Single-payer health reform: the feasible alternative
By Dr. Oliver Fein
The Progressive
September 10, 2009
President Obama sold single-payer health care short in his speech to Congress. It’s actually the only sensible solution to our health care crisis.
Obama said that a single-payer health care system would require us to “build an entirely new system from scratch.”
Not true.
We already have a working single-payer system.
For more than 40 years, single payer has served millions of American patients in the form of traditional Medicare. In essence, single payer is an improved Medicare for all.
Obama touted his plan as a way to reduce the escalating costs of health care in this country. But he’s exaggerating the amount of waste and inefficiency he can wring out of Medicare and Medicaid. And the Congressional Budget Office estimated that his plan would actually end up costing hundreds of billions of dollars.
But if we implemented single payer, the savings would be enormous. Medicare incurs approximately 3 percent in administrative overhead annually, compared to at least five times that figure in private insurance plans. If you factor in all the bureaucracy and paperwork inflicted on physicians and hospitals by the insurance industry, the administrative waste in our present system amounts to $400 billion annually.
By replacing the for-profit insurance companies with a streamlined Medicare for all, that $400 billion could be put back where it belongs: providing health care. The new system would basically pay for itself.
Insurance companies play no constructive role in providing health care. They do not give you a physical exam; they do not perform your surgery. What they do instead is fight claims, issue denials and screen out the sick, diverting huge sums away from much-needed care.
The savings rendered by cutting out private insurance companies and establishing a single-payer plan would be sufficient to cover everyone who lacks insurance now and to upgrade insurance for everyone else.
Our nation spends twice per person on health care as other industrialized countries do, but our health outcomes are significantly worse.
What gives? How can we spend more and get less than the rest of the world?
The answer is that most these countries have taken a fundamental step that we haven’t: the elimination of U.S.-style, for-profit private health insurance.
We should take that step.
Obama should have proposed a single-payer plan in the first place. Not that the path would have been politically easy. But single payer would have been easier to defend than the expensive, overly bureaucratic, patchwork mess that he is trying to sell to the American public.
It’s time for Congress acknowledge what patients and doctors across the country already know, that single-payer Medicare for all is the only way to achieve affordable and effective health care.
Dr. Oliver Fein is professor of clinical medicine and public health at Weill Cornell Medical College in New York. He is also president of Physicians for a National Health Program (www.pnhp.org).