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Single-payer insurance is the way to go for ailing health care system
It has been nearly 50 years since the U.S. government implemented significant health care reform, providing insurance for all Americans over 65 through Medicare. Doctors were apprehensive toward government sponsored health insurance.
The AMA, which at the time still included a majority of U.S. physicians, led the opposition to Medicare, but did not prevail. Thank goodness. Currently, health care is treated as a privilege for the wealthy, those employed by the state or a large business, and for those over 65. Leaving everyone else uninsured is not just morally wrong, it is economically wrong. Over half of all bankruptcies are due to medical bills, and many of those bankrupted had insurance, but were underinsured with large deductibles or limited benefits.
In recent surveys, two-thirds of Americans have favored universal coverage. The dissenting third probably fears the cost of covering the 50 million uninsured. But as it is, the U.S. spends far more on health care than anyone in the world. We just don’t get much for our money.
For spending 16 percent of our gross domestic product, or over $7,000 per person annually, we rank last out of 19 industrialized countries in several standard health measures. We can afford universal coverage, but it is not affordable with our current system of multiple insurers. We need a new system.
Private insurance companies just do what businesses do — they make money. To maximize their profits, they avoid losses by cherry picking. They know that the healthier half of the population accounts for only three percent of the spending, so they want to sell premiums to them. The sickest 10 percent account for over half of the medical spending each year, so they deny them coverage whenever possible. And let’s not kid ourselves — each of us is going to end up in that sickest group someday.
Pluralistic insurance options will not work. We may soon prove it again at the national level, though it has been proven already by individual states many times: Oregon in the ’80s, our own TennCare in the ’90s, and the 2006 Massachusetts plan, which is failing now. Making it mandatory to buy health insurance does not make it affordable. We need single-payer insurance.
Single-payer is government-sponsored health insurance like Medicare. Single-payer is not socialized medicine — socialized medicine is government-owned hospitals and government-employed doctors such as in the military or the Veterans Administration. I have yet to meet a doctor who loathed his time in the military.
Recently I have seen several excellent primary care doctors leave practice in Kingsport for socialized medicine at the VA. Fortunately though, most doctors still want to be in private practice. What about choice? Single-payer would improve choice. No longer could insurance companies divide doctors and hospitals into exclusive, competing networks. Every provider would take your insurance because there would only be one insurance. What about rationing? We have rationing now. Your tests and surgeries can be denied, your medication choices are restricted. The cruelest rationing of all is that faced by the uninsured. Waiting times? Canadians are currently complaining less than we are. Last week I saw two patients who plan to wait over four years for Medicare before they seek needed services.
People often assume that, as a doctor, I oppose government-sponsored health insurance. I don’t. This may sound like treason to doctors who retired a generation ago. At that time I was starting a solo practice myself and felt like Medicare was the source of most of my hassles, but only a fraction of my patients. I miss those hassles, compared to today’s. In the past 25 years, health care has become a commodity to be bought and sold based on the ability to pay and not on medical need. Doctors and nurses are deprofessionalized as “providers” while patients are depersonalized as “consumers.” And still there is no market solution to our dysfunctional health care system.
A survey of 5,000 physicians published last year showed that 59 percent favored national health insurance, up from 49 percent just five years earlier. Only 17 percent of doctors were still strongly opposed. The American College of Physicians has advocated universal health care for over a decade. Their only debate has been whether to continue with a pluralistic system of private insurers, government payers and nonprofits or endorse a single-payer system.
In the past year, they have endorsed single-payer as a legitimate, if not preferable option. I estimate that my overhead would drop 15 percent immediately with single-payer. Doctors and hospitals commit substantial overhead costs to keep up with multiple carriers and their denials and varying benefit packages. It seems hospitals employ more billing clerks than registered nurses. On the insurance side, Medicare spends three percent on administrative overhead while private insurers spend from 15-27 percent additionally on marketing, shareholder profits, and salaries and bonuses that can individually exceed $10 million a year for each of their executives. It is estimated that over $350 billion would be saved by moving from our current system to an improved Medicare-for-all system.
That is enough to cover the 50 million uninsured Americans. Granted, single-payer will unmask some serious problems, like the impending collapse of primary care. Most internists and family physicians are at full capacity now and cannot absorb 50 million newly insured people. Nevertheless, it is the logical first step to provide a structure to improve our ailing health care system. Last year HR 676, the U.S. National Health Care Act, had 93 cosponsors. This year congressional Democrats, Republicans, and industry lobbyists did not even allow single-payer proponents a voice in the debate until the past month. Unlike a half-century ago, it’s not the doctors leading the opposition.
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The only changes we would likely see would be small with a single payer system .
You would go to the medical clinic and see a RN who would make an accessment order blood test or other test if it was not an emergency.
Then a doctor would take those test results and make a decision on your medication or care with you.
The only other changes would be a lot less hand holding.
Americans would need to bring a friend if they need someone to hold their hand. Just like Soldiers get medical care. It is good enough for Veterans then it is good enough for you !
I really don't get the opposition to a strong public healthcare system in the US. I just can't understand it, coming from a country which has a perfectly functional public healthcare system.
The term 'medical bankruptcy' is probably entirely alien in most countries. In the US it accounts for reportedly half of all bankruptcy. Many of those are people who were insured, but were dumped by their carrier when they became ill.
