State needs single-payer health system

Birmingham News, Oct. 10, 2010

The cost of health care is out of control. We have to do something about it. Now.

As a nation, we spent about $8,000 per person on health care last year. That includes premiums, co-payments, deductibles and out-of-pocket payments for what insurance didn't cover. That's also the money employers didn't put into paychecks because they sent it to an insurance company.

It's also taxes. Medicaid is bankrupting many state governments, including ours, but health care costs also include taxes for the veterans medical system, military medicine and Medicare.

In 1970, health care costs were only $350 per person. Government experts expect the spending to rise to $13,000 per person by 2018, the year the major cost-controlling measures of the new health care law finally become fully effective. That would be more than $30,000 a year for an average family.

We can't afford to wait for the law to do whatever it's going to do to control costs.

Medical expenditures in Great Britain, Sweden and Spain are about $3,000 per person each year. The quality of health care in those countries scores very high in international comparisons; in some cases, higher than ours. People who live there are generally well-satisfied with the care they have.

America can follow their example and provide high-quality health care for everyone for about half of what we're spending now. What it would take is a publicly financed, national health insurance program like those in European countries -- a single-payer health care system.

Today, of every U.S. dollar spent for health care, 30 cents or more go to administration, most of it wasted on the paperwork and bureaucracy imposed by private health insurance companies. By comparison, the administrative overhead in the Medicare system is less than 4 cents per dollar.

We need the efficiency of a single, publicly financed health care system, like an improved form of Medicare, providing affordable, high-quality care for everyone. Medicare preserves the right to choose and change one's physician, fundamental to patient autonomy. Patients would be free to seek care from any licensed health care professional.

Our health facilities should be geared toward optimal patient care, not for optimal return to shareholders. Hospitals should operate as public service organizations, with regional planning agencies setting their global budgets, including their capital expenditures. This would eliminate most of today's irrational waste.

So, is this the way our country should go?

Doctors would like it. Physicians in single-payer countries live comfortably, much like physicians here. They have much less medical school debt, much lower malpractice insurance and wonderful freedom from hassles with insurance companies.

Patients would like it. We'd all pay a little more Medicare tax, but we'd be free of those sky-high premiums, co-payments and deductibles, and free of wrongful claim denials. We'd know that every one of us could get all of the care we really need, without favoritism and with no one left out.

Businesses would like it. No more double-digit premium increases each year to struggle with. No more worrying about the cost of health care for employees. Employers could get out of the health insurance business and back to doing what they know best.

A single-payer program would also give us powerful tools like the ability to negotiate fees and pharmaceutical prices, thus giving us long-term cost control.

States all across the country are looking hard at what the new health care reform law requires of them. Many states are also looking hard to see if a state single-payer option would make sense for them.

Alabama should be looking at a state single-payer option, too.

Wally Retan, M.D., of Mountain Brook is state coordinator for the Alabama chapter of Physicians for a National Health Program ( and Health Care for Everyone -- Alabama ( E-mail: