Clarifying what single-payer health care is and is not

By Howard Waitzkin
Taos News
Thursday, 18 July 2009

First I congratulate Justin Bailey, Erich Kuerschner, and all other people in the Taos area who are working hard to reform our health care system.

Although I support these efforts, I want to clarify what single-payer health care is and is not. In their articles, both Bailey and Kuerschner argued on behalf of a single-payer system but did not address several of its key features.

A single-payer health program basically would extend Medicare to the entire population. Although Medicare is not without problems, people over 65 years of age widely support the system and express satisfaction with it.

Under Medicare, the government occupies a very small role. The government collects payments from workers and employers and then distributes funds to health care providers for the services that Medicare patients receive.

Because it is such a simple system, the administrative costs under Medicare average between 3 and 5 percent, according to most studies. This small percentage means that the vast majority of Medicare expenditures pay for clinical services as opposed to administrative expenses.

On the other hand, private insurance generally shows administrative expenses between 20 and 30 percent. This much larger percentage means that about one quarter of every dollar spent on health care goes for administrative costs.

Many of these expenditures pay for activities such as billing, denial of claims, supervision of co-payments and deductibles, scrutiny of pre-existing conditions that disqualify people from care, and exorbitant salaries for executives (in many cases totaling between $10 and 20 million per year).

A single-payer national health program would achieve universal access to care by drastically reducing administrative waste. Because private insurance companies no longer could spend money keeping people out of the system, all of us would receive the care that we need without co-payments, deductibles, or other expenses at the point of service.

Under a single-payer system, the average family and the average business would spend the same or less than they currently spend on medical expenses.

Unfortunately, the Obama Administration and many of our Congressional representatives do not support the single-payer proposal, even though national polls consistently show that the majority of people in our country favor this approach.

The Obama administration has proposed a "mixed approach," which includes a "public option," organized along the lines of a single-payer system. However, the overall national health program would include the current private insurance industry and would therefore maintain a much higher level of administrative costs than a single payer approach.

Because the mixed approach will achieve much less savings by reducing administrative waste, the projected costs of the system have become prohibitive. Concern about these high costs has become the focus of the current debate in Congress.

On the other hand, there are two important bills in Congress that would achieve a single-payer system. In the House of Representatives, the bill is HR676, introduced by Rep. John Conyers and cosponsored currently by 85 other representatives. Sen. Bernard Sanders recently introduced a similar bill, S703, in the Senate.

These bills deserve our support because they truly would achieve a single-payer national health program that would guarantee universal access for all of us.

It is wonderful to realize that our own Rep. Ben Ray Lujan became a cosponsor of HR676 shortly after he entered Congress in early 2009.
Carlos Cisneros and Roberto (Bobby) Gonzales have introduced similar single payer legislation in the New Mexico Legislature.

Although Sen. Tom Udall did cosponsor single-payer legislation in previous sessions of Congress, he has not yet cosponsored 5703 since he entered the Senate this year.

Sen. Jeff Bingaman has not cosponsored S703, even though he generally supports improved access to health care.

President Obama consistently has argued that it is important to preserve the for-profit private insurance industry as part of his proposal – with even more tax subsidies for the industry. The Obama proposal essentially will compel families and individuals to buy insurance, from either the private industry or the government, with the poor assisted through a means-testing approach with huge administrative costs.

The mixed private and public approach has failed to achieve universal coverage in multiple states (most recently Massachusetts) and countries.

Let's focus our attention and organizing on the real single¬ payer approach, which is the only way to avoid the failure to achieve universal health care which has plagued us for so many years.

As Winston Churchill said, "Americans will always do the right thing - after they've tried every other option."

Howard Waitzkin, M.D., a professor at the University of New Mexico-Albuquerque, lives and practices medicine in Taos. He helped write the single-payer proposal of Physicians for a National Health Program, a professional organization with about 20,000 members This proposal led to the current legislative bills in Congress that would enact a single-payer national health program (HR676 and S703).