Health Care's Missing Piece? A Single-Payer Health Care System.
It would give all citizens the medical services they need.
By Barbara Holzer
The U.S. lost bragging rights to the world's best health care some time ago.
The factors that now distinguish our health care are all negative: runaway costs, unconscionable waste, unfair and inefficient private insurance plans, and insufficient medical care that is out of the reach of millions.
Most agree: This is not just inexcusable; it is despicable.According to a study conducted last year by the Commonwealth Fund, a private foundation focused on improving health care, 75 million American adults – representing 42 percent of people under 65 – had either no insurance or inadequate insurance coverage in 2007. In a poll released Feb. 25 by the Kaiser Family Foundation, which specializes in public opinion research on health, more than half of Americans said they cut back on health care last year because of costs. People hunger for a real solution, especially now, with heavy job losses, home foreclosures and a nation in economic peril.
Never has there been more urgency to revise and rebuild the way the U.S. delivers health care.
Some states have tried modifying their existing systems. Maine, Massachusetts, Minnesota, Oregon, Tennessee, Vermont and Washington have all attempted reforms since the late 1980s aimed at providing universal health care. The plans varied from state to state, but they had two things in common: They all continued to rely on private health insurance, and they all failed. During a 10-year period, the number of uninsured in each of those seven states remained virtually the same.
Millions of Americans heard President Barack Obama tell Congress on Feb. 24 that "health care reform cannot wait ... will not wait another year" and that every American "must have quality, affordable health care."
Public Citizen is urging the administration to accomplish this with a single-payer system, because it really is just what the doctor ordered. It is not a quick fix or a halfway measure, but a complete makeover of our impoverished system. It would give all Americans all the medical services they need, and all the bills would be paid from a single fund administered by the government.
Momentum for the single-payer health plan is accelerating. On Jan. 26, Rep. John Conyers Jr. (D-Mich.) introduced H.R. 676, The U.S. National Health Care Act/Expanded and Improved Medicare for All. Twenty-eight cities and 46 local governments have already endorsed H.R. 676, as has Public Citizen.
"Single-payer health insurance is the right solution. It is publicly funded, privately delivered comprehensive medical care for everyone," said Dr. Sidney Wolfe, acting Public Citizen president and director of the Health Research Group at Public Citizen. "That means the health care expenditures of an entire population are paid for through one source – the federal government or a government-run organization – that would collect all health care fees from tax revenue, and pay out all health care costs."
Wolfe is a member of the Physicians for a National Health Program (PNHP), a nonprofit organization that has been advocating for a single-payer health plan since 1987. Public Citizen held a press conference Feb. 18 at which the Chicago-based group presented its report on the latest attempt to resuscitate health care reform in Massachusetts.
In 2006, the state tried expanding Medicaid for the poor while requiring people with middle-class incomes to purchase a health plan from a pre-selected list of private insurance options – or face fines. The plan was touted as a potential model for the nation, and many speculated that Obama was watching the state's progress with the new program.
But the PNHP report showed that, after just two years, the Massachusetts plan already has failed. As much as 5 percent of the state remains uninsured, and coverage for some of the poorest residents has actually worsened, causing some to interrupt treatment for life-threatening diseases. Furthermore, the reform has done nothing to control costs, and has led to $1.1 billion in additional costs in fiscal 2008 and $1.3 billion in fiscal 2009. Budget overruns have forced the state to siphon about $150 million from safety-net providers such as public hospitals and community clinics.
The new system has only reinforced the economic power of bloated private health insurers, and the goal of universal access to medical care was never reached.
U.S. lags behind
All other major industrialized nations provide some form of health coverage for all their citizens. Most of these systems offer a broad range of benefits at no cost to the patients. In comparison, the U.S. spends more than twice as much per person as these other nations but ranks near the bottom in quality and access to care.
The World Health Organization last ranked health system performance in 2000 using major health indicators such as life expectancy, infant mortality and immunization rates. Among its 191 member nations, the U.S. ranked 37. How could we be left so far behind, and why has this problem been allowed to persist?
"There are millions of reasons, and they all start with a dollar sign," Wolfe said. "For the past 20 years, the insurance industry has been among the largest donors contributing to influential politicians, feeding the greed in Washington while solidifying its position as kingpin of America's health care."
The single-payer system would effectively shut down the private health insurance business, a necessary shakeout for the health of the nation. In the interim, expect insurance industry lobbyists to wage a misinformation campaign about the benefits of single-payer health care as they fight tooth and nail to hold onto their lucrative turf.
As for Obama, he included a $634 billion line-item for health care reform in the budget he presented to Congress on Feb. 25. The following week, the president met with a variety of organizations and legislators in a health care summit, organized to gather information from stakeholders as he moves forward on health care reform this year. Initially, no single-payer advocates were invited to the summit. After pressure from the public, and from Public Citizen, the White House relented and invited Conyers and Dr. Oliver Fein, PNHP president, the day before the summit.
The national debate is only beginning. It will undoubtedly generate a lot of heat before we see the light.
Barbara Holzer is Public Citizen's broadcast and marketing manager.