U.S. needs single-payer health care

By Hedda Haning, M.D. 
The Charleston (W.Va.) Gazette, June 29, 2012

Now that the U.S. Supreme Court has essentially approved the Affordable Care Act, including the individual mandate, what affect will it have?

It will make practically no difference at all. So take a big breath and settle down. We will still have an inadequate health-care system that costs too much and covers too little. We will still have people going without care or going underwater, even bankrupt, to obtain necessary care. We do not have the best health-care system in the world, and the law won't change that.

Skimpy health insurance policies will consume at least 9.5 percent of family income, but leave patients unable to access care due to high deductibles, co-payments, co-insurance and other out-of-pocket costs. Nationally, 78 percent of those bankrupted by illness or injury are insured at the start of their illness, including 60.3 percent who had private coverage.

That is because the health-care industry will still be in the hands of the private industry that makes its profit by collecting premiums and denying care. Private insurance also tells you which physicians and which hospitals you can use. Big Pharma provides our drugs with absolutely no limits at all on charges. The pharmaceutical industry uses federally supported research to develop new patented drugs that often provide little improvement over those already available but cost orders of magnitude more.

The act was modeled on Massachusetts' law. Six years after the Massachusetts law went into effect, the people are not happy. A June 11 poll in Massachusetts found 78 percent of patients say the cost of care in Massachusetts is a serious problem, and 63 percent say it has gotten worse. Patients report longer waits, higher premiums, higher co-payment and less satisfaction with care. That is private insurance, private health care. The number of bankruptcies due to medical illness and costs has continued to increase in Massachusetts.

Design of the act reflects political considerations, not sound health policy. As physicians, we cannot accept this inversion of priorities.

Instead of eliminating the root of the problem - the profit-driven, private health insurance industry - this legislation hands them $557 billion in taxpayer money through 2020. The total windfall to private insurers from the Affordable Care Act, including tax subsidies, consumers' share of premiums and overhead and profits on Medicaid managed care plans, is well over $1 trillion, according to a Bloomberg Government study.

The American people desperately need a universal health system that delivers comprehensive, equitable, compassionate and high-quality care, with free choice of provider and no financial barriers to access. Polls have repeatedly shown an improved Medicare for All, which meets these criteria, is the remedy preferred by two-thirds of the population. A solid majority of the medical profession now favors such an approach, as well.

How do we know it will work? We know because it works for the rest of the developed world, which pays much less, and gets much more.

By replacing the private insurers with a streamlined system of public financing, our nation could save $400 billion annually because unnecessary wasteful administrative costs will drop, going from 31 percent to 5 percent of our health-care expenditures. That's enough to cover all the uninsured and to upgrade everyone else's coverage without having to increase overall U.S. health spending by one penny. There is legislation before Congress (H.R. 676), the "Expanded and Improved Medicare for All Act," which would do precisely that.

There is no question that the government can tax individuals to provide services. That approach is clearly constitutional. Medicare is constitutional. That is why we physicians signed on to the amicus brief to say there is an alternative to the Affordable Care Act mandate.

Only a single-payer Medicare for All system offers effective tools for cost control like bulk purchasing, negotiated fees, global hospital budgeting and capital planning. And in a single-payer system, you pick your own caregivers. The government is the single payer, not the single provider. Think about plain Medicare and drop two words - "over 65."

For more information about single-payer health-care reform, see Physicians for a National Health Program ( and get active.

Dr. Hedda Haning, a retired physician in Charleston, is active with Physicians for a National Health Program and a signer of a friend-of-the-court brief in the Affordable Care Act case that was before the U.S. Supreme Court.