Single-payer health system would cost less, provide more

By Katie Johnson
Post-Bulletin (Rochester, Minn.), Feb. 19, 2016

The presidential primaries have catapulted "Medicare for All," or a single-payer health program, back into the national debate about how to fix our chronically ailing health care system. There's no shortage of claims and counterclaims.

Here's a question that cuts through the chatter: If you were offered a health plan that guaranteed all the care that you need — including prescription drugs, dental, vision and long-term care — for no more money, and likely less, than what you're paying now, would you sign up for it?

What if such a plan also included free choice of doctor and hospital and also had no copays or deductibles?

Is this an unaffordable pipe dream? No. It's the reality of a single-payer national health insurance program, as outlined in H.R. 676, the Expanded and Improved Medicare for All Act. The bill currently has 61 congressional sponsors.

Studies have shown such a program, if enacted, would reap huge savings — about $400 billion annually — by eliminating all the wasteful paperwork associated with our current (and very complex) multipayer system of paying for care.

The money we'd save by setting up such a streamlined, nonprofit system would be plowed back into covering everyone, improving benefits and retraining insurance company workers into more socially beneficial tasks such as providing actual care.

It's not difficult to see why surveys have repeatedly found that two-thirds of Americans support this kind of "Medicare for All" approach when it's been explained to them. It's simple, efficient and equitable.

In the U.S., we spend $9,086 per person — that's 17.1 percent of Gross Domestic Product — on health care, more than any other developed country in the world. Despite this, we have mediocre health outcomes. Compared to 34 other democratic nations, we rank 27th in life expectancy, 24th in cancer mortality and 31st in infant mortality.

The situation is dire. About 45,000 Americans die annually due to their lack of insurance. Medical bills contribute to two-thirds of personal bankruptcies. These problems are unheard of in other developed nations.

We spend 31 cents of every dollar on administrative tasks, most of it waste. This includes insurance company paperwork, overhead, CEO salaries and profits, not to mention all the paperwork inflicted on doctors, hospitals and patients.

Private insurers' overhead ranges from 12 percent to 20 percent. In contrast, Medicare's overhead is about 2 percent, and Canada's single-payer system operates with about 1 percent overhead. So there would be big administrative savings right off the top.

Single payer is a national health insurance system in which a single public or quasi-public agency organizes health care financing, but delivery of care remains largely private. Single payer is an "everybody in, nobody out" system. Everyone is covered.

Single payer is not socialized medicine. Socialized medicine is publicly funded and publicly delivered, as in the British National Health Service or in our VA system. Single payer is publicly funded and privately delivered, much like Medicare works today for seniors.

The combination of public funding and private delivery ensures decisions about health care are made by you and your doctor — not by bureaucratic lobbyists, corporate influence or for-profit insurance companies.

Single payer is not Obamacare. Obamacare leaves profit-oriented private insurance companies at the heart of our system, with all the problems — denials of care, high overhead, siphoning of dollars away from care to corporate coffers — that entails. And Obamacare will leave an estimated 27 million Americans still without insurance coverage in 2025.

Single payer is not more expensive for families. A "Medicare for All" program would eliminate health premiums, deductibles, copays, co-insurance, replacing them with taxes based on ability to pay. One recent study shows 95 percent of U.S. households would end up saving money under H.R. 676 — and all would have ready access to care.

Educate your friends about single payer, and urge your lawmaker to co-sponsor H.R. 676. We'll save lives and money, and we have no time to lose.

Katie Johnson, a fourth-year medical student at Mayo Medical School in Rochester, is pursuing a career in pediatrics.