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Thursday, August 18, 2011

A Single-Payer Health System Is the Answer to Our Debt Woes

Political news has been dominated in recent months by debate about a "debt crisis" in the United States. Two leading newspapers now say the solution to our debt issues is apparent and relatively simple. But do the American people, and our leaders, have the will to see it through?

The answer, says the St. Louis Post-Dispatch in an editorial dated August 10, is a single-payer health system. The Charleston Gazette, in the capital city of West Virginia, followed up with a similar editorial on August 16.

If the editorial boards of two newspapers get it, why can't we say the same for leaders of our two political parties? The Post-Dispatch hints at the answer to that question:

If America truly is serious about dealing with its deficit problems, there's a fairly simple solution. But you're probably not going to like it: Enact a single-payer health care plan. See, we told you that you weren't going to like it.

Why does the P-D assume that people aren't going to like it? Probably because it knows that conservatives will portray single payer as a "big-government solution," and Democrats don't have the stomach to counter that narrative. Also, understanding the need for single payer requires coming to grips with some facts. And many Americans are too lazy to do that. The P-D lays it out in clear terms:

Everyone who has studied the deficit problem has agreed that it's actually a health care problem — more specifically, the cost of providing Medicare benefits to an aging and longer-living population. The bipartisan National Commission on Fiscal Responsibility and Reform reported last December: "The Congressional Budget Office (CBO) projects if we continue on our current course, deficits will remain high throughout the rest of this decade and beyond, and debt will spiral ever higher, reaching 90 percent of GDP in 2020.

"Over the long run, as the baby boomers retire and health care costs continue to grow, the situation will become far worse. By 2025 revenue will be able to finance only interest payments, Medicare, Medicaid, and Social Security. Every other federal government activity — from national defense and homeland security to transportation and energy — will have to be paid for with borrowed money."

What to do? The P-D lays out the options--and they aren't all that hard to understand:

That being the case — and nobody argues that it isn't — there are two broad ways for the government to address its spiraling health care costs. One, shift more of those costs to recipients, by trimming benefits and/or extending eligibility ages and indexing eligibility to personal income. This is politically unpalatable, particularly to most Democrats, President Barack Obama being a conspicuous exception.

The second way for government to address its health costs is not to shift them, but to reduce them. This is what a single-payer health care system would do, largely by taking the for-profit players (insurance companies for the most part) out of the loop.

Removing the for-profit players, of course, will bring howls of protest from their lobbyists. And that means we will continue to be held hostage by Big Insurance:

The advocacy group Physicians for a National Health Program estimates that "private insurance bureaucracy and paperwork consume one-third (31 percent) of every health care dollar. Streamlining payment through a single nonprofit payer would save more than $400 billion per year, enough to provide comprehensive, high-quality coverage for all Americans."

Once everyone is covered, the government would have the clout to bring discipline into the wild west of health care spending. It could insist that providers be paid for quality of service, not quantity. Health facilities and equipment could be managed by regional boards. Medical services could be "bundled" — rather than paying hospitals and doctors and laboratories separately, there would be fixed prices for treatments. And so on.

The Charleston Gazette notes that the Obama health-reform law is facing court challenges--and that could prove to be a good thing:

Some federal courts are ruling that America's breakthrough 2010 medical reform is kaput because government cannot force people to pay for health insurance. (Governments force people to buy car insurance. What's the difference?)

If the historic reform eventually is killed, we hope it leads to a better alternative. We hope America finally joins other advanced democracies by adopting a government-run "single-payer" universal health plan covering every citizen.

The Gazette provides additional insights into the causes of our debt problems:

America's federal debt nightmare has three obvious causes: (1) The gigantic U.S. military and foreign invasions that gobble $1 trillion per year. (2) Huge Republican tax giveaways to the high-bracket elite. (3) Snowballing Medicare and Medicaid expense as America's population ages.

Regarding the latter, enormous savings could be gained if America switched to a single-payer system. It would eliminate waste by commercial insurance firms, whose large staffs try to avoid paying medical bills. It also would extend medical insurance to millions of "working poor" families who lack it.

ObamaCare certainly is a step in the right direction. But the Gazette says it doesn't go far enough:

President Obama's 2010 reform compromised with many special interests and did a halfway job, extending coverage to 33 million more Americans. A complete single-payer plan would finish the crusade.

Oddly, conservatives who scream loudest about federal deficits also vow to destroy the 2010 U.S. medical reform. They would dump the 33 million Americans into jeopardy.

Most modern democracies have decided that health care is a human right, available to all. America should join them -- and save $400 billion a year in the process.

It will take an informed public, and leaders with spine, to get it done. Sadly, those qualities seem to be in short supply these days.


Anonymous said...

Even though it would likely mean the end of the for-profit insurance industry, I don't understand why American businesses aren't supportive of single-payer insurance. Paying for employees health insurance is most employers second biggest expense (after salaries) and it's their biggest impediment when compared to overseas businesses. If they could get rid of that expense it would make American companies more competitive globally.

Anonymous said...

Yeah - that'll work. The golden answer from 2 awful newspaper editorial boards. Removing profit will reduce cost? The government would then produce efficiency? Seriously? What historical evidence suggests the government can do anything efficiently? There's no incentive. It can't go out of business. There is no accountability. Open your minds. And the car insurance analogy...come on...people can choose not to drive. Government is not your daddy. Grow up.

Anonymous said...

To the second commenter, accountability and competence are big issues over here ... But they have single payer systems in France and Germany which seem to work in an accountable and competent way. are you saying that the US is inferior to the Germans and French?

Private companies have not only a motive to produce a profit but also a legal duty to do so, moreover they have a duty to ensure that profits increase year to year. This duty is to the shareholders, not the policyholders, and every dollar that the company can avoid paying for "medical cost" enriches the bottom line. Private insurers have a legal duty to minimize payment to policyholders as much as possible, and if they can hire a call center to givr people the runaround, they'll be able to put millions of dollars back in their bottom line