Is Universal Coverage enough?

by Ann Settgast, MD
Twin Cities Daily Planet Jan. 19, 2009

The upcoming change in administration has brought optimism and hope to the American public. Now is the time to demand meaningful healthcare reform rather than a replay of past failures. As a physician, I know that offering a placebo in place of known effective treatment is unethical. Hence, while I applaud the good intentions of Senator Tom Daschle, the Healthcare for America Now (HCAN) coalition, and others, I advise against their proposals to extend a system that is fundamentally flawed. In these times of economic uncertainty and crisis, single payer is the only fiscally responsible option for reform...and it is the only solution that will actually work.

Many physicians agree that the largest limitation to providing quality care to our patients rests in the structure of our current system. In an April 2008 survey in Annals of Internal Medicine, 59 percent of U.S. physicians said they would support government action to establish national health insurance.

Most Americans believe lack of health insurance is a "serious problem" (NPR/KFF survey, Feb 2008). Current reform proposals claim to be the way forward. However, expanding our flawed system will not solve the serious problems we face -- rising costs and lack of coverage (for uninsured and underinsured). Unfortunately, having coverage in our system does not guarantee care. One-fourth of the insured go without needed care due to cost; three-fourths of individuals bankrupted by medical bills had insurance when they became ill. Is this a system worth perpetuating?

Reform efforts such as those proposed by HCAN and outlined by Senator Daschle maintain a central role for private insurance companies, and are thus doomed to fail because they cannot control costs. They increase coverage only by increasing cost. These proposals duplicate key elements of reform efforts that have consistently failed: Massachusetts in 1988; Oregon in 1989; Tennessee, Minnesota and Vermont in 1992; Washington State in 1993; and Maine in 2003. In each case, rising costs foiled the reform effort, and none durably decreased the number of uninsured. Similarly, the 2006 Massachusetts law, which represents a mandate model of reform, is threatened by rising costs. While the number of uninsured MA residents has fallen modestly, 14% of residents in 2007 remained uninsured at some point in the year. Many MA residents cannot afford the "required coverage". A 56-year-old making $30,000 annually must spend $7,164 in premium and deductible alone. Today, hundreds of thousands of MA residents remain uninsured. Relying on government subsidies that cannot be sustained, and requiring people to buy insurance they cannot afford, is no solution. Such "reform" expands the role of wasteful private insurers, does nothing for the tens of millions underinsured, and relinquishes the colossal savings that would be achieved under single-payer.

Administrative costs in the U.S. health-care industry are a whopping 31% -- more than double that of most industrialized nations. The administrative costs of our private insurers are drastically higher than those of our current single payer (Medicare administrative overhead is less than 2%). This excess is squandered in medically unnecessary activities such as marketing, underwriting, and profit-making. Providers also have unnecessarily high overhead as they struggle to deal with hundreds of different plans. By eliminating this waste, a single-payer system will save our country an estimated $350 billion a year -- enough to provide comprehensive health care for all at no additional cost.

In conclusion, I urge the reader to be wary of doomed efforts that focus on lack of insurance and ignore the broader problems of access, affordability, and skyrocketing costs. Single-payer insurance is not socialized or government-run medicine. Care will be provided by private physicians and hospitals, just as it is now, but patients will have increased choice of providers because there will be no insurance meddling. They will also have comprehensive coverage coupled with freedom from the fear of financial ruin due to illness. H.R. 676, the U.S. National Health Insurance Act, has more than 90 co-sponsors in Congress more than any other health reform proposal. Successful implementation will effectively fix our broken system.


Ann Settgast, MD, is the co-chair of Physicians for a National Healthcare Program -- Minnesota Chapter. Originally published on 1/19/09