Forward to Single Payer Health Care

By Kay Tillow
Daily Kos, Jan. 17, 2016

A new day is breaking for single payer health care. This concept of publicly funded, universal health care, locked out of the national debate six years ago, has made it on stage in the presidential debates. Millions of people are hearing the concept of single payer (an improved Medicare for all) for the first time, and they like what they hear.

The December Kaiser tracking poll has reported that 58% of people support Medicare for All. Among Democrats the support is 81%, Independents 60%, and Republicans 30%.

Seven more Congresspersons signed on to HR 676 in December and January bringing the cosponsors on Rep. John Conyers’ HR 676, Expanded and Improved Medicare for All, to a total of 60. This is the model single payer legislation in Congress that would assure care to all with no premiums, no co-pays, no deductibles. All medically necessary care, including dental and drugs, would be covered. Everyone would choose their own physician and hospital—no more networks, preferred providers, or surprise bills from someone in the surgical suite who was not on your insurance company’s approved list.

The US is the only industrialized country that has not yet moved to a system of universal healthcare. That failure takes a toll on our health, our lives, our economy. The US pays over $9,000 per capita annually yet the median is under $4,000 in the countries that make up the Organization of Economic Cooperation and Development.

We pay more but get less. We rank 19th out of 19 countries in preventing deaths due to causes that were amenable to medical care. The US does poorly in life expectancy—51st in rank among the countries of the world. We live up to 4 years less than people in the countries that have universal health care systems. Our infant mortality rate is going up instead of down leaving us at 28th in the world. The US rate for maternal mortality is 12.7 per 100,000 live births. Canada’s is 4.8.

In terms of equality, the US has a long way to go. A study by Dr. Adewale Troutman and Surgeon General David Satcher found that there are over 83,000 excess deaths annually among African Americans. Employers whose workforce is predominately female can still charge higher prices for health coverage because of that fact. Insurers who sell on the exchanges can charge up to three times the regular premium because of age. The drugs and care crucial to those with AIDS, MS, epilepsy, leukemia, cancer, mental health and a host of other problems can be priced beyond the reach of patients. Discrimination has not ended.

In December of this year the Kaiser Tracking Poll reported that 46% of the population views the health care reform law passed in 2010 as unfavorable while 40% view it favorably. That is not all attributable to the crazed campaign of misinformation perpetrated by the far right. The very real problems that were not solved by the law plague us with differing impacts on various strata, but leaving no one truly protected. When the ACA is fully implemented, over 30 million will still be uninsured. That alone will bring us 30,000 unnecessary deaths per year.

While the uninsured numbers have diminished, the underinsured, those who nominally have insurance but cannot afford care, are increasing. Over 25% of the insured go without needed care because of the cost. That rises to 46% in low income families. Premiums rise by double digits. Deductibles are now in the thousands. Insurance is no longer a guarantee against bankruptcy. While the provisions of the ACA pour billions into subsidies to the insurance companies, care is priced beyond the means of far too many. Doctors and hospitals are off limits in the networks set up by the insurers who still control our system, and state insurance departments are unable to keep up with regulations.

We deserve better. Across the country and here in Kentucky the single payer movement is gaining support. The city of Vicco in Eastern Kentucky’s Floyd County passed a resolution endorsing HR 676. The city commissioners sent their resolution to Congressman Hal Rogers asking him to sign on. Boyle County has also passed a resolution for HR 676. So has the city of Louisville, the city of Morehead, and the Kentucky House of Representatives. This past year medical students at the University of Louisville organized a student chapter of Physicians for a National Health Program, and a group of their colleagues at the University of Kentucky are working to do the same. A campaign of outreach, education, and activism can win more hearts and minds to this real solution.

We have an immediate fight on our hands to block any backward steps in Medicaid expansion. The new governor has threatened to impose onerous conditions on this best part of the ACA, and all people of good will must demand that our Frankfort representatives stop the threat.

But the current health system will never cover us all, never end the denial of care, never stop the rationing based on the ability to pay. It’s your money or your life in this market-based system.

The costs for those who must purchase insurance will continue to increase. The deductibles and co-pays will rise. Employer-based insurance will continue to depress wages as employers shift more of the costs onto the workers. Cadillac plans are rare. We have mostly broken down junkers.

The essential difference between the US and other countries is that the insurance companies are at the center of our health care system. Their drive for profit is at the core of why health care is so expensive. Over 30% of US health costs are attributable to profits and administrative costs.

Insurance companies and their experts say the high costs are due to overuse of care. It just isn’t true. In the US we visit physicians half as much as those in other countries, and we spend fewer days in the hospital. All of the co-pays and deductibles and all of the cost control efforts written into the ACA are based on this wrong diagnosis.

Marcia Angell, MD, former editor of the New England Journal of Medicine, says that under our current market-based system, we cannot simultaneously improve care and lower costs. Improving care costs more. Cutting costs cuts care. To change those dynamics, we must cut out the cause of the problem—the profit-based insurance companies. That will allow us to remove the administrative wastes and profits and apply those funds to extending care to everyone and improving it for all. It’s the right thing to do! Let’s make it happen.

Kay Tillow is a leader of Kentuckians for Single Payer Health Care and the All Unions Committee for Single Payer Health Care--HR 676. She resides in Louisville.