Single-payer health care gains traction, local physician advocates

By Amanda Zhou and Kris B. Mamula
Pittsburgh Post-Gazette, November 23, 2017

When Rep. John Conyers, D-Michigan., introduced a bill in Congress in 2015 that would create a single-payer health care system, he picked up 49 co-sponsors.

In September, he had 120 co-sponsors when he introduced the bill again, reflecting the gains the idea has made locally and nationally for a privately delivered, publicly financed universal health care system that limits the role of health insurers.

“Everybody’s in. Nobody is out. No such thing as separate networks,” said Ana Malinow, a Shadyside pediatrician who has treated many children who didn’t have health insurance. “The way we get there is a single-payer health care system.”

Dr. Malinow, who served as president of the Chicago-based Physicians for a National Health Program in 2007, recently revitalized the Pittsburgh chapter of the organization, which has about two dozen physician members from the region. PNHP also has been collaborating with the Western Pennsylvania Coalition for Single Payer Healthcare, an organization founded in 2006 and chaired by veteran labor negotiator Ed Grystar.

“Our goal is to build a strong grassroots organization, independent of political parties,” Mr. Grystar said. “Just because you’re insured doesn’t mean you necessarily have access to health care.”

Over the years, a lack of health insurance has caused easily treated medical problems to instead reach a crisis, Dr. Malinow said.

She remembered two patients from her years working at Ben Taub Hospital in Houston, Texas. In one case, an infection spread up a child’s arm, requiring intravenous antibiotics because the parents couldn’t afford a prescription medication. Another child wound up in the intensive care unit for treatment of asthma because the parents couldn’t afford a prescription inhaler.

“I honestly knew nothing about the U.S. health care system,” Dr. Malinow said. “I just knew it was broken.”

The Texas Medical Association calls its state the “uninsured capital of the U.S.,” but Dr. Malinow said the problems in Texas are, in fact, endemic in the country’s health care system, where high insurance premiums, co-pays and deductibles put health care out of reach for many families.

Still, single-payer health care bills have been historically difficult to pass. Limiting the role of insurance carriers in the health care equation likely would encounter resistance, said Martin Gaynor, professor of economics and health policy at Carnegie Mellon University.

“If we thought the Affordable Care Act was a big transition, that’s nothing, that’s peanuts compared to this,” Mr. Gaynor said.

In 33 years of practicing medicine, pediatrician Scott Tyson said he has seen health insurance companies take a bigger role in medical decisions, which has not always benefited patients.

“The insurance industry has taken more and more of the power away from patients and providers,” said Dr. Tyson, who has offices in Mt. Lebanon, Peters and Robinson. “Getting the insurance industry out of the picture is the only way to control costs and give health care back to patients and providers.”

Single-payer health care is the norm for countries from Singapore to Canada to Germany, though each country has its differences.

While proponents point out that the United States spends more on health care per capita than most other developed countries yet scores worse when it comes to preventable deaths, life expectancy and child mortality, critics point to wait times and the lack of incentives for drug and treatment innovation under single-payer systems. In Canada, a Fraser Institute study found it takes around 8.5 weeks to see a specialist after visiting a general practitioner and then another 9.8 weeks to receive a procedure.

According to the Kaiser Foundation, 49 percent of the U.S. population is covered by private insurance and 35 percent is covered by Medicare, Medicaid or another form of public insurance. “Obamacare” reduced the uninsured portion of the population from 16 percent to around 9 percent.

For a Medicare-for-all option, the federal government could choose to expand Medicare Advantage plans, where the government contracts with private insurers to provide medical care, said Amelia Haviland, associate professor of statistics and health policy at CMU.

The option favored by Sen. Bernie Sanders, I-Vermont, would expand Medicare to include all citizens under 65 with additional coverage for dental, hearing and vision.