Enhanced single-payer health insurance would save lives and money and provide high-quality care
By Julie Keller Pease, M.D., and Kevin Twine
Portland (Maine) Press Herald, June 18, 2014
Not surprisingly, columnist Steve Robinson of the Maine Heritage Policy Center has jumped onto the story of the Department of Veterans Affairs scandal to sound the alarm about “single-payer” and “socialized medicine” (“VA corruption devastating for Michaud, single-payer fans,” June 7).
As physicians and concerned citizens, we offer a more rational and reasoned perspective. The problems within the VA have in fact presented another opportunity for us to shine a light on the many benefits of an improved version of Medicare for all.
Historically, there have been long waits for care at the VA. This is not unique to the VA. Compared to the rest of Americans, eligible veterans have better access to quality health care, and in some areas the VA has been unable to recruit enough doctors and mental health professionals to keep up with demand.
This is not all the VA’s fault: There is a national shortage of primary care doctors, and there is no evidence that wait times in the private sector for primary care are any shorter. For example, a family practitioner who arrived in rural Maine last August now has a wait time of almost 11 months for new patients. Many practices in Maine and elsewhere are not accepting any new patients.
Long waits for VA care are often associated with the time it takes to determine if veterans are eligible to receive care at the VA. Not all veterans are eligible. Currently, about 2.3 million veterans and their family members are uninsured, representing about 5 percent of the 47 million medically uninsured Americans in our country today.
When people are uninsured, and don’t get the care they need, the results can be catastrophic. We have learned that an estimated 40 veterans reportedly died while waiting for VA care in Phoenix.
This is tragic. However, in Maine, more than 130,000 of our citizens lack health insurance and are unable to access health care. It is estimated that because of this, 150 Mainers will die this year.
Even more devastating, more than 46,000 Americans die every year because they cannot access the care that they need, mostly because they lack health insurance or have substandard plans. In dramatic contrast, if we were to expand and improve Medicare to cover all Americans, these “excess deaths” would be avoided.
Not only would an improved Medicare for all cover everyone and save lives, but it would save money by eliminating much of the enormous administrative overhead generated in our current fragmented system of care.
William Hsiao, an internationally recognized health care economist and designer of health care systems around the world, testified before a select committee of the Maine Legislature in October 2010. He estimated that Mainers could save 10 percent of total health care spending, or $1 billion in the first year alone, by implementing a universal Medicare-like system. UMass economist Gerald Friedman estimates that a universal Medicare system would save as much as $570 billion per year nationwide.
Single-payer national health insurance, an improved Medicare for All, would offer a single tier of high-quality care to everyone. Everyone would be able to choose any provider and source of care in the U.S. It would address wait times in an organized way, be transparent and accountable, and allocate medical resources based on need, not ability to pay.
In the furor over the manipulation of waiting lists, we cannot overlook the many positives about the Veterans Affairs health care system. The VA has pioneered quality improvement initiatives and delivery system changes. It has an electronic medical record system that is far ahead of the private sector. Its administrative overhead is far less than the private health insurance industry’s.
Veterans’ service organizations praise the VA, even as they report the wait times, precisely because of its high quality. Patient and provider satisfaction within the VA system is consistently much higher than within the private, for-profit sector of our fragmented health care system.
As for substituting a voucher-like insurance system for the VA, would anyone in their right mind suggest that we take Maine’s veterans out of the VA and put them into Gov. LePage’s PL 90 health insurance plan?
We have much to learn from both the problems and the successes within the VA system. We applaud the steps taken by Sens. Bernie Sanders, I-Vt., and John McCain, R-Ariz., to quickly address some of the problems. And we will continue our efforts to promote universal access to quality health care for all Americans, via an improved system of Medicare for all.
Julie Keller Pease, M.D., and Kevin Twine are both residents of Brunswick, Maine, and members of Physicians for a National Health Program and Maine AllCare.