Physicians for a National Health Program
April 28, 2003
Private Health Plans Versus Social Insurance: Implications for Health Care
Reform
by Don McCanne
Private health plans are responsible for much of the administrative waste that uniquely characterizes the health care system of the United States. And for this outrageous cost and inefficiency, these plans are providing highly flawed and inequitable methods of pooling funds and allocating health care resources. We are receiving remarkably little value from this very costly industry.
Yet the leading incremental proposals for health care reform call for an expansion of the role of private plans as a method of expanding health care coverage to more individuals. Because of the unacceptable inadequacies and high costs of our current system we will have major reform soon. But before we invest more resources into the health plan industry, we should review the policy implications to decide whether this would be a worthwhile investment.
An evaluation of funding through private health plans would not be complete without comparing this model with a model of public funding through social insurance.
Publicly funded systems of social insurance have a mission to allocate the health care resources as equitably and as efficiently as possible.
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https://pnhp.org/publications/private_health_plans_versus_social_insurance.php
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Many of the leading proposals for reforming health care would use individual or employer mandates along with tax policy to expand enrollment in private health plans. Many supporters of such incremental reforms understand the benefits of the single payer model, but they believe that it lacks political feasibility. They correctly believe that achievable modest steps are better than no reform at all. But they have to live with the fact that modest reforms have only slowed the rate of deterioration in our system, as the net result of incremental improvements has been a negative. Costs are up, more people are uninsured, under-insurance is epidemic, and portions of our health care infrastructure are threatened with insolvency. And since the newer models of health care coverage leave patients exposed to greater risk, coverage alone is no longer an adequate goal for reform. Our goal must be universal coverage that ensures both financial and health security.
It is no longer acceptable to debate merely whether or not single payer reform is feasible. The debate now must center on whether it is ethical to support reform that increases costs as it perpetuates inequities, or should the ethics of the health policy professions mandate support for an affordable, equitable, universal system of health care coverage? The onus of proving that it is ethical to support inequities and waste because of political feasibility must now be placed on those with lesser goals for reform.
Please use this article to help change the terms of the debate. Share it not only with our colleagues for their use in the debate, but also share it with those who would accept a lesser ethical standard for reform. Let’s end the debate over political feasibility, and begin the debate over the ethics of supporting reform that perpetuates and expands waste and inequities.
For health care justice for all,
Don McCanne, MD
President, Physicians for a National Health Program
www.pnhp.org
don@mccanne.org
Home telephone: 949-493-3714