By Andrew D. Coates, M.D.
Times Union (Albany, NY), Oct. 9, 2015
Why won’t “single payer” — the call for one public health insurance program to cover all necessary medical care for every person in the United States — go away? Wasn’t it dismissed already from the mainstream discourse?
Instead of vanishing from the public eye, “single payer” or “Medicare for All” has already entered the 2016 elections. The presidential campaign of Vermont’s longtime single-payer advocate, Sen. Bernie Sanders, deserves much of the credit.
But perhaps “Obamacare” is the larger factor. Although the Affordable Care Act reduced the number of uninsured, after the “overhaul,” health care in the U.S. today is even more about money and even less about the care of patients.
In our present moment, “post-reform,” rising deductibles, rising co-pays and onerous co-insurance costs have become “the usual.” Financial barriers to care are ubiquitous.
The Affordable Care Act did not regulate the rise of premiums. Nor did it prohibit the narrowing networks of providers, as so many plans do. Nor did the “reform” rein in skyrocketing drug prices.
Additionally, about 31 million people in our nation remain inadequately insured. Being “underinsured” is not the same as being uninsured. It is when one’s health insurance fails to protect the household finances in the face of illness.
As for the uninsured, the Census Bureau reports 33 million people lacked any coverage at all last year, a number that is roughly expected to persist for a decade.
By so many measures, Obama’s Affordable Care Act has failed as “reform.”
One of the nation’s top health care journalists, Ricardo Alonso-Zaldivar of The Associated Press, recently highlighted the emerging national discourse (“Again? Health care debate expands for 2016,” Oct. 5). He outlined three basic positions: those for single payer; those for “repeal and replace” (without a credible alternative); and those for maintaining the status quo.
He asked renowned Princeton historian of the American medical system, Paul Starr, to comment. Starr succinctly amplified what both mainstream Democrats and Republicans have been saying about single payer. “It’s a dead end,” Starr said, because its supporters “don’t face up to the significant tax changes that would be necessary.”
Will the old cry “No new taxes!” effectively bury single payer in the upcoming election season — even though a nonprofit, streamlined single-payer system would actually save our nation and people hundreds of billions of dollars annually?
The problem for the establishment is that the fundamental contradiction that drove the passage of the Affordable Care Act — that the wealthiest nation on Earth fails to guarantee health care to all of its inhabitants, that the health of the nation overall is mediocre on a world scale — still drives the American debate.
The health care needs of the American people have yet to become the central focus of our health system.
A meaningful health care overhaul for the United States would be a program that would cover everyone, eliminate profiteering, control costs, improve quality and outcomes, lessen disparities, protect caregiver-patient relationships and guarantee maximum choice of provider.
Single payer could do all of these things.
Under single payer, equitable, progressive taxes would replace premiums, co-pays, deductibles and out-of-pocket costs for necessary care.
One study found that as many as 95 percent of all U.S. households would save money under a single-payer program — after taking into account the “significant tax changes that would be necessary.”
The costs of health care are inescapable. In a democracy, the question should be how to share those costs and to pay for care in the fairest way, so that each person might gain the opportunity to be as healthy as possible.
Perhaps the idea of single payer won’t go away simply because it would work.
On this score, evidence from other nations leaves no doubt. As even Donald Trump quipped this summer: “As for single payer, it works in Canada, it works incredibly well in Scotland.”
It is time to for us to embrace solutions. Further debate will reveal the need for action. We need single payer now.
Dr. Andy Coates of Delmar is immediate past president of Physicians for a National Health Program, chief of hospital medicine at Samaritan Hospital in Troy, and clinical assistant professor of medicine at Albany Medical College.