Single payer health care is the only way to control costs

by Dr. Peter Mahr
Our current healthcare system is a mess for both those who carry health insurance and those without. Only a single payer national health insurance program that provides public financing for privately delivered healthcare services can clean up this mess and provide all Americans access to needed medical services regardless of ability to pay.

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 plan 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, OR. He is also chairman of the Portland Oregon chapter of Physicians for a National Health Program.