By Don McCanne, MD
California Family Physician
Fall 2008
An efficient health care financing system should ensure that everyone receives the health care they need without facing undue financial hardship. Because of the millions of uninsured and the rapid expansion of inadequate underinsurance products, the burden of medical debt has become commonplace for all too many Americans.
Since affordability has become a major concern for most Americans, it is important to look at the true cost drivers that can be improved: deterioration in our primary care infrastructure, the overuse of non-beneficial, high-tech services, failure to establish a rational system of health care pricing, and the profound administrative excesses that waste financial resources that could be better spent on health care.
Our fragmented system of using a multitude of private and public payers is responsible for much of the administrative waste. Private insurers waste far more on administration than do public programs, but they all contribute to the costly administrative burden placed on the health care delivery system. Simply replacing this dysfunctional financing system with a single public insurance program would free up enough funds to expand reasonably comprehensive coverage to everyone.
Our fragmented system has also made it difficult to get our health care pricing right. Just think of what we pay for one MRI scan compared to what we pay for the initiation of a management program for a newly diagnosed diabetic. Or consider how we price pharmaceuticals compared to other nations. The administrators of a single, publicly administered financing system would have the ability to negotiate proper prices — high enough to cover legitimate costs and provide fair profits, yet restricting coverage for services without value, such as marketing or copycat drug research.
We will never be able to eliminate all non-beneficial high-tech excesses, but we are beginning to identify them more precisely. A single payer financing system could be used to realign incentives to discourage the excesses while making sure that appropriate high-tech services are delivered. Britian’s National Institute for Health and Clinical Excellence (NICE) program is a good start in that direction.
The most important affect that single payer financing would have on our health care delivery system would be to use incentives to reinforce our primary care infrastructure, thereby providing a medical home for everyone. There is no single step that would do more to bring us higher quality care while moderating spending excesses.
The private insurance industry wants to cover only the healthiest — primarily the healthy workforce and their young, healthy families — and turn those with significant health needs over to publicly financed programs. Acknowledging that their administrative services are expensive, they propose providing value by expanding their disease management programs. What could be worse than an intrusion into the medical home by a private insurance bureaucracy that siphons off health care funds that should be used for patient care?
A single payer national health program would provide all necessary care for everyone through a universal risk pool that is equitably funded through the tax system, without creating a financial hardship for anyone. It also very effectively addresses the problem of escalating health care costs, ensuring much greater value in our health care spending, beginning with providing each of us with a medical home.