Forum asks: Is single-payer the future of Ohio health care?

By Michael O'Brien
The Athens (Ohio) News, Sept. 22, 2013

At a recent public forum, community members had the opportunity to learn more about single-payer health-care systems.

The forum was hosted by the Single Payer Action Network, Ohio (SPAN), a statewide coalition of organizations and individuals who say they're working to enact fundamental health-care reform that guarantees full and comprehensive access to a full range of medical services.

Insurance exchanges under the Patient Protection and Affordable Care Act (PPACA) are set to open Oct. 1 nationwide, making access to affordable health care a primary concern for many Ohioans.

Whether referred to as single-payer or Medicare for all, SPAN believes the current market-driven system is not sustainable. Under a single-payer health-care system like Medicare, medical service providers would be paid directly by the federal government.

During an opening presentation, SPAN Ohio Director Debbie Silverstein stressed that the issue of health care and the Patient Protection and Affordable Care Act evokes very strong emotions.

"We want health care to be there when we need it but what if resources aren't there? Obamacare is a good start but we're not done yet," Silverstein said. "Health care is a basic human need."

Proponents of single-payer systems cite reduced administrative costs in Medicare compared to those of for-profit medical insurance companies. Silverstein noted that since 1970, the health-insurance industry has seen a 2,500 percent rise in the number of administrative jobs compared to a roughly 100 percent increase in jobs for direct health-care providers.

Opponents to single-payer systems argue that Americans without health insurance are not denied access to care, citing federal law that requires hospitals to treat people without insurance.

Speaking in Cleveland in 2007, then-President George W. Bush addressed an effort in Congress to expand eligibility to State Children's Health Insurance Program (SCHIP), cited a common argument against government having a larger role in access to health care.

"I mean, people have access to health care in America. After all, you just go to an emergency room," Bush said. "I mean, think of it this way: They're going to increase the number of folks eligible through SCHIP; some want to lower the age for Medicare… to get more people to be a part of a federalization of health care. In my judgment, it would lead to not better medicine, but worse medicine. It would lead to not more innovation, but less innovation."

Silverstein used her own experiences to illustrate the difference between medical services in the U.S. and France, which provides universal health care.

While visiting a sister in France, Silverstein said she suffered a severe foot injury, the result of tripping on a curb. Despite her concern over the cost, Silverstein went to an emergency room at a Paris hospital.

"I was afraid I had broken my left foot," she recalled. "After some deliberation due to concern for cost, I did go to the emergency room. When I explained that I had fallen, the first question asked was 'Madame, when you fell, did you hit your head?' They then proceeded to evaluate my problem and get me checked in. My bill for the emergency room visit was zero."

Silverstein explained that her experience at an Ohio hospital was very different and illustrative of what many Americans experience when seeking medical care. Suffering from severe headaches, Silverstein sought care at a Cleveland hospital.

"I suffered a very bad headache that was unrelenting unless I was flat on my back," she said. "After six weeks, a friend suggested I try the Headache Clinic at the Cleveland Clinic. I called to make an appointment and started to explain my symptoms. I was interrupted and was asked if I had insurance. I had to go through the insurance verification before they were concerned about my condition."

The event's panel discussion included Silverstein, Ohio University professor of sociology Deborah Thorne and local health-care advocate Warren Hayden. All agreed that the negative economic impacts of medical debt are widespread even for people with insurance.

Thorne stressed that even the rich are not immune to the consequences of getting sick in American. In 2008, Thorne coauthored a book with now Massachusetts Sen. Elizabeth Warren titled  "Get Sick, Go Broke. Health at Risk: America's Ailing Health System-and How to Heal It."

Thorne said her research into medical bankruptcies shows 62 percent of all personal bankruptcies nationally result from medical debt, and 78 percent of the people involved had insurance at the onset of their illness. A follow-up study, focused on Massachusetts, which has a system similar to the ACA, showed little difference in the percentage of medical bankruptcies.

"Medical debt is a leading factor in 49 percent of home foreclosures, and medical debt is one of the leading reasons middle- and lower-income Americans cannot get financing to purchase a home," Thorne said. "The PPACA will not necessarily lower incidence of medical bankruptcy. Unless you're Bill Gates, you are not immune to medical bankruptcy."

As for the future of health care going forward, beginning in 2017, provisions in the PPACA would grant exemptions to states that develop plans similar to those in the health-care law including single-payer or Medicaid for all systems. SPAN sees this as an opportunity to enact a single-payer system in Ohio.

"Over 60 percent of all health-care costs in the U.S. are paid for by taxes," said Hayden. "When you look at Medicare, Medicaid, veterans, anyone who works for the government and a number of non-profits funded by the government, there are huge amounts of tax dollars already going into the system. We would not need a whole lot more because of the savings that would come about from a single-payer system."

SPAN supports on effort by Healthy Ohioans Work to place an initiative on the 2014 ballot that would force the state to expand Medicaid in Ohio and would put the state on the road to a single-payer system. Ohio is one of several states that have opted not to expand Medicaid coverage despite a guarantee of federal funding. Gov. John Kasich has pressed the Republican-controlled Legislature to act but the House and Senate have so far resisted the expansion.

At the close of the forum Silverstein expressed surprise that the audience did not raise the issue of individuals having to pay for someone else's health care.

"We are all in this together. We are a society, a community, and Americans have always cared about each other and have always cared for one another," Silverstein said.