Thanks, Dr. Funke, for wasting ink and others' time. No need to even read this. Everybody knows you're a liberal so you're going to be carrying the water for Obama and his socialist policies. I sure hope you don't get seriously ill after this plan goes in to effect. You'll be wishing you had been on the other side of the issue. I promise you that.
A good example of government run health care is how well they are not taking care of our veterans through the Vererans Administration hospitals.
While visiting friends in Texas last year, my daughter had appendicitis. We were sent to the ER by a primary care physician with paper in hand stating that her appendix was near rupture.
We waited in the ER for 8 hours without being seen while non-English speaking hispanic after hispanic was ushered ahead of us for things ranging from runny noses to cuts on their fingers. It was not until the ER was emptied, that we were seen. It was one of the most stressful 8 hours of my life. The trauma nurse told us that they have to give top priority to the uninsured and none of those people will ever pay a dime. The high price we are about to pay will help to foot their bills. I was shocked.
It is illegal aliens that have driven up the cost of healthcare to the point that are benefits are shrunk to the point that we are all basically uninsured. If the law was changed that they only had to give life and death treatment to non-citizens to stop the use of the ER as a doctor's office, it would go a long way towards putting our system back to the way it was 20 years ago... the best in the world.
BTW, that 40+ million uninsured the one keeps throwing at is includes all those illegals.
"Clayton, it's not as if the US healthcare system has zero waiting time. And while doctors will generally treat anyone, they are going to have to pay one way or another. The uninsured end up getting lumbered with large and unexpected debts - and as I understand it often with 'penalties' for not being insured."
Dylan, you are mistaken because people without insurance are not penaltilized for not having insurance, but instead get a discount from the providers, and they do have to pay, but it can be done through monthly installments.
When it is written law that the government cannot negotiate drug prices, and lobbist are all over capitol hill, we are always gonna have problems health care. If Canada and Great Britian can take care of their citizens then there is no excuse for perscriptions in the U.S. to cost two and three hundred dollars a piece, but you go across the boarder to Mexico or Canada and pay ten dollars, then that says alot about money, congress and doctors.
Clayton, it's not as if the US healthcare system has zero waiting time. And while doctors will generally treat anyone, they are going to have to pay one way or another. The uninsured end up getting lumbered with large and unexpected debts - and as I understand it often with 'penalties' for not being insured.
Even those with insurance aren't safe. Insurance companies, above all else, are out to make a profit. They routinely deny coverage. If you contract a terminal condition chances are your insurance will drop you ASAP anyway - if your insurance is from your employer, then your employer will be pressured to fire you.
Profit making and healthcare are not good bedfellows.
As for waiting times - those things are generally massively overblown when they are brought up in this arguement.
The US already spends the more public money per-capita on healthcare than any other country and most people get nothing.
I define a suscessful system as one that provides the best health care for those that need it, when they need it.
It appears that with most countries that have government sponsored health care there is a waiting period, which in some instances can be deadly.
Also I believe the USA has some of the best health care providers in the world.
I personally know a person that does not have health insurance, but was not denied any care when they developed cavitial pneumonia. They were treated quickly and with great success, and are paying for the health care provided by the hospital and others, on the installment plan.
I know of no one that has been turned away when they were really in need of health care by any of our local hospitals, if they had insurance or not, and not put on a waiting list for that treatment.
I'm becoming more and more fascinated by Germany's system.
Just how do you define a sucessful (sic) system, Clayton?
Clayton, I think you are pretty seriously misinformed.
While many countries offer private medical insurance in additional to government coverage, pretty much the entire western world offers universal coverage.
There are many variances in how that is delivered, such as a fully socialised state-owned system all the way to a more familiar private-providers public-insurer as Dr. Funke suggests. For most countries the system is something of a middle-ground.
Where I live I can go to a fully state-funded hospital or clinic, I may have to wait a bit longer sometimes. Or I can go to a private provider were I will have to pay some portion of the cost (unless I have private insurance), but state insurance will cover a significant portion too.
I've had broken bones, blood poisioning, my wife has had two kids, including one pregnancy with serious complications requiring repeated hospitalisation, and to date I have paid out $0 for that treatment. I pay for some portion of most perscriptions and GP visits, but a small portion.
My tax rate for this (and all other state services) is still less than many US residents would pay on the same income.
As a former health care giver, I am shocked and saddened to see what has become of health care in America. $ 1. 4 million is being spent per day in DC by the health care lobbyists so your elected representative is getting taken care of and has quality health care we pay for and can't afford ourselves for our families, I know what is deemed, defended and supported in Tennessee and Virginia as quality health care and clearly profit care comes ahead of patient care. http://www.wisecountyissues.com/?p=62 MRSA ( methicillin resistant staphylococcus aureas ) is infesting our communities because filthy, uncaring hospitals and emergency rooms are breeding them and spreading them into our schools, homes, restaurants. How many more Americans' will be diseased or die while 74 % of Americans' are begging for health care reform ? More people died in America last year from MRSA complications than AIDS. When MRSA and a flu bug start mixing, it won't be pretty and we are being infected by the very health care system we depend on and trust to keep us safe and healthy.
The only problem seems to be that although some countries have attempted single payer government funded health care, to my knowledge, none of them has been sucessful.
Although I am not in favor of single payer government funded health care, if anyone can provide even one example of any country that has sucessfully implemented single payer government health care, I might reconsider.
Great piece Dr. Funke. One of the first really intelligent commentaries with documented research about the importance of a single payer system. Unfortunately, the power of the insurance companies will never allow this to happen.