Time for universal coverage/single-payer system

By David M. Pratt
The Buffalo News, April 7, 2017

Contrary to what many U.S. citizens believe, research on health care outcomes shows that the United States has one of the worst health care systems in the developed world.

The 2000 World Health Organization (WHO) study on health care outcomes found that the U.S. ranked 31st out of 191 countries studied despite spending a greater percentage of its gross domestic product on health care than any other country. Per the WHO study, the U.S. ranked 39th in infant mortality and 36th in life expectancy.

In a 2014 study conducted by the Commonwealth Fund, the U.S. ranked dead last in overall health care outcomes in comparison with 11 industrialized countries. According to the Commonwealth Fund study, the U.S. ranked last in access, efficiency, equity and healthy lives.

The most pressing question is: Why do we get such poor outcomes despite spending so much? The answer to this question is related to the extraordinary sums we spend on administrative costs in the U.S. compared to other industrialized countries.

According to the Commonwealth Fund, administrative costs account for 25 percent of the health care dollar in the U.S. compared with an average of 12 percent in other developed countries. Lower administrative costs in these countries have been achieved through the use of a single-payer system, which is considerably more efficient than our multipayer system.

According to Gerald Friedman, Ph.D., professor of economics at the University of Massachusetts (2013), we would save $476 billion per year in administrative costs alone in a single-payer system.

In addition, nearly all other developed nations provide universal coverage, which has also been shown to be instrumental in reducing cost.

Universal coverage encourages preventive care, routine care and early intervention. In our system, the uninsured (or underinsured) delay care until there is a dire need, which is substantially more costly to treat. In addition, universal coverage provides negotiating leverage for various medical expenditures, most notably pharmaceuticals.

According to Friedman’s calculations, total annual administrative and pharmaceutical savings in a single-payer/universal coverage system would be $592 billion per year, enough to fund expanded coverage, improved benefits and enhanced reimbursements to providers.

We have recently experienced a tumultuous political debate on health care in the U.S. and still the recently proposed House bill pleased very few.

The best research we have indicates that the universal coverage/single-payer option is by far the most economical and clinically effective system. It’s time to be rational about health care in this country. It’s time to “make Americans healthy again.” We owe ourselves good health care. Cost can be manageable if we are willing to reconstruct our largely employer-funded, private insurance system. It’s time to reconsider adopting a universal coverage/single-payer system.

David M. Pratt, Ph.D., is a New York State licensed psychologist in private practice at Western New York Psychotherapy Services.