By Justine McCabe, Ph.D., and John R. Battista, M.D.
Connecticut Viewpoints, July 12, 2017
The only viable solution to our ongoing national healthcare crisis has waited in the wings for a long time. Teddy Roosevelt included the idea in his 1912 platform. President Truman proposed it in 1945. President Johnson succeeded – partly – with Medicare. Now more than ever, single-payer national health insurance needs to move to the national stage for serious consideration.
Significantly, there is, again, growing public support for single payer. An April Economist/YouGov poll found that a majority of Americans support “expanding Medicare to provide health insurance to every American.” Last year, Gallup polling found 58 percent of Americans support replacing the ACA with a federally funded health insurance system for all.
Indeed, our CT Democratic legislators should take notice: in a 6/23/17 Pew poll, 52 percent of Democrats, 64 percent of liberal Democrats, and “Fully 66 percent of Democrats and Democratic leaners ages 18 to 29” support a single national health insurance system. An April survey found nearly half of physicians supported single payer, particularly because of its time-saving simplicity relative to the current multi-payer, for-profit system.
As health caregivers, our experience reflects public support for single-payer system despite an unresponsive federal government. For example, in 2000, we introduced a single-payer bill to the Connecticut General Assembly, “The CT Health Care Security Act.” Strikingly, people – often in other legislative hearings – showed up in large numbers to support our bill then before the Labor Committee (where it was passed, before dying). The CT Human Services Committee audience literally broke into applause at our suggestion that the committee reject proposed changes to Medicaid and transform the program into single-payer insurance for the state.
Yet, despite strong public support for single payer, our federal government has tried to suppress it, dismissing this option during the ACA hearings of 2009: no single-payer advocate was included in then-U.S. Sen. Max Baucus’ (D-Montana) health care hearings despite support by 60 percent of Americans. Those trying to speak from the audience were arrested.
Our government has even tried to hide public support. In our 2006 op-ed in The Hartford Courant (“Seeking Coverage for All”) we described a government-sponsored task force charged with seeking Americans’ opinion on improving our health care system. It found that people around the country – including CT – overwhelmingly supported a national health insurance program. Connecticut respondents ranked national health insurance first over all other possible reforms. Yet, in their final report (September 2006) this “Citizens’ Health Care Working Group” excluded citizens’ choice – single payer – from their recommendations to Congress.
Senate Republicans have tabled a vote on their approach to replacing the Obamacare/Affordable Care Act (ACA). A June PBS/Marist national poll reveals that only 17 percent of Americans approve of what they’ve seen of the plan – with good reason. According to the Congressional Budget Office, 22 million Americans would lose health insurance under this Republican proposal.
Moreover, according to the Centers for Disease Control, there are still another 28.6 million people with no health insurance despite the ACA. If the Republican bill passes, we, the wealthiest country in the world, would have 50 million people – about 16 percent of the population – without health insurance. That means less primary care, increased use of expensive “ER care,” as well as an increase in mortality associated with being uninsured. And even if our health care financing system remains the ACA, national health care expenditures are projected to increase from 17 to 20 percent of GDP by 2025 according to the actuaries of the Centers for Medicare and Medicaid Services (CMS).
Let’s face it. Our current health care financing system is simply incapable of containing costs.
How do we solve the two main problems constituting our health care crisis: lack of universality and uncontainable costs? For-profit private health system will never solve either of these central issues.
We need a paradigm change.
Single payer resolves these problems. Precisely because it is not-for-profit, unlike private health insurance, it does not spend 18 cents of each health dollar on administrative costs – advertising/marketing, policy underwriting, multimillion-dollar executive compensation, profits for investors. By contrast, Medicare, a single-payer system, is highly efficient with about 2 percent administrative cost.
So savings from our for-profit health care system to single payer could provide health insurance for everyone and keep costs down not only by eliminating the inherently high administrative costs of private health insurance, but also by negotiating global hospital budgets and prescription drugs in bulk. Single-payer systems succeed primarily because they spread risk across the whole population. Such a vast pool includes both young and old, healthy and ill, recognizing the reality that everyone eventually gets sick; everyone eventually dies.
Advocates of for-profit health insurance will tell you that we have the best health care in the world. True but only if you can pay for it. In reality, the U.S. spends twice as much as developed nations with national health insurance – we spend the most per capita anywhere – $9,237 – yet we have poorer health outcomes. For example, the U.S. ranks 12th in life expectancy among the 12 wealthiest industrialized countries, according to the Kaiser Foundation.
Single-payer health insurance, like Medicare, is not socialized medicine. It is a health insurance payment mechanism not a health delivery plan. Such a system would not own hospitals, or employ doctors and nurses. Like Canada’s national health insurance program, single payer/Medicare-for-all would continue the U.S. tradition of fee-for-service with choice of any willing provider. Imagine the boon to small businesses if every individual already had health insurance; for people who keep dissatisfying jobs just to keep their health insurance.
The current Republican challenge to the ACA provides another opportunity for Americans to insist on a health care plan that provides insurance for everyone while containing costs. Let’s insist that our representatives transform Medicare to Medicare-for-All.
Justine McCabe, Ph.D., is a clinical psychologist, and John Battista, M.D., is a psychiatrist at Riverbend Psychiatric Associates in New Milford.