What About a Single-Payer System?
By Steffie Woolhandler
New York Times
Room for Debate Blog
August 10, 2009
“The Health Insurers Have Already Won” reads the cover story in Business Week’s Aug. 6 issue. That’s the short answer to why the public option option is off the table as well as to why the new bill will use an individual mandate to force the uninsured to buy private insurance. Or, more fundamentally, why Congress didn’t pursue the single-payer, Medicare-for-all approach used in other developed nations.
The public option was never single payer. Certainly, the option would have cut into private insurers’ profits (that’s why they killed it). But their profits — about $10 billion — are a fraction of what they waste on marketing (to attract the healthy); de-marketing (to avoid the sick); billing their ever-shifting roster of enrollees; fighting with providers over bills; and lobbying politicians. Doctors and hospitals spend billions more on paperwork, none of which the public option would save.
In contrast, single payer would eliminate private insurance, saving nearly $400 billion annually on insurance and provider paperwork, enough to cover the uninsured and plug the gaps in coverage for those with insurance.
In 2007, 62 percent of U.S. bankruptcies occurred in the wake of medical illness, and 77 percent of those in medical bankruptcy had health insurance (usually private insurance) when they first got sick.
Private health insurance is a defective consumer product, and Congress has no business forcing uninsured Americans to buy it.
In order to get the bill out of committee, Speaker Nancy Pelosi promised single-payer supporters, led by Representative Anthony Weiner of New York a floor vote in the fall. This is a tremendous victory for single-payer supporters like my group, the 16,000-member Physicians for a National Health Program. Members of Congress, many of whom say they personally support single payer, must now go on record on the eve of the 2010 electoral cycle. Constituents take note!
Steffie Woolhandler is a professor of medicine at Harvard Medical School, a primary-care doctor and co-founder of Physicians for a National Health Program.
http://roomfordebate.blogs.nytimes.com/2009/08/10/what-happened-to-a-public-health-plan/#steffie