St. Louis Post-Dispatch Editorial
St. Louis Post-Dispatch Editorial
August 19, 2003
Can 8,000 docs be wrong?
08/19/2003
LAST WEEK, nearly 8,000 doctors called for the government to toss our absurd private health insurance system out the window and establish single-payer national health coverage for everyone. They’re absolutely right.
The group included two former U.S. surgeons general, the former editor of the New England Journal of Medicine and a raft of medical school professors and deans.
They are frustrated at a balkanized system that wastes billions on bureaucracy and marketing, drives doctors to distraction, confounds patients and leaves 41 million Americans with no coverage at all.
The waste is painful. Blue Cross in Massachusetts employs more people to cover 2.5 million New Englanders than Canada employs to cover 27 million Canadians, the doctors group notes. Canada has a single-payer system. Like every other industrialized nation except ours, Canada provides medical coverage for everyone.
The doctors group, Physicians for a National Health Program (www.pnhp.org), thinks a single-payer system could save $200 billion a year. That might be enough to cover the uninsured at no extra cost.
But the politically powerful insurance lobby stands in the way. So do free-marketeers in Congress who think government always equals waste.
When it comes to health care, they’re wrong. American health care economics is capitalism turned upside-down.
The free market works because customers will shop for the best price and quality; that brings efficiency. But health care customers rarely shop based on price, because they’re not paying. Their insurance company or the government are picking up most of the tab.
This warped system leads to spectacular inefficiencies. Left on their own, doctors and hospitals can run up costs with little resistance from patients. To counter that, employers push managed-care insurance systems to leash the docs and hospitals. The insurers create astounding bureaucracies to make providers toe the line. The providers set up counter-bureaucracies to battle multiple insurance companies.
The upshot: Only 87 percent of the private health insurance dollar goes to medical providers, and much of that is eaten up by the providers’ counter-bureaucracy. Billing and administration eat up 26 percent of hospital revenues.
We have something close to a single-payer system for our old people: Medicare. Providers get 98 percent of each Medicare dollar, putting private insurers to shame. So why isn’t the whole country on Medicare? The 8,000 physicians are proposing something close, but better. There would be one government health insurer. The government would bargain a budget with each hospital and set rates for doctors. Naturally, the government would have the financial clout here. Costs would be controlled. And patients would have free choice, since all providers would be in the network.
Deciding how to pay for it would be a problem. But corporations and employees are already paying a mint for health coverage. A combination of taxes on employers and workers would do the trick.
Americans deserve health coverage they can never lose. Single-payer is an efficient way to get it.