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12 ways PNHP members can work toward a single-payer national health program:
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What is Single-Payer? Single-payer is a term used to describe a type of financing system. It refers to one entity acting as administrator, or "payer." In the case of health care, a single-payer system would be setup such that one entity--a government run organization--would collect all health care fees, and pay out all health care costs. In the current US system, there are literally tens of thousands of different health care organizations--HMOs, billing agencies, etc. By having so many different payers of health care fees, there is an enormous amount of administrative waste generated in the system. (Just imagine how complex billing must be in a doctor's office, when each insurance company requires a different form to be completed, has a different billing system, different billing contacts and phone numbers--it's very confusing.) In a single-payer system, all hospitals, doctors, and other health care providers would bill one entity for their services. This alone reduces administrative waste greatly, and saves money, which can be used to provide care and insurance to those who currently don't have it.
All Americans would receive comprehensive medical benefits under single payer. Coverage would include all medically necessary services, including rehabilitative, long-term, and home care; mental health care, prescription drugs, and medical supplies; and preventive and public health measures.
Hospital billing would be virtually eliminated. Instead, hospitals would receive an annual lump-sum payment from the government to cover operating expenses--a "global budget." A separate budget would cover such expenses as hospital expansion, the purchase of technology, marketing, etc. Doctors would have three options for payment: fee-for-service, salaried positions in hospitals, and salaried positions within group practices or HMOs. Fees would be negotiated between a representative of the fee-for-service practitioners (such as the state medical society) and a state payment board. In most cases, government would serve as administrator, not employer. Financing The program would be federally financed and administered by a single public insurer at the state or regional level. Premiums, copayments, and deductibles would be eliminated. Employers would pay a 7.0 percent payroll tax and employees would pay 2.0 percent, essentially converting premium payments to a health care payroll tax. 90 to 95 percent of people would pay less overall for health care. Financing includes a $2 per pack cigarette tax. Administrative Savings The General Accounting Office projects an administrative savings of 10 percent through the elimination of private insurance bills and administrative waste, or $150 billion in 2002. This savings would pay for providing medical care to those currently underserved. Cost Containment The Congressional Budget Office projects that single payer would reduce overall health costs by $225 billion by 2004 despite the expansion of comprehensive care to all Americans. No other plan projects this kind of savings. Different Perspectives on the Benefits of Single-Payer Patients Each person, regardless of ability to pay would receive high-quality, comprehensive medical care, and the free choice of doctors and hospitals. Individuals would receive no bills, and copayment and deductibles would be eliminated. Most people would pay less overall for health care than they pay now. Doctors Doctors' incomes would change little, though the disparity in income between specialties would shrink. The need for a "wallet biopsy" before treatment would be eliminated; time currently wasted on administrative duties could be channeled into providing care; and clinical decisions would no longer be dictated by insurance company policy. Medical endorsements include PNHP (9,000), the American Public Health Association (30,000), American Association of Community Psychiatrists, Massachusetts Academy of Family Practice, American Medical Women's Association (13,500), Alameda-Contra Costa Medical Society, American Medical Student's Association, D.C. Medical Society, National Medical Association (6,500), American College of Physicians (Illinois Chapter), Long Island Dermatological Society, Islamic Medical Association, American Nurses Association, the Nurses' Network for a National Health Program, and the D.C. chapter of the American Medical Association. Hospitals The massive numbers of administrative personnel needed to handle itemized billing to 1,500 private insurance companies would no longer be needed. A negotiated "global budget" would cover operating expenses. Budgets for capital would be allocated separately based on health care priorities. Hospitals would no longer close because of unpaid bills. Insurance Industry The need for private insurance would be eliminated. One single payer bill currently in the House (H.R. 1200) would provide one percent of funding for retraining displaced insurance workers during its first few years of implementation. Business In general, businesses would see single payer limit their health costs and remove the burden of administering health insurance for their employees. Congress Single payer would be the simplest and most efficient health care plan that Congress could implement.
Organize a Town Hall Meeting in Eight Weeks PNHP Board Member, and Vermont Health Care for All activist Dr. Deb Richter helped organize three town hall meetings over a six-month period in Buffalo, New York. The hearings were attended by more than 500 health professionals and members of the public. Patients, doctors, nurses and other health professionals testified before city, county, state and federal legislators. Each town hall meeting generated considerable media coverage. These meetings were organized with only six committee members at an average cost of $250 per meeting.
