Single payer system is path to universal care

By Bill Roy
Topeka Capital-Journal
Saturday, June 21. 2008

At the end of a long presentation outlining new services, new doctors, new facilities and a growth in income this year at a rate greater than the growth of the economy, Dr. Kent Palmberg, the unusually savvy and successful senior vice-president and chief medical officer of Stormont Vail HealthCare, sighed and quietly said, "I'm not sure where all this is going, but we'll probably end up with something like Medicare for all."

He added, "I'm not sure that's all bad. They pay promptly, predictably and adequately, with a minimum of paperwork. That beats costly fighting with scores of insurance companies, plus caring for the many uninsured."

Palmberg's audience was about 35 retired physicians, men and women who had provided good medical care for Kansans over some, or all, of the last 50 years, and who participated in the unprecedented growth of our profession.

I watched closely. None flinched, none shook his head or raised her hand to register an objection.

Their probable attitudes coincide with a 2007 study published in the Annals of Internal Medicine that found 59 percent of physicians in the U.S. support "government legislation to establish national health insurance," up 10 percent in five years.

Palmberg, who oversees the nearly 170 physicians who provide care at 23 locations in Northeast Kansas, also was affirming the December 2007 endorsement by the American College of Physicians, medicine's largest specialty society, of a single payer national health system as "one pathway" to universal coverage.

Dr. C. Anderson Hedberg, president emeritus of the 124,000 member ACP, was quoted as saying, "This new proposal by the ACP brings single payer into the mainstream. It's the logical next step."

Dr. Marcia Angell, former editor of the celebrated New England Journal of Medicine, came on stronger, "There's only one choice for universal health care at a cost we can afford, and that's single payer, Medicare for all."

It has never been a secret that a single payer system is the most economic, efficient and fair way of providing universal care.

But Harry and Louise, the deceptive but effective 1993 television creation of the Health Insurance Association of America, so greatly intimidated legislators and their staffs that they crawled into a non-policy corner 14 years ago and have never come out.

During the fateful early 1990s when Hillary and Bill Clinton were fighting for universal care, the Journal of the American Medical Association under the courageous editorship of Dr. George D. Lundberg scored possible health care reforms by set criteria, and the single payer system was by far the best.

Lundberg kept his job, but the AMA did not buy the study results.

Closer to home, just last year the Kansas Health Policy Authority paid good money to the Schramm Raleigh Health Strategies to help them with ideas to present to the Legislature for health reform.

The Arizona firm provided cost estimates for several reform measures based on Kansas health expenditures of $8.228 billion in 2004-2005.

They calculated universal coverage using current payment mechanisms would cost $8.7 billion.

But a single payer system that eliminated insurance carriers could provide universal coverage for $7.4 billion.

The staff and board of KHPA chose not to present the Schramm and Raleigh single payer-universal coverage proposal to the 2008 Legislature, probably not wanting to embarrass their clients, the legislators and Gov. Kathleen Sebelius.

But pressure is building. Some day shifting public opinion and looming personal, business, state and federal bankruptcies will make elected officials consider a single payer-universal care system, which, in one form or another, has been adopted by every other industrial democracy, many of which have healthier populations that live longer. All spend substantially less.

Dr. Bill Roy is a retired physician and former member of Congress. He has a law degree and lives in Topeka. He may be reached at