Letters to the Editor


Letter to The Kansas City Star, Sun, Jan. 26, 2003
AS I SEE IT: Single-Payer System Would Fix Health System


The United States’ health system is in crisis. Despite spending at least twice as much per capita as any other country, we have 41 million uninsured people, another 30 million underinsured, and everyone watching costs go up and our access down. Expensive high-tech care is available to some, but even basic and preventive care is often unavailable to many. Our national health indicators rank with the best of the third-world countries rather than the industrialized democracies.

This inequitable and costly situation is increasingly unacceptable to most Americans, including physicians and health policy experts. Many proposals involve maintaining much of our expensive and inefficient system and throwing in more money to cover some additional people.

In Canada (the country whose social and economic structure is most similar to our own), a single payer, the government, pays the bills while people are free to choose among providers of medical services, most of them in private practice.

Everyone is covered, regardless of income, age, employment status, or pre-existing condition. No one loses insurance if they lose their job or exceed their deductible. Hospitals are funded by global budgets worked out on an annual basis. Administrative cost savings to doctors and hospitals are enormous.

Those who observe that there are waits for some elective services in Canada are confusing how health-care resources are distributed (inequitably in the United States, equitably in Canada) and how much we spend on health care. Per capita, the United States spends twice what Canada spends and four times what Britain spends; if either country could afford to spend anything close to these levels, there would be no waits for any services in either country. What we lack is a structure that is rational and equitable, as is single payer.

And cost? A single-payer system would dramatically reduce administrative costs. Canada’s system has a 1 percent overhead and the U.S. Medicare system overhead is less than 4 percent. These compare with the greater than 20 percent overhead of our biggest HMOs.

Overall, administrative costs in the United States, including all paperwork and billing, are about 30 percent of our health-care budget. Reducing it to Canadian levels would save enough money to cover our uninsured. More than half of our health dollars are already tax-supported (Medicare, Medicaid, government employees, military, tax breaks to providers, etc.), and the new taxes needed would be offset by decreased insurance premiums and out-of-pocket costs.

The American people can demand a rational cost-effective system that provides equitable, necessary access to health care for all. Eliminating insurance industry profit and implementing a single-payer system can be a central part of this solution.

Joshua Freeman is chairman of the department of family medicine at the University of Kansas Medical Center. His opinions are not necessarily those of the university or the hospital. He lives in Kansas City, Kan.