-Planning- You will need approximately $300 for flyers, business cards, mailings and sound equipment. A contact person, preferably a health professional who can take calls from people who want to testify. It is best if this person is also on the working committee. Select someone to be the master of ceremonies. This person will have to introduce the legislators and those people who are testifying. This person should have a great sense of humor and be able to keep the audience engaged and alert with charisma, wit, charm and good timing. -At Eight Weeks- Pick a place to have your hearing. The location will determine the type of audience you will attract. We held our first meeting at the University of Buffalo and mostly doctors, nurses and health professionals showed up. The second one was in a church, where the audience was mostly the elderly. The third one was at a community college and we drew mostly students. Choose a focus for your hearing. Our first one concentrated on the problems associated with managed care. The second focus was on the un- and underinsured. The third focused on vulnerable populations, including the mentally ill, the chronically ill, and the underserved. Print business cards--at least 1,000. These should have the title, location, purpose of the event, and contact person's phone number. The cards not only serve to advertise the event, but are great for health professionals to pass around at work to patients and colleagues who may want to testify. Start collecting stories as soon as you can. Obvious sources are nurses, doctors, and health professionals from particularly hard-hit fields like psychiatry. We found we didn't have to go digging for these cases; most of them heard what we were doing and came to us. It is more likely that you will have to turn people away. That is why it is better to have a focus for your hearing. Send out invitations to legislators. We invited city, county, state and federal legislators and the state attorney general to our meeting. We had about ten appear at each meeting. In your invitation you should explain who you are and what the hearing is all about. -At Six Weeks- Print flyers and begin posting them in hospitals_particularly in places where doctors and nurses will see them. Divide up the names of the legislators amongst your core group. We had lists of the names, addresses and phone numbers of all the legislators printed up for each committee member. This makes it easier to go through. Call each legislator to be sure that they received the invitations. Many of them will try to weasel out of the event later if you don't make a follow-up call enough in advance. This way they know you know that they received information about the event. -At Four Weeks- Send a media advisory to all of the television, radio and newspapers in your area. This should include the who, what, when, where and why of your event. Try to get your local public radio or television stations to do a longer piece if you can. We had one TV station stay for the full two hours of our first event. Continue to collect stories. You should limit testimony to five minutes maximum. We required written testimony from everyone in advance. This forces people to be more succinct and is much more effective in getting people's stories across. We weren't completely successful at this but most people complied. Arrange for sound equipment. We had one microphone for the legislators, one for the master of ceremonies, and one for those testifying. You should also try to get someone to videotape and audiotape it. We had several legislators who were unable to attend ask us for copies of the tape. -At Two Weeks- Send another press release and follow it up with a phone call. Sometimes you can get an interview this way, especially with newspapers and radio. This serves two purposes-getting the message out and free advertising, especially if they run an advance story a few days prior to the hearing. Our local public radio station let me read my own radio essay about the destruction of medicine by managed care-two days prior to the event. They also announced the event several times during the day. Call any legislators who are not sure if they are coming or ones you haven't heard from, yet. -At One Week-Day of the Event- Call all of those who have agreed to testify to remind them of the time, place, date, etc. Remind them of the time limit of five minutes for their testimony. If they haven't already done so, get them to submit their testimony in writing. Send another press release. This one should include the names of the legislators who have confirmed that they will attend. It is also effective to include little sound bites of the stories they will be hearing. Example: A 19-year-old girl with a rare form of cancer will describe her experience with her insurance company when she was refused a vital treatment prescribed by her doctor. Call the media contacts again to see if they're coming. -Night of the Event- Get there at least one hour ahead of time. You will need at least three people to sign people in. We only had one person doing this at our first event and some people never signed in. We now have a mailing list of over 500 people who have attended our events. This is also a good chance to get people to sign the Call to Action. We enlarged some of the slides from the PNHP slide show to put up along the walls as people came in. This is very effective. Start on time. Leave a half hour or so at the end for discussion. We allowed questions and comments from the audience at this time. The legislators responded to questions and comments during the last half hour. Let people know you are part of a powerful grass roots movement. You are not going away. This is only the beginning for the single-payer movement in the United States. |