Posted on August 7, 2007

Single-payer care deserves debate


Expanding Medicare best alternative to current system

Drew Richardson
The News Leader

The last time I wrote about filmmaker Michael Moore’s latest opus, “Sicko,” I stated that I believed the documentary succeeded in characterizing the dire circumstance of our broken health care system. Between the approximately 45 million uninsured Americans, the underinsured and the insecurely insured, most of our citizens are at some financial risk stemming from a medical catastrophe. This is in spite of America’s present large health care expenditures, costs that are rapidly outpacing general inflation and employee income. Even the business community has come to realize that it cannot support the interests of one business—the health insurance and broader health care industry—to the detriment of all other businesses. But what of proposed solutions?

Let’s look for a minute at the broad implications of various proposed plans for promulgating health care change in this country.

Although many plans on the table boast of universal health care, some merely have all citizens having some form of mandated health insurance. Only one piece of currently proposed federal legislation advocates universal and unrestricted access to health care. There is a big difference between having health insurance and having universal access to health care. The latter is what is referred to as a single-payer health care system and is essentially what Canada, Great Britain, France and Cuba (depicted in Moore’s film) have. Examples of the former category include such domestic plans as the Wyden Healthy Americans Act, the Stark/Edwards/Hackler Plan, and the Kennedy/Dingell Medicare for all (this latter is largely public with an optional private plan). Proponents of such plans talk of reasoned transition, shared responsibility, efficiency and consumer choice. Critics suggest that these plans suffer most importantly from offering no real structural change and therefore no reform to the present system. They leave the bureaucracy and upwardly spiraling costs of the insurance/health care industry largely intact. To add insult to injury, the hated complexities and downsides of means testing, co-pays, deductibles, exclusions, denials and appeals are all still there. Furthermore, these critics argue that, from a tactical and practical point of view, that the Rush Limbaughs of the world and the powerful and inflexible pharmaceutical and health insurance industries will not see these plans as any more acceptable than fully developed and pure single-payer health care.

So what is single-payer health care? Essentially it involves expanding the present Medicare system to cover everyone and eliminating private insurance (with the claimed accompanying savings of hundreds of billions of dollars). Additional features would include the absence of means testing, no concern for pre-existing conditions, the restoration of independent doctors and hospitals who negotiate with Medicare and would be chosen freely by consumers and one public agency processing and paying bills.

Because it would be unneeded with this system in place, the present Medicaid program for the indigent and its associated administrative costs would be eliminated. Proponents suggest that costs could be contained and quality maintained through more efficient review by the single insurer. Costs would be financed through a progressive income tax. Such a plan is represented in proposed legislation contained in House Resolution 676 that currently has 73 cosponsors in the House of Representatives.

Unfortunately, an opinion column is really no more satisfactory a vehicle than a movie for defining and contrasting health care proposals. Although I hope the former serves to challenge the mind and instill enthusiasm for more detailed consideration, my commentary must end with a recommendation for formal debate to occur at the Valley’s major universities. These would include large audiences and participating proponents representing notions ranging from a defense of the status quo to the most far-reaching plan of change. Representatives from the communities of consuming individuals and businesses should be included.

As I have said before, I believe we must move forward with ready dispatch, but I also believe we need serious thought replete with all the components of rigorous and open debate allowing for a full defense and critique of all ideas put forth. I believe voters in 2008’s presidential and congressional elections will demand such.

Dr. Drew Richardson is a retired FBI agent and cardiovascular physiologist. He teaches forensic science at James Madison University. Contact him at