By Joie Meissner, N.D.
Vital News, Summer 2013 (Seattle)
First introduced to the House of Representatives in 2003, H.R. 676, the national version of the universal single-payer health care plan, is very much like Medicare. One entity collects all the fees and pays all the clinics and doctors.
A single-payer plan eliminates the excessive administrative costs inherent in managing the thousands of different health care plans and organizations such as PPOs (preferred provider organizations), CDHPs (consumer directed health plans), HMOs (health maintenance organizations), and HSAs (health savings accounts) in our current multi-payer system. By streamlining all of these plans and carriers into one efficient system that contains checks and balances on hospital, drug, and device prices, a single-payer system would provide an estimated savings of more than $200-$300 billion annually.1,2 By controlling drug prices in a manner akin to that of other countries with single-payer systems, we could save billions each year on our drug costs.
Another result of combining all the current plans into a single, user-friendly system is that many health care providers and patients who submit their own claims (including naturopathic physicians and their patients) would spend less time haggling over insurance claims. Doctors would have more resources to devote to their patients, and patients would have more time to devote to their own health. As the legions of billing clerks at hospitals such as Duke University Hospital are reduced to manageable numbers, fewer resources would be expended on the financial overhead of health care. With less need for physicians to act as billing clerks, the quality of care provided to patients would be greatly enhanced. (More on this topic will be discussed in article 3 of this series.)
Whereas our current multi-payer private insurance system is run as a for-profit enterprise, a Medicare-style, universal single-payer system is a socially responsible health care plan designed to serve the public good.
Unlike our current multi-payer system under which 30 million Americans will remain uninsured after Obamacare is fully implemented in 2022, all Americans would be covered under a universal single-payer system.3 Since universal single-payer health care covers all persons regardless of their health status and is free at the point of care, it eliminates the current standard operating practices such as ‘cherry picking’ and ‘lemon dropping’, where health plans offer coverage to healthy patients and deny or restrict coverage to those whose needs are greater. Under a universal single-payer system, health care coverage would no longer be tied to employment and its cost would no longer be an incentive for employers to limit an employee’s work hours. Furthermore, medical bankruptcies would no longer be a commonplace phenomenon, but instead would become a relic of the past.4
Should a single-payer health care system be implemented, we would no longer be the only industrialized country in the world that does not provide some type of universal health coverage to its people.5 All Americans would be comprehensively covered for medically necessary services such as office visits, inpatient and outpatient services, long-term care, mental health, reproductive health care, dental, vision, prescription drug and medical supply costs which could include certain drugs, medical equipment; midwifery and natural medicines may also be included.6
Under a Medicare-style single-payer plan, patients would be able to see any licensed health professional of their choice, and most hospitals and clinics would remain privately owned and operated, receiving a budget from the NIH to cover all operating costs.7 Rather than imposing increased financial burdens on those most ill, everyone (including the healthier among us – the cherries) would be included in the insurance pool, such that the burdens of health care expenditures are more humanely distributed.
How Would We Pay for a Universal Single-Payer Health Care Plan?
Proposed single-payer systems place a strong emphasis on preventive care. In general, it is less expensive to prevent a disease or to properly manage a disease process that has already begun rather than provide treatment in its more advanced stages. Because providing access to preventive care would presumably lead to increased primary and secondary prevention of disease it would lessen the use of expensive heroic treatments like by-pass surgery, chemotherapy, and kidney dialysis and decrease the number of costly emergency room visits for routine care.
Studies have shown that a universal single-payer system could be successfully funded using monies currently paid into government health care programs (Medicare, Medicaid, trusts and other federal health care programs), along with increasing the personal income tax on the top five percent of income earners, instituting a modest and progressive excise tax on payroll and self-employment income, a modest tax on unearned income and a small tax on stock and bond transactions.8
By eliminating expensive governmental payouts to the privatized multi-payer system, recapturing tax loopholes to employers who provide health benefits, streamlining costs and enabling the ability to bargain down costs of goods and services, dismantling our current for-profit, multi-payer health care system would result in huge savings. Health care economist Gerald Friedman, PhD, reports that “While providing superior health care, a single-payer system would save as much as $570 billion now wasted on administrative overhead and monopoly profits. A single-payer system would also make health care financing dramatically more progressive by replacing fixed, income-invariant health care expenditures with progressive taxes.”9
The combination of capturing the money that the federal government now spends on health care, plus the modest tax increases, plus the savings from increased efficiency would finance a single payer health care system at reduced cost to most individuals, families and businesses. Additional revenue currently paid into state funded health care programs can also be used to fund a single payer system.
