This is the beginning of a series of diaries to explain what single payer national health insurance is, and what it is not. Many Americans, even Kossacks, are confused as to what single payer or other forms of universal coverage are about, and have bought into, maybe even subconsciously, too many false beliefs regarding our current "system."
In discussing this issue, the most important piece of information to hold on to, is that:
EVERY OTHER DEVELOPED COUNTRY IN THE WORLD
ALL THE OTHER WESTERN CAPITALIST DEMOCRACIES
EVERY SINGLE ONE
...has SOME form of universal health coverage for their citizens. Only the United States does not.
They differ from each other in how they do this, and the mechanisms and details do matter... Canada is different from the U.K., is different from France is different from Germany, Japan, Austalia, Taiwan, etc... But only the United States does not have something. Remember that whenever somebody says, "yes... but..."
Most of the material comes, with permission, from an organization of which I am a longtime member, Physisicans for a National Health Program, a single issue organization advocating a universal, comprehensive single-payer national health program. PNHP has more than 14,000 members and chapters across the United States. Since 1987, we've advocated for reform in the U.S. health care system. A large part of our work involves educating health professionals about the benefits of a single-payer system--including fewer administrative costs and affording health insurance for the 46 million Americans who have none. Our members and physician activists work toward a single-payer national health program in their communities. PNHP organizes rallies, town hall meetings, and debates; coordinates speakers and forum discussions; contributes Op-Eds and articles to the nation's top newspapers, medical journals and magazines; and appears regularly on national television and news programs advocating for a single-payer system.
An Overview Introduction to What We Mean By Single Payer
Single-payer national health insurance is a system in which a single public or quasi-public agency organizes health financing, but delivery of care remains largely private.
Currently, the U.S. health care system is outrageously expensive, yet inadequate. Despite spending more than twice as much as the rest of the industrialized nations ($7,129 per capita), the United States performs poorly in comparison on major health indicators such as life expectancy, infant mortality and immunization rates. Moreover, the other advanced nations provide comprehensive coverage to their entire populations, while the U.S. leaves 46 million completely uninsured and millions more inadequately covered.
The reason we spend more and get less than the rest of the world is because we have a patchwork system of for-profit payers. Private insurers necessarily waste health dollars on things that have nothing to do with care: overhead, underwriting, billing, sales and marketing departments as well as huge profits and exorbitant executive pay. Doctors and hospitals must maintain costly administrative staffs to deal with the bureaucracy. Combined, this needless administration consumes one-third (31 percent) of Americans’ health dollars.
Single-payer financing is the only way to recapture this wasted money. The potential savings on paperwork, more than $350 billion per year, are enough to provide comprehensive coverage to everyone without paying any more than we already do.
Under a single-payer system, all Americans would be covered for all medically necessary services, including: doctor, hospital, long-term care, mental health, dental vision, prescription drug and medical supply costs. Patients would regain free choice of doctor and hospital, and doctors would regain autonomy over patient care.
Physicians would be paid fee-for-service according to a negotiated formulary or receive salary from a hospital or nonprofit HMO / group practice. Hospitals would receive a global budget for operating expenses. Health facilities and expensive equipment purchases would be managed by regional health planning boards.
A single-payer system would be financed by eliminating private insurers and recapturing their administrative waste. Modest new taxes would replace premiums and out-of-pocket payments currently paid by individuals and business. Costs would be controlled though negotiated fees, global budgeting and bulk purchasing.
Key Features of Single-Payer:
• Universal, Comprehensive Coverage:
Only such coverage ensures access, avoids a two-class system,
and minimizes expense
• No out-of-pocket payments:
Co-payments and deductibles are barriers to access, administratively
unwieldy, and unnecessary for cost containment
• A single insurance plan, administered by a public or quasi-public agency:
A fragmentary payment system that entrusts private firms with
administration ensures the waste of billions of dollars on useless
paper pushing and profits. Private insurance duplicating public
coverage fosters two-class care and drives up costs;
such duplication should be prohibited
• Global operating budgets for hospitals, nursing homes, HMOs and other
providers with separate allocation of capital funds:
Billing on a per-patient basis creates unnecessary administrative
complexity and expense. Allowing diversion of operating funds for
capital investments or profits undermines health planning and
intensifies incentives for unnecessary care (under fee for service)
or understatement (in HMOs)
• Free Choice of Providers:
Patients should be free to seek care from any licensed health care
provider, without financial incentives or penalties
• Public Accountability, Not Corporate Dictates:
The public has an absolute right to democratically set overall health
policies and priorities, but medical decisions must be made by
patients and providers rather than dictated from afar. Market
mechanisms principally empower employers and insurance bureaucrats
pursuing narrow financial interests
• Ban on For-Profit Health Care Providers:
Profit seeking inevitably distorts care and diverts resources from
patients to investors
• Protection of the rights of health care and insurance workers:
A single-payer national health program would eliminate the jobs of
hundreds of thousands of people who currently perform billing,
advertising, eligibility determination, and other superfluous tasks.
These workers must be guaranteed retraining and placement in
meaningful jobs.
Tommorrow we will go through some of the Facts and Myths regarding Single Payer.
You can also scroll towards the bottom after clicking on this linkto get more specific information on the details of single payer.