By Jenna Dooley
Northern Public Radio, January 4, 2019
John Perryman is a pediatrician with Mercyhealth in Roscoe. He sees patients struggling to afford medications. Some families, he says, disappear for stretches of time when they fall off an insurance plan. On this week’s Friday Forum, Jenna Dooley talks with Perryman about his view as well as from a major opponent of the idea.
Perryman is northern Illinois co-president of Physicians for National Health Program, or PNHP. The organization supports single payer insurance, also known as “Medicare for all.” In this scenario, the government handles the expenses so private plans become obsolete.
Perryman says the issue wasn’t on his radar until the Bernie Sanders campaign. As he did more research, he found the data compelling. Sanders didn’t make it to the White House but pieces of legislation remain calling for an overhaul of the U.S. healthcare system.
“It’s, I shouldn’t say perfect,” Perryman said. “It’s just so much better than what we have now in terms of outcomes, cost control, things of that nature.”
But implementing such a system could cost trillions of dollars.
Perryman argues the country is already spending more than the rest of the globe for healthcare and the outcomes don’t always compare well.
“You would be shifting funding from many private insurers to the government, but even now government spending accounts for about two thirds of healthcare spending already,” Perryman argues. “So we’re about two thirds of the way there already. When you factor in the efficiencies that single payer brings, the administrative efficacies, which are massive, savings on drug costs, savings on certain types of medical service costs, the savings will either equal or exceed the expenditure with adding more people and offering more services.”
Perryman notes there are major insurance companies and pharmaceutical companies with clout in Washington that do not support the single payer proposals and will stall anything that tries to make major changes.
There are a lot of jobs associated with those entities; Perryman acknowledges it is a significant number of workers.
“The number of jobs you’re talking about, I believe it’s about 1.7 million jobs,” Perryman acknowledged. “But it’s about the number of people who get fired every month in this economy. And there are supports in place for those people, so they won’t just be left high and dry.”
There’s also the complexity of explaining a new system to patients. Perryman says the easiest way to explain the benefits of a single payer system is that is gives more control to patients.
“They could choose to see whoever they want to,” Perryman said. “The second is no out of pocket expenses. They don’t have a copay, they don’t have a deductible, anything like that. And that’s really important because that ends up limiting the amount of care that’s used when out pocket expenses are too high. So the two big practical things for them would be they don’t have to pay anything out of pocket and they can go where they want.”
So who or what pays for single payer?
“Taxes would have to make up for it,” Perryman said. “But with what we pay now in payroll taxes, we are already a good chunk of the way there. There would need to be some additional tax revenue somewhere. There are a variety of ideas in terms of what they would be. Perhaps a more graduated payroll tax, taxes on unearned income such as capital gains, state taxes, transaction taxes and stocks, things like that.”
Perryman says not overhauling the system leads to preventable deaths every day.
“What happens is [patients] don’t get the services they need. They don’t fill the prescriptions, they don’t go see the doctor. And there are tens of millions of people who fall into that category. So what ends up happening now with what we have is we have many people die and many people who suffer needlessly, or people who are bankrupted because of healthcare. So that’s why it has to change.”
But not everyone agrees that single payer is the magic bullet.
Robert Moffit is a senior fellow in Domestic Policy Studies at the Heritage Foundation, a conservative think-tank based in Washington D.C. He says it is a mammoth consideration because it would transfer all major decision making over healthcare to federal officials.
“In other words, there’s no alternative,” Moffit said. “If healthcare is an entitlement at the point of service, then, basically, government officials are going to make all the key decisions about who gets care, how they get care, when they get care, and under what circumstances they get care. So the key decisions in such a system are invariably political decisions.”
He fears medical decisions will be driven by budgets or government pricing outside of any kind of independent market.
“I think that that is likely to result in a highly impersonal and bureaucratic system of care delivery,” Moffit said.
Moffit acknowledges criticisms of corporate medicine, and says consumers should have more of a say in their healthcare plan.
“The fact of the matter is most Americans, for example, don’t pick their own health insurance plan or the benefits or the treatments or the medical procedures available to them,” Moffit said. “These decisions are all made by third parties.”
He argues that is the direct result of government policy which allows private insurers to make key decisions in what plans employers can offer.
“One of the arguments that my colleagues at the Heritage Foundation make is that we ought to basically change the fundamental structure of the system so people can pick and choose the kind of healthcare they want and carry it with them from job to job without a tax or a regulatory penalty,” Moffit said. “But the argument against third party payments is a good argument. The problem is that the Medicare bureaucracy is no more sensitive to consumer wants or needs than corporate health insurance.”
Moffit doubts any major overhaul will come in a single piece of legislation.
“The idea that you can solve the problems of the healthcare sector of the economy which is $3.5 trillion in one big bill — which is what President Obama really tried to do — is a huge mistake.” he said. “I don’t think that you can do it. I think the system is too big, it’s too complex to kind of try to do that. I do think we could make some very, very direct changes right now that would loosen things up a little bit and give people more options than they have today.”
For him, that includes giving states authority over insurance.
“Frankly, if California or Vermont or New York want to have a single payer system then they can do it,” he said. “But it will mean though that they’re not going to force the rest of us to finance it or bail them out.”
Moffit also belives individuals and families should have individual tax relief so they can purchase health insurance.
“And they can pick and choose the plan they want without a tax or a regulatory penalty, whether that plan is offered through their employer, or a trade association, or a religious organization, or any other type of group that would offer health insurance like a union or a fraternal organization,” Moffit said.
More consumer control, Moffit argues, would improve trust in the healthcare system.
“They can’t trust politicians. And I don’t think they can trust corporate executives,” Moffit said. “I think they should trust themselves and they should have the authority and the power over their own healthcare dollars and their own healthcare decisions. That’s a radical shift from what we have today where in fact you have no control over any of that.”
Like Perryman, Moffit says there are major obstacles to changing the existing structure.
“An awful lot of people do very well by defending and protecting the status quo,” Moffit said. “If you do not have to face intense competition for goods and services that you’re providing, that’s a pretty good situation.”
Both men agree systemic change is needed, but admit it will be difficult to achieve in a single sweep given competing interests in Washington D.C.