Health care economists have conducted studies for numerous states. Such studies demonstrate that switching to a single-payer model would lead to substantial savings. The latest of these studies, published in 2013 by economist Gerald Friedman, examined the economic effects of implementing a single-payer style plan in Pennsylvania. Results indicate that Friedman’s plan would reduce health care costs by 23%, saving $33 billion in 2014. Friedman explains that the savings would enable Pennsylvania to cover all residents and still save the state $17 billion, which he calculates would amount to a savings of $1,335/person. Another positive effect of this plan would be the creation of 120,000-200,000 new jobs in Pennsylvania.10 In the near future, Dr. Friedman plans to do a similar study in Washington State.11
For a quick summary of how single-payer health care works and how it can be funded, click the link below to watch this fun and informative 4 minute YouTube video http://www.youtube.com/watch?v=RAvy9jew9dM.12
What Is the Current Status of Single-Payer at the State and Federal Levels?
Many states have single-payer bills. For example, Vermont’s version of single-payer legislation was passed by both houses and the state is currently applying for a waiver (allowable under P-PACA/Obamacare) to implement a state single-payer system. In Washington, there is a single-payer bill, HB 1085, the Washington Health Security Trust (WHST). As licensed health care practitioners, naturopathic physicians are included in HB 1085. A hearing on HB 1085 that took place on February 1st of this year was very well attended by Washington residents who provided compelling testimony to our
legislature. Nevertheless, the bill did not get out of the House Health Care Committee, so the bill did not pass during the recent legislative session.13,14
Single-payer bills in most of the states have a number of advocacy organizations actively pursuing their passage. For example, Physicians for a National Health Program, Health Care for All, United for Single Payer and Health Care-NOW are single-payer advocacy groups maintaining chapters in Washington State and numerous other states across the country. Major proponents of these state bills are forging networking alliances with other social justice groups, funding research studies on the economic impact of state single-payer plans and pressing for the passage of H.R. 676, the national version of a universal single-payer plan.
At the federal level, H.R. 676, also known as the Expanded and Improved Medicare for All Act, was first introduced to the House of Representatives in 2003 and reintroduced again in 2009 and in 2011 by its author, Congressman John Conyers, Jr., D-MI. (Dennis Kucinich, D-OH, co-authored the bill.) At the time of its reintroduction in 2009, the bill had 88 co-sponsors. Congressman Conyers again reintroduced H.R. 676 on February 13, 2013. The bill currently has 46 co-sponsors.15
According to Quentin Young MD, a longtime advocate of universal health care, the “health-care-industrial-complex” has nearly 34% of our massive health care expenditures at its command to garner political influence and mount mass media campaigns to defeat the single-payer option.
Nevertheless, he maintains that polls show that the majority of the general public and conventionally trained physicians support a universal coverage system like single-payer.16
Physicians for a National Health Program of Western Washington, Health Care for All Washington and Health Care-NOW are a few single-payer advocate organizations in Washington State to contact for more information.17,18,19
Physicians for a National Health Program of Western Washington:
Health Care for All Washington:
If your congressperson is not already a co-sponsor, you can call or write him/her to see where he/she stands on this issue. Below is a link to Library of Congress Website that gives a list of H.R.676 co-sponsors http://beta.congress.gov/bill/113th-congress/house-bill/676/cosponsors20
Special Thanks To: Sherry Weinberg, MD, Don Bunger, Helen Thorsen CDP, Don Mitchell, MD, Jim Squire, MD, Marti Schmidt, JD, David McLanahan, MD, Kathleen Myers, DDS, Betty Capehart, Kathleen Randall, MA
References available here.
This article is the second of a three-part series. Part 3 of this article-“How Natural Medicine May Fare in the Universal Single-Payer Plans that Are Currently Being Proposed ” will discuss how natural medicine, naturopathic physicians and their patients could benefit from the implementation of single-payer health care plans that have been proposed with special emphasis on single-payer campaigns in Washington State.
Dr. Joie Meissner is a WANP member and primary care physician in Seattle’s Capital Hill area. Currently on the board of directors Physicians for a National Healthcare Program of Western Washington, her personal interests include food safety, securing a universal healthcare system and clinical research on multiple sclerosis at Bastyr University.