Single Payer Health Care
By any measure, cost, cost per person, percentage of GDP, the American health care system is the most expensive in the world, but delivers very poorly on the investment. The World Health Organization rated the American system 37th in the world in health care delivery. Alone among industrialized nations the American system does not allow universal access, and cost is what prevents people from getting health care. 50% of bankruptcies in the United States are precipitated by health care costs.
The American system is a patchwork system, in which about 15% of the population is just plain left out, and many others have inadequate coverage or lose coverage as soon as they become ill. Every other industrial nation provides a simple framework that covers everyone with access to health care that they do not lose when something happens. Medicaid and Medicare provide a large percentage of the dollars in the system, but the controllers of the system, the controllers of what Congress does to modify the system, are the insurance companies and the drug companies. The lobbying and political contribution money on Capital Hill and at every state legislature work powerfully to keep a system funneling huge profits to selected players despite the clear indications that the system is failing the American people.
Study after study is conducted, report after report is issued, but the American system continues to get more muddled. More people fall through the cracks, insurance company profits continue to climb, and government spending to keep up spirals out of control. The insurance companies continue to buy Congressman with legalized bribes, so that the one thing that actually has a chance of making sure all Americans get the care they need without going broke is kept off the table.
We are dealing with several separate but related problems. One aspect is the cost of administration. Millions of dollars are spent dealing with the myriad of paperwork presented by a patchwork with hundreds of insurance companies and plans. Medical offices hire staff simply to deal with insurance companies. Standardized paperwork and standardized coverage would solve much of that problem, which also suggests the possibility of one unified system. Insurance companies also seem to make more money if they deny coverage, and a unified system would do away with that problem by covering everything.
Another aspect of the problem is that while we want doctors to determine treatment, not insurance companies, but as our culture becomes one in which greed becomes more and more the dominant element, in some parts of the country doctors are ordering unnecessary tests in order to line their pockets.
The incentives we currently have all serve to drive costs up and drive more people into bankruptcy. Just tinkering with this system is not going to solve the problem, mostly it will serve to make the rich richer and leave the rest of us ever more exposed to disaster, medical and financial. The only way to get the incentives right for low cost quality health care for all is to place that front and center in the system. In other words, cover everyone, have people pay according to their financial means, and do not pay doctors according to how many MRI’s they order. There are a variety of ways to achieve such goals. Many countries around the world cover everyone yet still deliver better health care than is found in this country. Some countries have a National Health Care system. Others have the government pay the costs based on tax revenues but doctors work in the private sector. Canada has a system that is run separately in each province. But the principle that there is one payer and that everyone is covered, and that you do not lose coverage when you are sick or not able to work underlies it all. Call it a single payer principle. And that is what the US needs if the 50 Million people who do not currently get proper care are to get care, if medical bankruptcies are to be eliminated, and the medical industrial complex is to no longer suck up resources that would be better employed in other parts of the economy.