The Only Humane and Affordable Option: Single Payer Health Care
By Marvin Malek Byrne
Times Argus and Rutland Herald
April 19, 2009
It looks like the federal stimulus money will be bailing out Vermont, so the health care cuts Governor Douglas proposed won’t be implemented.
So that will allow us to return to the status quo. Let’s all breathe a sigh of relief.
Now we can contentedly return to preexisting condition clauses, businesses unable to afford coverage for their employees, bankruptcies brought on by gaping holes in health coverage, high deductibles, vanishing access to primary care, 50,000 + Vermonters lacking coverage altogether, a dysfunctional system in which no one really knows what their health coverage will be like in 3 years.
A pretty sad state of affairs. Governor Douglas and his legislative collaborators characterize the Catamount program as a major advance. Remarkable, since it barely deserves to be looked on as a finger in the dike—it’s insuring only 0.8% of Vermont’s population.
The health care crisis is caused primarily by unsustainable levels of medical cost inflation. During Douglas’ tenure in office, health costs in Vermont have risen from $2.8 billion in 2002 to $4.2 billion in 2007—an unsustainable rate of increase, greater than the US as a whole nearly every year.
This has occurred despite the much touted “Chronic Care Initiative”—the lynchpin of Jim Douglas’ health care cost control strategy. This strategy has not and will not control costs. I have yet to meet a single doctor who believes it will control costs. And curiously, BISHCA—the state government’s prime financial department—doesn’t appear to believe in the chronic care initiative either: BISHCA predicts continued very high increases in health costs as far as the eye can see.
Four years ago, the governor was an unyielding obstacle to the enactment of single payer health care—the one type of health reform that would cover everyone in Vermont while actually reducing health care costs
When you try to tell most Americans that the act of providing quality health coverage to everyone in the population can reduce health costs, their skepticism is overwhelming. How could covering people who aren’t currently covered, while eliminating deductibles, preexisting condition clauses and other insurance company dodges actually reduce costs?
Here’s how costs are reduced:
First, when our entire population is in the same insurance pool, we are then in a strong position to negotiate better prices for wheel chairs, drugs, etc. This is why citizens in every other developed country spend so much less than we do for the same drugs.
Second, there is better planning of resources to meet population needs. Throughout the US, there are innumerable examples of proliferation of high cost services adding to overall costs—-these includes centers which only perform elective surgery (emergency surgery is a money loser for hospitals), excessive numbers of MRI and CT scanners, etc. On the other hand, the US has allowed basic services to deteriorate—we have a severe deficiency of primary care practitioners, and have seen the closure of emergency departments throughout the country, leading to life threatening crises.
Third, the care of individuals with chronic illnesses is better in the other developed countries: Single-payer systems have truly comprehensive databases to serve as a starting point, and people with chronic illnesses aren’t facing huge deductibles, inability to afford their medication, and even periods of no coverage at all as we face in the US. Vermont’s Chronic Care Initiative is a mere shadow of what we could have were we to create a single-payer system.
Finally—and most importantly—the absurd level of administrative costs in the US could be brought down to a reasonable level rather than eating up more than 30% of every health care dollar.
The possibility of providing lifelong coverage at far lower cost by bringing everyone into a single risk pool is not some ivory tower theory. Some version of this is the status quo in every other developed country. And that is why every other developed country provides universal health care for every citizen from cradle to grave at half of our per capita spending. And virtually all of these countries have far better health outcomes for their populations. It is also notable that despite fiscal crises as great or greater than what we’re facing in the US during the current economic downturn, not one country with a single-payer system is even considering cutting coverage.
Since achieving any health reform would be a massive political undertaking, it is tragic that Obama seems intent on achieving universal health coverage by building on the existing “system”. This is an error of historic proportion.
If President Obama implements universal insurance coverage with this model, within 4 - 6 years, we will see levels of federal debt that will make George W Bush’s deficits look like a minor car loan. We’ll see cuts in coverage, and the re-ascendancy of the Republicans—who will be able to correctly characterize the Democrats as irresponsible, and undoubtedly implement further cut backs (though they will offer no viable alternative approach to achieve universal coverage). We could be set back many years if the public at large develops the impression that universal coverage is inherently too expensive.
Senator Kent Conrad (D- N.D.) correctly refers to health cost inflation as the 800 pound gorilla threatening the long-term stability of our economy, forcing continued unsustainable borrowing from China, Japan, and other countries, leading to debt burdens that threaten our children’s and grandchildren’s well-being.
If Obama and the Washington Democrats pass universal health care using the existing system, we will all be eaten by the 800 pound gorilla.
Regardless of what health reform legislation is ultimately enacted in Washington, it will doubtless be financed jointly by federal and state governments. And if it actually does provide coverage to every Vermonter, it would do so at a vastly higher cost than the single-payer reform I described in this article. I don’t believe that we in Vermont can afford this much redundancy and waste.
Even though it will not be enacted nationally, there is good reason to believe that the Obama administration will adopt a supportive stance toward states attempting to create statewide single payer systems. The president has stated on many occasions that if he could start over creating a health system for the US, it would be a single payer system. Well, let’s let the president know that that is exactly what we want as well.
There are now bills in both houses of Vermont’s legislature (H100 and S88) and the US Congress (HR 676 and S703) which would give us single-payer health reform. Vermonters should contact their legislators to get them on board.
It’s time to broaden our vision and create an affordable and humane health care system.
We’ve waited long enough.
Marvin Malek Byrne, MD MPH is a general internist working in Barre, Vermont.