IBM should support single-payer

Barre-Montpelier (Vt.) Times Argus, March 26, 2011

I was astonished when I read the rationale given by IBM’s John O’Kane in opposing the inclusion of IBM and other self-insured companies into the single-payer system the Legislature is attempting to craft.

His reason for opposition: Doing so would “introduce inequity among employers and introduce new administrative costs.”

I do not know what country Mr. O’Kane lives in. In case he lives in the United States, it’s really hard to see how he could fail to notice that many employers are scrambling to find affordable insurance policies for their employees, paying higher prices for ever poorer coverage, and that the inequity among employers is gaping. Many small businesses can’t find affordable coverage at any price. In the majority of states which don’t have community rating laws, employers can be severely punished for hiring ill employees.

They may be priced out of the market entirely. Meanwhile, in every other developed country (most every one has some version of a single-payer system), all employers are treated in an equitable, consistent manner, not punished for hiring individuals with chronic illness, and they pay far less for their employees’ health coverage than they pay here in the United States.

Consequently, support of single-payer systems among businesses in every one of those countries is virtually universal. In fact, I am not aware of IBM or any of the other companies mentioned in the article lobbying these other governments to change to a U.S.-like free-for-all insurance system.

And the argument that such a proposal would raise administrative costs would seem to locate O’Kane in some alternate reality. Currently, IBM’s employees may or may not accept coverage (e.g. if they can’t afford their portion of the premium, or receive coverage through their spouse or through Medicare), and if they refuse coverage and the employee fits into a specific category, then IBM may have to contribute to the Catamount fund. Newer employees may be in a category of “not yet eligible.” Some employees may opt for individual coverage, others for family coverage. By the way, over the last three years, a new cost-control strategy of large national companies has been to provide incentives — sometimes direct financial payoffs — to elect individual rather than family coverage, and raising premiums for family coverage much more than the employee contribution for individual coverage. Not exactly a step forward for the kids of the country.

On the other hand, if Vermont adopts a single-payer system, then all Vermont employees will be treated in the identical fashion. All employees — and their family members — are covered, and payments into the system are predictable. In fact, the system would be so simple, that it’s hard to understand why IBM would not be able to save money by reducing the staffing in their personnel department.

In contrast, the massive administrative burden the existing multi-insurer system imposes on every medical provider is orders of magnitude more complex than anything IBM could possibly be describing. Every one of these self-insured companies that doctors and hospitals contend with have different procedures for approving tests and X-rays, different billing procedures, different drug formularies, and different panels of specialists on the companies’ lists of preferred providers. And added to the complexity are the policies of Medicaid, Medicare, the other insurers in the state, the workers compensation insurers, retiree supplemental policies, etc. The necessity to hire so many employees in our billing and administrative departments forces us to boost the price of every medical bill we send to patients, and to insurers. IBM and Walmart also are paying for all our administrative employees.

In addition, if every Vermonter is brought into the single-payer system, the comprehensive single payer database will allow us to detect aberrant practice patterns and fraud much more easily than the current chaotic system allows. And we will be in a much stronger position to negotiate better prices for hospital beds, wheelchairs and perhaps finally stop paying 50 percent more than all the single payer countries do for prescription drugs.

So I ask IBM, Home Depot and other national companies to act in a way that will create a better future for Vermont by creating an affordable single-payer health care system. You haven’t been complaining in any of the other single-payer countries, why not support it here in the United States?

Dr. Marvin Malek is an internist working at Central Vermont Hospital on the hospital care team. He is a member of Vermont Physicians for a National Health Program.