Single-payer system will cover everyone, save money and improve quality

By Laura Helfman, M.D.

PNHP note: The following is a letter that Dr. Laura Helfman sent to Sen. Bob Corker, R-Tenn., on May 23, 2014. 

Dear Senator Corker:

I am an emergency physician at Children’s Hospital (Erlanger) and a member of the Physicians for a National Health Program. I live in Coalmont, Tenn., in Grundy County where my husband has been a teacher for 28 years.

Although I was unable to join PNHP with their lobbying efforts yesterday, I wanted to let you know how I feel about our crisis in health care. I strongly support The American Health Security Act of 2013, Senate Bill S. 1782.

We have already seen in the first few months of the ACA (Obamacare) that competition is not keeping costs down. Out-of-pocket expenses have risen for all but a few Americans. An average family of four now spends more than $23,000 annually on health care costs, more than double what it was 10 years ago. This is unsustainable and unconscionable.

I think you will find that Republicans and Democrats of note are beginning to stand behind a public national single-payer insurance program which will cover everyone in America, save money and improve the quality of health care delivery. 

Senator Corker, I think you owe it to the people of Tennessee to critically look at this bill. I believe it is in keeping with your fiscal sensibilities as it eliminates waste and unnecessary administrative clutter. It is a sensible way to deliver health care. A healthier population will be a productive population. We cannot afford as a nation to continue to spend more than double the health care dollars than every other OECD nation and still have worse outcomes. The time is now to innovate for real change in health care.

Please review the synopsis of the bill below:

The American Health Security Act of 2013 (S. 1782) provides every American with affordable and comprehensive health care services through the establishment of a national American Health Security Program (the Program) that requires each participating state to set up and administer a state single payer health program. The Program provides universal health care coverage for the comprehensive services required under S. 1782 and incorporates Medicare, Medicaid, the Children's Health Insurance Program, the Federal Employees Health Benefits Program and TRICARE (the Department of Defense health care program), but maintains health care programs under the Veterans Affairs Administration. Private health insurance sold by for-profit companies could only exist to provide supplemental coverage.

The cornerstones of the Program will be fixed, annual, and global budgets, public accountability, measures of quality based on outcomes data designed by providers and patients, a national data-collection system with uniform reporting by all providers, and a progressive financing system. It will provide universal coverage, benefits emphasizing primary and preventive care, and free choice of providers. Inpatient services, long-term care, a broad range of services for mental illness and substance abuse, and care coordination services will also be covered.

A seven-member national board (the Board) appointed by the President will establish a national health budget specifying the total federal and state expenditures to be made for covered health care services. The Board will work together with similar boards in each of the fifty states and the District of Columbia to administer the Program.

A Quality Council will develop and disseminate practice guidelines based on outcomes research and will profile health care professionals’ patterns of practice to identify outliers. It will also develop standards of quality, performance measures, and medical review criteria and develop minimum competence criteria. A new Office of Primary Care and Prevention Research will be created within the Office of the Director of the National Institutes of Health (NIH).

The Program is designed to provide patient-centered care supported through adequate reimbursement for professionals, a wealth of evidence-based information, peer support, and financial incentives for better patient outcomes. The Program seeks to ensure medical decisions are made by patients and their health care providers.

The Program amends the tax code to create the American Health Security Trust Fund and appropriates to the Fund specified tax revenues, current health program receipts, and tax credits and subsidies under the Affordable Care Act. While the final structure of the financing component is still under consideration and is subject to change, the tax revenues in the draft include a new health care income tax, an employer payroll tax, a surcharge on high income individuals, and a tax on securities transactions.

The federal government would collect and distribute all funds to the states for the operation of the state programs to pay for the covered services. Budget increases would be limited to the rate of growth of the gross domestic product. Each state’s budget for administrative expenses would be capped at three percent.

Each state would have the choice to administer its own program or have the federal Board administer it. The state program could negotiate with providers and consult with its advisory boards to allocate funds. The state program could also contract with private companies to provide administrative functions, as Medicare currently does through its administrative regions. State programs could negotiate with providers to pay outpatient facilities and individual practitioners on a capitated, salaried, or other prospective basis or on a fee-for service basis according to a rate schedule. Rates would be designed to incentivize primary and preventive care while maintaining a global budget, bringing provider, patients, and all stakeholders to the table to best determine value and reimbursement.

Finally, the Program also relieves businesses from the heavy administrative burdens of providing health care coverage, puts all businesses on an even playing field in terms of healthcare coverage, and increases the competitiveness of American companies in the global marketplace. Every other industrialized nation has been able to use the power of a public authority to provide universal health care. The American Health Security Act of 2013 seeks to do just that for all Americans and their businesses.

Thank you for your time.

Laura Helfman, M.D., is clinical instructor at the UT College of Medicine and practices emergency medicine at Children’s Hospital in Erlanger, Tenn.