Why Obama's Public Option Is Defective, and Why We Need Single-Payer.
By Drs. Steffie Woolhandler and David Himmelstein, July 22, 2009
Once Congress finishes mandating that we all buy private health insurance, it can move on to requiring Americans to purchase other defective products.
A Ford Pinto in every garage?
Lead-painted toys for every child?
Melamine-laced chow for every puppy?
Private health insurance doesn’t work.
Even middle-class families with supposedly good coverage are just one serious illness away from financial ruin.
Illness and medical bills contribute to 62 percent of personal bankruptcies — a 50 percent increase since 2001. And three-quarters of the medically bankrupt had insurance, at least when they first got sick.
Coverage that families bought in good faith failed to protect them. Some were bankrupted by co-payments, deductibles, and loopholes. Others got too sick to work, leaving them unemployed and uninsured.
Now Congress plans to make it a federal offence not to purchase such faulty insurance.
On top of that, it’s threatening to tax workers’ health benefits to meet the costs of simultaneously covering the poor and keeping private insurers in business.
President Obama's plan would finance reform by draining funds from hospitals that serve the neediest patients. His other funding plans aren’t harmful, just illusory. He’s gotten unenforceable pledges from hospitals, insurers and the American Medical Association to rein in costs, a replay of promises they made (and broke) to Presidents Nixon and Carter. And Obama trumpets savings from computerized medical records and better care management, savings the Congressional Budget Office has dismissed as wishful thinking.
The president’s health plan can’t make universal, comprehensive coverage affordable.
Only single-payer health reform — Medicare for All — can achieve that goal.
Single-payer national health care could realize about $400 billion in savings annually — enough to cover the uninsured and to upgrade coverage for all Americans. But the vast majority of these savings aren’t available unless we go all the way to single payer.
A public plan option might cut into private insurers’ profits. That’s why they hate it. But their profits — roughly $10 billion annually — are dwarfed by the money they waste in search of profit. They spend vast sums for marketing (to attract the healthy); demarketing (to avoid the sick); billing their ever-shifting roster of enrollees; fighting with providers over bills; and lobbying politicians. And doctors and hospitals spend billions more meeting insurers’ demands for documentation.
A single-payer plan would eliminate most insurance overhead, as well as these other paperwork expenses. Hospitals could be paid like a fire department, receiving a single monthly check for their entire budget. Physicians’ billing could be similarly simplified.
With a public insurance option, by contrast, hospitals and doctors would still need elaborate billing and cost-tracking systems. And overhead for even the most efficient competitive public option would be far higher than for traditional Medicare, which is efficient precisely because it doesn’t compete. It automatically enrolls seniors at 65 and deducts their premiums through the social security system, contracts with any willing provider, and does no marketing.
Health insurers compete by NOT paying for care: by seeking out the healthy and avoiding the sick; by denying payment and shifting costs onto patients; and by lobbying for unfair public subsidies (as under the Medicare HMO program). A kinder, gentler public plan that failed to emulate these behaviors would soon be saddled with the sickest, costliest patients and the highest payouts, driving premiums to uncompetitive levels. To compete successfully, a public plan would have to copy private plans.
Decades of experience teach that private insurers cannot control costs or provide families with the coverage they need. And a government-run clone of private insurers cannot fix these flaws.
Drs. Steffie Woolhandler and David Himmelstein are associate professors at Harvard Medical School. They co-founded Physicians for a National Health Program, a nonprofit research and education organization of 16,000 physicians, medical students, and health professionals who support single-payer national health insurance. For more about the group, go to www.pnhp.org. This piece was distributed by the Progressive Media Project, an affiliate of The Progressive magazine. To subscribe to The Progressive, for only $14.97, click here.
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Comments
Aaaaah, good to see more blatant disregard for those "meddling" facts by the conservatives. Let me guess the excuses, they are always the same...
Conservative argument number one, "Ask a Canadian"- well, CTV News did that. They found that 91% of Canadians feel their system is superior to the United States' system. Quality of Care in Canada is ranked 30th by the WHO and the US is ranked 37th. Canadians feel that the "evil mastermind" who "devised" single payer health care is so "vile" (a Mr. Tommy Douglas) that they voted him the "Greatest Canadian" in history in 2004. And so reviled were they at their "government run and failed" system that when the Conservative Party offered making the health care system more privately run, public backlash (by conservatives!)led them to take back the suggestion. Besides, Canadians live longer, have lower infant and maternal mortality rates, and have lower cancer occurrence and mortality rates, and less of every disease comparatively than the United States. 70% to 80% of Canadians approve of the waiting times. Only 3% of Medical procedures in Canada, France and Britain are delayed.
Conservative argument number two, "It will cost too much"- It has never ceased to amaze me that we can always find more money to invade and kill people in other countries, whether Afghanistan, Iraq, Somalia, or elsewhere, and we can always find money to bail out banks who got their money from cheating Americans but we can never find money for something worth it. By switching to single payer, Americans would actually SAVE $400 billion annually, due to cuts in administrative spending, bloated CEO salaries, bonuses, shareholder paybacks, etc.
Conservative argument number three, "Socialized Medicine puts a bureaucrat between you and your doctor"- Actually, socialized medicine REMOVES the bureaucrat. Right now, if anyone on this page got seriously ill, it is very likely your insurance company (assuming you're insured with all the redlining) would dump you like a celibate prom date because they need to maximize profits, and in order to do that, must cut costs. Guess what guys? We are all "costs"! Yay! A single payer system (read this SLOWLY conservatives) publicly funds INSURANCE (stay with me) but leaves delivery to privately operated not-for-profit facilities. Ask anyone with Medicare how their experience has been, then ask anyone with a private insurer or HMO. The Commonwealth Fund found that Medicare recipients are far more satisfied with their experience.
Conservative argument number four, "SOCIALISM, SOCIALISM, SOCIALISM!!!!!"- Don't worry guys, the reds will be easy on ya, just like they have been with the libraries, fire departments, military and police stations. Just think conservatives, you guys are the ones always talking about how great our police are. They keep those "scary old Negroes" out of your gated communities don't they?
A few other notes I want to make after reading Man Coulter's... umm... "article". Yes, "Universal Food Coberage" should exist. Also, most of the uninsured are not poor. According to an ASPE Issue Brief released by the United States Department of Health and Human Services, only 25% of the uninsured are below the poverty line and not even all of them qualify for Medicaid/Medicare (those programs are not based on income alone but also other factors). Everyone may use a doctor at different amounts, that is precisely why we need universal coverage, what if middle or lower income people need MORE use due to serious illness, etc. and can't pay for it? Health care is a human right, not a privilege for a few. If capitalism is so efficient, what the hell happened? Why is somebody filing for bankruptcy every 30 seconds due to medical bills? Why can't 50 million people get insurance? Most of it is redlining and cost cutting for maximized profits Ann, why don't they pay 15% of GDP for care in other nations? Why don't they have huge scales of bankruptcies due to medical bills? It's because they get what they need and get out for free. By the way, coverage is not a $20 deductible, I don't know where you got such an absurd idea from.
P.S.
What is this I hear about ineffective and inconvenient DMV's? I got my driver's license a week ago, I never scheduled an appointment, I waited ten minutes, took my test, took my picture, got my card and left, the whole thing took MAYBE 45 minutes. I live in South Chicago, a crowded area. If it took me that long, what the hell is taking you CONs so long in your uncrowded, lily-white, suburban DMV's?