Why Obamacare should be changed to a single-payer system

By Eric Naumburg, M.D.
The Baltimore Sun, Feb. 29, 2016

Your editorial "Health care non-debate" (Feb. 22) points out some important facts about the American health care system that are often denied or ignored. The American health care system is not doing very well, yet we are paying a lot for the privilege.

America has by far the world's most expensive health care system, yet our outcomes are relatively poor. The U.S. ranks 53rd in infant mortality, consistently does poorly in studies of preventable deaths (19th of 20th in a recent study of wealthy nations) and American life expectancy is lower than most wealthy countries in Europe, Asia and Canada, where the governments guarantee — and to a great extent finance — universal health care.

In fact, among wealthy countries, we are the only one that does not have universal health care. In spite of the Affordable Care Act, there are still over 30 million Americans without health insurance — a known risk factor for early death — and many more who are underinsured.

High deductible health insurance policies plus the cost of premiums, co-pays and co-insurance often mean that people essentially can't seek medical care without having to give up other necessities such as food and housing. One proof of this sad fact is that the most common cause of personal bankruptcy in America is a serious medical illness.

There are a million or so medical bankruptcies per year, even though the majority of people who end up in medical bankruptcy had health insurance when they became ill. Most people don't realize they are underinsured until they get a serious illness. In countries with universal health care, this problem does not exist. People there are horrified by the concept of medical bankruptcy and consider it immoral and inhumane.

The American health system was not always a laggard. In the 1970s our costs and outcomes were very similar to Canada's. But then the Canadians passed single-payer, universal health care. Today, Canadian costs are two-thirds of ours, their outcomes are better, and everyone in Canada has health coverage with few, if any, out of pocket expenses.

The happened because two countries went in different directions: While Canada embraced a non-profit, publicly financed single-payer system, we in American increasingly chose a for-profit, privatized health system.

Another example of a natural comparison between a private versus a public system would be the privatization of part of Medicare, the Medicare Advantage program, where health insurance is provided by large for-profit corporations. Medicare Advantage's costs are greater and rising faster than the publicly run part of Medicare but the patients in the private system are healthier and should cost less.

In fact, much of the savings in the Affordable Care Act as originally written were expected to come from slowly ending the Medicare Advantage program. Instead, the opposite has happened; Medicare Advantage has grown dramatically. The American experiment with privatization of the health system needs to end. It has been an abject failure.

Whether the solution for the American health care crisis is single-payer — i.e. a government run and financed health insurance system — or something else, the bottom line is the system needs to be publicly financed, universal and delivered by a health system that is non-profit.

Universal means everybody in, nobody out and no financial barriers to getting necessary health care. We need to create a health care system where people are not one major illness away from personal bankruptcy; where everyone is able to get needed care without worrying about cost; and where decisions about health care are made based on science and the input of patients and physicians, not by private, profit-driven health insurance companies.

Dr. Eric Naumburg is co-chairman of the Maryland chapter of Physicians for a National Health Program. He resides in Columbia.