By Robert Fulton
California Health Report, Jan. 23, 2014
Considering the prospects of a United States single-payer health care system, physician Matthew Hendrickson quipped: “Americans will always do the right thing, only after they have tried everything else.”
His message: Single-payer systems are the only surefire way to provide health care coverage to all while also controlling costs, and are bound to take root in the U.S. eventually.
Simply put, a single-payer system is government-run health insurance, with no premiums and no co-pays. Variations include the socialist British structure where providers are employed by the state; the Canadian version that has the government directly reimburse private-sector providers; or the French and German system, where the state pays providers through highly regulated insurance companies.
“I want to emphasize that single-payer is inevitable,” Hendrickson said during a talk at the California Health Professional Student Alliance’s Southern California Conference at UC Irvine Medical School in November.
The California Health Professional Student Alliance (CaHPSA) is a 5,000-member student-run, statewide non-profit that advocates for universal health care. The organization is a chapter of Physicians for a National Health Program, of which Hendrickson is a member.
The message of the conference, titled ACA 2.0, is that current reforms don’t go far enough.
“Our whole stance here on the Affordable Care Act is that it’s great that we’re expanding health care to more people, but it could go further,” said Irmina Haq, a recent graduate of Jefferson Medical College in Philadelphia, and a recruitment outreach coordinator for CaHPSA. “It needs amendment and it needs changes.”
Haq feels that the ACA doesn’t do enough to cover everyone nor contain costs, and that the only way to do so is through a national health-care system.
“I think we should cover everyone,” Haq said. “I think that currently we’re getting a lot of people signed up, but we’re still missing a lot of people. I think secondly, the ACA doesn’t do much about cost containment. Unless you do something to keep down costs, this whole thing is not going to work.”
Hendrickson believes that, on one hand, the Affordable Care Act has moved the United States closer to single-payer. According to Hendrickson, because of the Medicaid (Medi-Cal) expansion and additional federal health care subsidies, 70 percent of health care spending originates from tax dollars. On the other hand, Hendrickson also sees the ACA as a life raft for the insurance industry. More public funding funneled through the privately controlled insurance companies further entrenches the status quo.
“I don’t think it’s clear,” said Hendrickson, who works as an emergency physician in Los Angeles and Fresno. “The amount that the public is spending to cover health care is going to increase, but it’s all going to be funneled through the private insurance industry. So you’re really actually strengthening the current cancerous system that we already have. In the long term, it’s inevitable that we’re going to move to some single-payer system because the costs are unsustainable.”
Chuck Nguyen, who recently completed his post-doctorate studies at UCSD and is applying to medical school, recently had knee surgery. His school insurance has run out, so he’s trying to get insurance for him and his mother through Covered California.
“It’s so complicated,” Nguyen said. “I came (to the conference) hoping to know, is there an alternative, is there anything better? What’s the point of this? What can we do and basically how can it get better? How is this going to benefit me and my mom or people who can’t afford insurance?”
The possibility of a national single-payer health care system, a long-time dream of progressives and considered nearly impossible in today’s political environment, may be more realistic than some realize, at least in California. Ironically, the ACA may be the reason.
Written into the Affordable Care Act is a provision effective in 2017 that, according to the Kaiser Family Foundation, will “permit states to obtain a five-year waiver of certain new health insurance requirements if the state can demonstrate that it provides health coverage to all residents that is at least as comprehensive as the coverage required under an Exchange plan and that the state plan does not increase the federal budget deficit.” Supporters see this provision as a catalyst to launch a statewide single-payer system.
Further buoying supporters’ enthusiasm are a handful of close calls California has seen recently in the pursuit of a single-payer system. In 2006 and 2008, State Bill 840, also known at the California Universal Healthcare Act, made it through the legislature only to be vetoed by Governor Arnold Schwarzenegger. Focus on the ACA and political haggling have pushed a single-payer bill off the radar, but with super majorities in both houses and a Democratic governor, a single-payer bill could be resurrected.
Bill Zimmerman, a partner at the progressive advertising firm Zimmerman and Markman and long-time supporter of universal health care, explained the tightrope single-payer advocates must walk in their support of the ACA. If the Affordable Care Act is a resounding success, the public may not see the need for further reform. But if it’s a resounding failure, the public may be skeptical of further government involvement in health insurance.
“I believe it can be a stepping stone if it’s used that way, but it’s also speed bump in the sense that it’s going to make some people more skeptical about government involvement in health care,” Zimmerman said. “We’ve got to fight against the perception that the problem can’t be solved.”
Keyon Mitchell graduated from the University of Southern California with a Masters in social work, and is applying to medical school. He’s currently the Shearer Student Fellow for CaPHSA.
Mitchell grew up in parts of Los Angeles designated by the Department of Public Health as Service Planning Areas 4 and 6, and had limited access to health-care services. He grew up with Medi-Cal and remembers waiting months to see his primary care physician and receiving immunizations from free clinics. Mitchell said it took him more than two months to get an MRI at a local clinic after breaking a bone in his foot sustained while playing basketball in high school.
Based on his experiences growing up, Mitchell is a staunch supporter of single-payer.
“No system, I think, is perfect, but as far as a system that is the best for taking care of people here in the states, I think it’s the best system,” Mitchell said. “At the end of the day we want everyone to have coverage. We want everyone to have that idea that you deserve health care. If you’re sick you should be able to go to some sort of facility and get the care that you need. I think that’s not a novel concept.”