Single Payer Healthcare Only Way to Control Costs
A national reimbursement system can realign the delivery of healthcare services from one of maximizing profit to one in which we maximize health
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In a study released last week we learned that healthcare debt contributed to 62% of personal bankruptcies in 2007. And, surprisingly, 77% of those going bankrupt were insured when they first fell ill. The same year 47% of Americans reported some medical debt or payment problem and 16% of Americans’ had been contacted by medical debt collection agencies. Despite spending 16% of GDP on healthcare and increases in insurance premiums that dwarf growth in family income, millions are left bankrupt and 50 million more are uninsured. These figures highlight, in the starkest terms, how broken our employer-based private for-profit health insurance system is.
For all our money spent, the result is a fragmented complex healthcare system with poor outcomes. We are far behind other industrialized nations in terms of public health measures. Regional healthcare spending varies dramatically and has more to do with how many doctors there are per capita than other factors. The United States performs poorly on benchmark measures of preventative care and our management of chronic illness mirrors our chaotic and disorganized payment system. We consistently fail to meet evidence-based guidelines for chronic illnesses like diabetes and chronic lung disease.
At the same time business is booming for those who profit from healthcare. From 2003- 2007, the profits of the nation’s largest insurers rose 170.2 % to $12.6 billion. Pharmaceutical companies continue to gross billions of dollars with the top ten firms profiting a total of $75 billion in 2008. For-profit hospital chains and dialysis centers make millions while delivering worse outcomes when compared to non profit alternatives. Surgical sub-specialists make 3-4 times what generalists make.
So what do we do with a healthcare non-system that is a big money maker for insurers, some hospitals and the pharmaceutical industry but leaves one in seven people lacking insurance and most with insurance that is too costly and inadequate? How do we repair a delivery system that is expensive, focuses on moneymaking services rather than primary and preventative care and has little emphasis on evidence-based medicine?
Clearly the solution is to adopt a single payer national insurance program: publicly funded and privately delivered. We already pay for our current system with out of pocket payments and taxes. Personal income taxes pay for Medicare, Medicaid, public employee health insurance, tax breaks to employers who provide health insurance to their employees and healthcare coverage for military personnel and veterans. The sum total comes to 60% of our total health insurance costs. In essence, we are paying for national health insurance now. We just aren’t getting it. Instead, a single payer system would use tax dollars to provide true comprehensive healthcare coverage for all.
Furthermore, a single payer system is the only reform proposal that would drastically reduce the staggering administrative costs that accompany our private insurance industry. Profit margins, overhead and administrative costs associated with our current private insurance industry remove $350 billion from the healthcare system each year. In reducing administrative costs a single payer=2 0plan would save enough money to cover the 50 million uninsured.
Single payer health insurance also holds great promise for reforming the delivery of healthcare. With single payer, a reimbursement system can realign the delivery of healthcare services from one of maximizing profit to one in which we maximize health. Reimbursement for primary and preventative care can be emphasized while specialist and end of life care can be more rationally utilized. Regional spending can be leveled. And a one payer system can bargain effectively with the pharmaceutical industry, driving down medication costs which currently add $98 billion a year to the cost of our healthcare system.
In short, only a single payer system that eliminates for-profit, private health insurance can generate the cost savings to pay for a truly universal healthcare system. And, only a single payer system, with the tools of bulk purchasing, negotiated fees and global purchasing, can realign our delivery system to emphasize primary preventative care while bringing sanity to our skyrocketing healthcare s pending. A majority of the public and a majority of physicians support the adoption of single payer health insurance. Now is our chance to embrace true reform.
Dr. Mahr is a family physician who works for the Multnomah County Health Department at East County Health Center in Gresham. He is also chairman of the Portland Oregon chapter of Physicians for a National Health Program.
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Our current healthcare system is a mess for both those who carry health insurance and those without. Only an American single payer national health insurance program is going on but the program is not covering the whole Americans needs but Humana health insurance they are serving globally and have highly trained and professionalized crew and making the world better place.
Dr. Mahr, you need to design and propose a "proof of concept" with a pre stated methodology of evaluation. Engaging in endless debate may feel good, but probably unwittingly hardens positions, such that fewer folks listen downstream. If you are a passionate 'believer" in single payer...how would you design and execute it? I understand the worn out arguments about administrative costs...but what happens to all the other compensation of the industry? How is it regulated or controlled? Is everyone a captive of "your system" as you define it? Where might it be deployed in Oregon on an experimental basis? Would it be your intent that services for subscribers would be paid on a "par" basis with other payers or some highly discounted basis similar to Medicaid? Most importantly what would be the measures (other than universal coverage, please) that would measure success?
I am skeptical about "single" anything as being wise. "Choice" is practically an article of faith in this country. No choice, you get bad consequences. But that just pits my unsubstantiated beliefs against the author's. To make the leap to single payer without a "clinical trial" of sorts would be like ordering the nation that we must all be subscribed to Kaiser....perhaps more dramatic as Kaiser has a known track record. Single payer advocates would be better served on focusing on how it might demonstrate its beliefs using the enrollment of fellow "believers". Government and regulatory bodies should be more enabling to the demonstration. A method of independent evaluation should be defined in advance.
Help me understand why hospitals are unable to participate in national cost control efforts as US health care costs approach $1 in $5.
Nationally, 25 nonprofit hospital system recently made more than 250$ million net income each ("each").
The combined net income of the 50 largest nonprofit hospitals jumped nearly eight-fold to $4.27 billion between 2001 and 2006, according to theWall Street Journal.
No study show that, nationally, the nonprofits fulfill their mission to provide charity services to the public. In return they get extensive tax breaks. They are reaping a subsidy they don't earn -- and they are proud of it.
The only apparent irony in this is situation is the opinion held by those who also feel mandatory hospital or medical provider worship provisions should be written into any national reform.
rand dawson Siltcoos Lake
Peter Mahr correctly shines light on the way our non-system of care has evolved to focus on what makes money, to the point of crushing the possibility of investing in "what makes health"--because "there is no more money," one of the crucial excuses. Without at lease a "public option" in the first iteration of health reform, we absolutely will not make meaningful, broad progress in reducing inappropriate costs and prices while investing in better population health through primary and secondary prevention, early case-finding and interventions, and better coordinated care. We are so busy making money that those doing the "making" think they don't have the time to even communicate well with each other, let alone the primary care providers who often pick up the pieces. All of these thoughts come from (vicariously) painful, first-hand experience seeing how our current health care world functions, as a family doctor, and as a medical director in medical group and health plan settings.
You bet, and with single payer we can drive down prices with doctors and hospitals even more than Medicare and Medicaid, because we have "bulk purchasing power". Oh, I did not mean that...I meant other people. How about leveraging 20% across the board cuts to hospital staff that make 40% more than there counterparts in the countries systems we crave?