Single Payer Universal Health Care

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"Daybreak urgently reminds us that good political intentions are not sufficient to ensure the continuation of our democracy; informed vigilance is vital to that task."
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Single Payer Universal Health Care

Submitted by The humble Farmer on March 14, 2009 - 8:08pm

What is single payer universal health care and why do people either sigh or bristle when they think about it? We read that universal health care is health care coverage that is extended to all eligible residents of a governmental region and often covers medical, dental, and mental health care. Typically, most costs are met by single-payer health care systems or national health insurance. If you travel at all, or if you have friends or relatives in Europe, you already know that universal health care is implemented in most wealthy, industrialized countries --- with the exception of the United States. In recent years it is also provided in many poorer developing countries. Because universal single-payer healthcare works, it is now the trend worldwide.

So. Why do they have universal health care even in some poor developing countries and not here in the land of the free and the home of the brave where we put little sticky American flags on the back of our cars and proudly boast that we have the best of everything? We don’t have universal health care because too many people in the health care business are getting richer by overcharging you for services. --- Like the $220 one company charged my health insurance company this week for a chin strap that I later found on line for $19.95.

If you are young and just starting a family or are old and wondering if the kids can afford to bury you after they pay your medical bills, you should be interested in learning more about a single payer health care system. Bottom line --- it will save you money. It will raise your standard of living. You won’t have to sell your home or deplete your savings if you get sick.

We read that 28 industrialized nations guarantee access to health care as a human right. They have single payer universal health care systems like the type presently proposed in a bill now before Congress --- yet not one spends as much per capita on health care as the United States.

May I repeat that? - 28 industrialized nations have single payer universal health care systems and not one of them spends as much per capita on health care as the United States. Of course they don’t. Only in the United States are there so many paper-shuffling sticky fingers between your health insurance check and the hard-working health professionals who care for you.

Good news. The United States does not need to rank near the bottom among industrial countries in most everything from life expectancy (20th) to infant mortality (23rd) because --- some doctors have proposed legislation that would control skyrocketing health costs while covering all Americans. It would eliminate all those layers of sticky fingers. The bill also restores free choice of physician to patients and provides comprehensive prescription drug coverage to seniors, as well as younger people.

Under this bill, which is called H.R. 676, we read that a family of four making the median income of $56,200 would pay about $2,700 in payroll tax for all health care costs. No deductibles, no co-pays, no worrying about catastrophic coverage. The services covered include primary care, inpatient, outpatient and emergency hospital care, prescription drugs, durable medical equipment, hearing, dental and vision care, chiropractic treatment, mental health services, and long-term care.

Wow. Imagine an America without grange suppers and garage sales for veterans who lost their legs or, even worse, their minds in combat. Now you can get behind legislation that really will Support Our Troops.

I have a good friend who probably voted against universal health care for years. But --- when a family member needed years of intensive long-term care, it cleaned him. His fifty years of hard work and scrimping and saving went down the drain. They took it all. Had he lived in any one of 28 or so other countries (or an updated America); he’d be leaving his heirs some nice certificates of deposit. Hopefully, this bill will pass in time to save your estate.

Can you think of any other issue that so directly impacts the long-term welfare of you and your family as single payer universal health care? Shouldn’t you write to your friends in Washington and tell them what you think about H. R. 676? Your letter is really no substitute for the feasts and festivals put on for Congress by the greedy so-called health-care industry, but it would at least let them know that you’re watching.

Welcome Aboard, Humble Farmer!

Submitted by Chip on March 17, 2009 - 5:52am.

Greetings from WI, where most of my neighbors are bovine.

I liked how you cut to the chase:

>28 industrialized nations have single payer universal health care systems and not one of them spends as much per capita on health care as the United States.

>Under this bill, which is called H.R. 676, we read that a family of four making the median income of $56,200 would pay about $2,700 in payroll tax for all health care costs. No deductibles, no co-pays, no worrying about catastrophic coverage. The services covered include primary care, inpatient, outpatient and emergency hospital care, prescription drugs, durable medical equipment, hearing, dental and vision care, chiropractic treatment, mental health services, and long-term care.

Dun good, guy...

Well worn arguments against single payer

Submitted by calita on April 1, 2009 - 6:59pm.

Thank you, humble farmer, for laying out the argument in favor of single payer with such eloquence. There is quite a bit of misinformation about single payer health care, much of it confabulated and circulated by powerful interests in the health care sector.

A common concern is that consumers will no longer have choice of providers. To some extent this is true of socialized medicine, in which the government both delivers as well as pays for health care. The Veterans Health Administration, which provides care to military personnel, is a socialized system of medicine. Benefits are only available at government-owned medical centers which are staffed by health care workers who are government employees.

