Single Payer, By Default
San Diego Physician
February/March 2006
Single Payer, By Default
By Don McCanne, M.D.
(Editor’s Note: Though Dr. McCanne’s article is not the position of the San Diego County Medical Society, it will - it is hoped - stimulate discussion.)
Regardless of personal ideology or political persuasion, everyone in the policy community understands the strengths of the single-payer model of national health insurance. It would provide truly comprehensive coverage for absolutely everyone while putting into place mechanisms that would slow the rate of healthcare inflation.
There is no mystery about how this would be accomplished. Coverage would be automatic for everyone, from birth on. All reasonable, beneficial health services would be included. The current, highly inequitable mechanisms of funding care would be replaced with a single, equitable system of public funding. Numerous micro-simulations and the experiences of other nations have confirmed that replacing our highly inefficient, fragmented private and public insurance systems with a single, publicly administered program would free up more than enough wasted funds to pay for the deficiencies in healthcare coverage today.
The real task before us is to ensure that the large number of us who are healthy pay into a fund that covers care for the 20 percent of individuals who use 80 percent of health services. The most equitable method of doing that would be to establish a single risk pool. A multi-payer system might work, but it would have to be so tightly regulated that it functions as a single-payer system. Furthermore, micro-simulations have shown that multi-payer systems are the most expensive method of achieving universal coverage, whereas a single-payer system actually reduces healthcare spending.
We’ve tried most everything else, but high costs and fragmentation grow worse. Current trends, including CDHC, will only compound the problems. Employers and patients want something done now. More voices are joining the call for a “national solution.” The nation is growing weary of waiting for someone to come up with a better solution. Since there really isn’t any, we will soon have a single-payer program of national health insurance, even if only by default. Once Americans become comfortable with it, they will be as supportive as they are of our other social insurance programs: Social Security and Medicare.
For the full article (1200 words, single page):
http://www.pnhp.org/PDF_files/singlepayerbydefault.pdf
Comment:
By Don McCanne, M.D.
Reform advocates may find this single-page article to be useful as a handout to explain to others why national health insurance is inevitable.