I spend a lot of time talking with people about the potential benefits of a single-payer national health program. “Single- payer” health insurance refers to a single public plan in which the government would be the only insurer for all Americans, in contrast to the current system of multiple payers, which includes both the federal government and hundreds of private insurance plans.
The single-payer national health program would be paid for with a modest tax, much as Medicare is today. Instead of just covering the elderly, a single payer plan would cover everyone for all necessary hospital and outpatient medical care, as well as full prescription drug coverage, home-care benefits, and nursing home care.
The usual response I get from people is positive, supportive and enthusiastic. Everyone has horror stories about their lack of health insurance or the travesty of their current private health insurance plans, which cost more and more yet cover less and less.
When someone does express doubts about a single-payer health insurance program, the reservation I hear most frequently is “I don’t trust the government.” This is an interesting response, since “we, the people,” are the government in a democracy. If you are committed to the belief that less government is always better and that all current government services should be privatized, than the current costly and inequitable health care system fits with your belief.
However, the majority of us realize that we depend on the government for protection and many services, which we do not want to give up, including national defense, police and fire protection and public education. Medicare, Social Security and Medicaid are the federal government programs for the elderly, poor, and chronically ill, and most recipients of these programs are satisfied with them: Witness the rapid demise of President Bush’s attempt to privatize Social Security.
People who say they don’t trust the government need to recognize that the United States already has a health care system in which the federal government currently pays for 60.5 percent of total health care spending. This amounts to government spending of $4,084 per person in our country; the other 40 percent is paid by individuals and employers. By contrast, total health care spending in Canada, which has a single-payer national health care program, amounts to only $2,337 per person. In addition to paying less, Canadians get more comprehensive care and have better health care outcomes.
Yet some people fear that a single-payer system would result in government control and intrusion into health care, resulting in “loss of freedom of choice.” This is ironic in our current era of managed care insurance, where workers have to accept the insurance their employers choose for them and where insurance companies decide which doctors and hospitals patients can use. The myth of “loss of control” with government administration of our health care funds is perpetuated by for-profit health insurance companies, pharmaceutical companies and “free market” ideologues, who do not want to see windfall health care profits disappear from the marketplace.
What are the facts to counter this myth of “loss of control” with a national health plan? First, under a single-payer health care program, there would be free choice of health care providers. Patients would no longer be forced to see the providers on their insurer’s panel in order to get health care benefits.
Doctors and patients together would manage the care a patient needs, rather than for-profit insurers who invade a patient’s confidentiality and are interested in denying care to increase their profits.
Second, providers would have a method to negotiate fees, which they do not have now under managed care, where insurers in corporate boardrooms decide the reimbursement rates.
Third, decisions about the taxes, fees and benefits for a single-payer health insurance plan would not be under direct government control but would be decided by a diverse board representing patients, providers, business and government. Single-payer health insurance would replace all current private insurance premiums, co-payments, deductibles, and any other out-of-pocket payments, with a modest 2 percent income tax on individuals and a 7 percent payroll tax on employers. For most people, this is less than what they now pay in private health insurance costs, and they would receive much more comprehensive coverage. The payroll tax would replace all other employer expenses for employee health care.
Rather than taking away control, a single-payer plan would improve the health and longevity of Americans, as shown in the health outcome measures of other countries with single-payer national health plans. This is because the priority of such a program is to provide comprehensive health care coverage for everyone. This stands in contrast to the priorities of the private health insurance companies. They try to avoid insuring people who are ill and avoid paying for health care benefits in order to make profits fo their shareholders and provide outlandish compensations for their CEOs, as much as $29 million per year.
Single-payer health insurance is not “socialized medicine.” “Single-payer” refers to a health care payment system, not a health care delivery system. Under a single-payer program, the government would simply take in money via taxes and pay benefits to heath care providers and hospitals. A total of $350 billion would be recaptured for health care by eliminating the private insurance industry, as administrative costs under the current system consume 31 percent of our health care dollars. Our current health care delivery system would remain in place, with private doctors and hospitals continuing to provide care for their patients. The government would not own hospitals and doctor practices, nor would health care providers be government employees, as they are in socialized medicine.
Too many doubters say that single-payer health care is not politically feasible and that incremental steps are the only possible way to try to reform our expensive and broken health care system. To paraphrase Dr. Steffi Woolhandler, a Harvard physician and co-founder of Physicians for a National Health Program, “Politics is not the art of the possible but the art of creating the possible. And what is possible is what people believe can be done.”
We, the people, are the government; we live in a democracy; and we need to exercise our political rights in order to access our health care rights.
