of malpractice litigation towards
providing health care and you will have the resources to provide medical
care to everyone in this country. Develop a better real time system than
the malpractice lawsuits to monitor and insure quality of health care. Think
of all of the ad time on TV that would be freed up if attorneys weren't
advertising ways to sue the health care providers. Find another way other
than malpractice suits for attorneys to make money.

Give all health care providers in the private sector the same electronic
medical records system and malpractice protection that they have in the VA
system. The VA system is already a single payer system. Expand the VA
system to cover everyone in this country, not Medicare. There is too much
time and resources wasted trying to collect deductibles and co-payments from
medicare recipients. The Medicare regulations compliance is another waste
of health care resources.

This email was from a retiree:

Congratulations, Mr Wasik, on your column regarding this subject. I
agree with you wholeheartedly!

While I enjoy being covered by Medicare, I believe the Medicare
Advantage system is abused by insurance companies - this aspect of
Medicare should be abandoned. Every year I am bombarded with
brochures about signing up with one of these plans.

I have a daughter and son-in-law who are finishing up their graduate
degrees to become teachers - they have no insurance at all, though
they work part time. They do not get regular checkups. Another
daughter and her husband pay terribly expensive premiums for
"catastrophic" coverage with huge deductibles, as he is self employed.
They don't get regular checkups either, despite being in their 40s.

This is a terrible state of affairs in which the supposedly
first-class nation has far less than first-class health care.
Thanks for your column. I hope you will continue to talk about it.

What about small business? They (like myself) are generally not covered by group plans, so they pay through the nose, have high deductibles and get socked with double-digit increases every year.

I work in an office with three other men, we are all commission
salesmen. One of us is on Medicare, the rest, me included, buy health
insurance on the open market and pay high single coverage rates. A single payer
program would work best for us.

Here's another letter from a phyisician:

I am an emergency physician in Oregon who has produced 48 minute video "Health, Money and Fear" which addresses why our health care non-system costs so much, what it says about us and what we can do about it. It is available for viewing, in chapters, at (as is a two minute trailer).

The project started as an exploration and I came around to advocating for "single payer" or "publicly financed, privately delivered" care... or whatever you want to call it. In any case, we need a system in which the focus is on health instead of maximizing profits for all of the players. Physicians could be leading the charge on health reform; however the primary care providers are buried and I am afraid the specialists have become the mercenaries of The Industry.

My intent in producing "Health, Money and Fear" is to educate the
public about the perverse incentives in our non-system.

Yet another doctor:

The most under-reported story is how strong and diverse the support is for
single payer national health care. Even though 66% of Americans and
59% of doctors want single payer, including two Nobel prize winners in
economics, Drs. Joseph Stiglitz and Paul Krugman, the media ignores it
or mischaracterizes it as government run.

Here's another good point about the trillions we're spending on bailing out the banks (many have said they don't want the money and are returning it to the Treasury):

What this nation's economy needs is a single-payer plan that eliminates the thousands of health plans and their huge administrative costs that drain 31% of our health care dollars without ever laying hands on the patient. Without single-payer healthcare this nation's economy will never recover. HR676 Medicare-for-all will not only expand health care to 100% of the people, and save $400 billion annually, but it will bail out 100% of our employers to the tune of $6000 per employee per year. It will stimulate them to keep the employees they have and add new employees for growth. What better way of keeping jobs in the US? We cannot allow the insurance industry to win this issue. I'd rather see our bailout money going every US employer, not just a choice few.

This is from a licensed psychologist:

As both a provider and consumer of health care, I have put considerable attention into sorting out the realities of this issue, and find myself--along with the majority of health care providers--strongly supporting single-payer. Unfortunately, we often feel like voices in the wilderness. It is rare to find solid pieces like yours in the mainstream media.

And this last one from another doctor who focuses on my main point: Let's let people vote with their dollars in a grace period where we offer the private and public systems side by side.

If enough others follow your lead perhaps we will be able to make a realistic comparison between what this approach has to offer and the others....

What can you do? Call, write or email your Congressional representatives and tell them you want them to support single-payer health. Rep. John Conyers has such a bill worth supporting. Then contact the White House and tell President Obama you want him to propose and back such as plan. Here's a contact:

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