But this is not true of single payer, in which the government is merely the financier of care, directly reimbursing our choice of public and private providers. In fact by removing cost as a barrier to health care, options would increase for most consumers.

A second fear is that government would become an unwelcome third party between patient and physician, rationing health care and dictating therapeutic options. In fact this is precisely where insurance companies are positioned today. They generate profits by slashing benefits (such as maternity and mental health services), by requiring approval for certain procedures and referrals to specialists, by restricting the number of in-network providers, contracted hospitals and participating pharmacies, and by setting lifetime caps on benefits.

A third argument is that single payer would drive up the cost of medicine. In fact it is our multi-payer, private health care system that has inflated costs. Up to 30% of insurance premiums and up to 15% of our health expenditures represent administrative waste. This includes shareholder dividends, executive salaries and benefits. The expense of designing and marketing thousands of different insurance plans. Sales commissions paid to independent brokers. Underwriting to weed out high risk applicants from the pool of healthy, profitable participants. The inefficient claims review, prior authorization, and provider reimbursement process. Fully one third of administrative dollars go to political contributions, federal lobbying and public relations activities. The Congressional Budget Office and Office of Management and Budget estimate that switching to single payer would save taxpayers a minimum of $250 billion in administrative costs alone.

Many fear that the burden of universal health care will be borne by those who currently are employed or have insurance. In fact hospitals and doctors already shift costs for care of our nation’s uninsured to the private sector as a matter of routine.

Switching the cost of care from employer to taxpayer is not merely sleight-of-hand. First, eliminating the deduction for employer health premium contributions will recover $250 billion in tax revenues.

Second, public programs are cheaper to run. We already have an example in Medicare, serving all citizens over the age of 65. It is paid for through a 2.9% payroll tax split evenly between employers and workers and monthly beneficiary premiums, $96 in 2008. It spends less than 2% on administrative costs.

If public plans were not so much more economical, private insurers would not be so adamantly opposed to a public insurance option in national health reform. In fact, our tax dollars partially subsidize private health care plans for seniors, known as “Medicare Advantage” so that the insurance industry can compete with the government run Medicare program. Where is the logic in that?

Single payer would help to control costs by having a central agency to contract directly with pharmaceutical companies to purchase in bulk. Drugs and devices account for 10% of our expenditures and are rising at a rapid clip. We pay up to 70% more for medications than any other developed nation because of patent protections won by drug manufacturers. It is no coincidence that in 2008 the industry contributed $29 million to presidential and congressional campaigns and spent $230 million in federal lobbying.

The government could control costs by negotiating reasonable fees for health care providers and global budgets for hospitals. Together these account for over half our nation’s $2 trillion in health expenditures. As it is, private insurers set fees for hospitals and physicians in a manner shrouded in mystique and lacking in logic. They market hundreds of different plans, each with their own rules for what services are covered at what levels of reimbursement requiring what kinds of documentation. The free-market doesn’t lower the cost of care, it ups it.

To illustrate: Duke University Health System in North Carolina is among our nation’s top ten medical centers. In 2008 it admitted 41,000 patients, performed 34,000 surgeries and delivered 3,100 babies. It employs 900 billing personnel to deal with 700 different insurance contracts. In the same year McGill University Health Center in Montreal hospitalized 39,000 patients, performed 34,000 surgeries, delivered over 3,000 babies and employed 12 people to do the billing. Canada has single payer.

Canadians enjoy better care and outcomes than do we. In fact the United States ranks 39th of 119 industrialized countries, lagging in measures such as life span, infant mortality, preventable death. Moreover, within our country there are subpopulations, notably minorities and the poor, for whom outcomes are poorer than in the third world.

Our present, multi-payer, profit-driven system of health care is characterized by an overreliance on costly, oft unproven and frequently inappropriate medical technology. It incentivizes intensive care, with most of our dollars devoted to end-of-life treatments which do little to enhance quality of life or the dignity of death.

We need to focus on coordinated preventive services and chronic disease management which are more effective using fewer dollars. A centralized health plan could allocate limited resources to do just that. Under single payer our government could improve quality of care in the United States by spearheading investigation into the outcomes of different treatments of diseases, known as “comparative effectiveness research”. This would help us to save money that is being wasted on ineffective therapies.

Our present system serves the interests of powerful lobbies and is a disservice to our people. Take a closer look at single payer and lend your support to H.R. 676, The National Health Care Act and Senator Bernie Sanders American Health Security Act.