Why Single Payer is our Only Affordable Choice

Some of our Health Care institutions are the best in the world at what they do. If you want to separate conjoined twins we can do it. Technically we are the best.
But measured by outcomes, our so called health care system is one of the worst in the world. Last check impoverished Cubans have a longer life expectancy and a lower infant mortality rate than we do. Yet we spend far more per capita on health care than any other country in the world. If this is a system, it is extraordinarily inefficient.

I suggest we do not have a health care system at all. We have a number of subsystems designed to benefit limited groups of participants. The largest Government run subsystem is the Medicare System designed to care for the elderly. This is the most efficient system in the country in terms of delivering medical treatment with a low overhead cost of 3.6%. Each HMO constitutes a health care subsystem with an average overhead cost of 11.7%. The overhead cost of the Canadian Government run health care system is 1.3%. Because we spend so much more per capita, if we spent the money we now devote to health care as efficiently as Canada or Britain, every American could enjoy health care far superior to what they have.

Why then do we have this outcry about the potential cost of health care reform?! That is because all the proposals on the table keep the present system intact. Therefore the cost of covering the 45 million uninsured and filling the gaps in HMO coverage that cause many thousands of bankruptcies each year will be expenditure additional to what we already spend. That means spending much more per capita on health care than the excessive amount we now spend. Some reasonably argue that we cannot afford this extra expenditure.

In practice a system designed to guarantee health care security to everyone, that is based on payment of premiums to private insurers, would be an administrative nightmare. Suppose a participant paying his own premiums into such a system loses his job, what is the mechanism for continuing payment of premiums? One can only imagine the red tape involved in managing continuity of coverage and the endless disputes and law suits resulting from HMOs refusal to pay for illnesses during periods of unpaid premiums. Then there are the millions of chronically unemployed and casually employed who cannot contract to pay premiums. Covering the majority of those now uninsured through the private insurance industry would be a costly administrative nightmare for the Federal Government and a massive transfer of wealth from the taxpayers to the HMO industry.

Contrast this morass with the administrative simplicity of a single payer system. Every citizen and legal resident gets a “Medicare Plus Card” He takes this card to any doctor in the country and presents it for treatment. The doctor treats him and bills Medicare Plus. The patient pays an out of pocket based on income. He takes his card and his prescription to the Pharmacy. The prices of his medications have been negotiated by Medicare. He pays his out of pocket and leaves. This freedom of choice is what all Medicare patients enjoy today.

The conclusion staring us in the face is that we can only pay for universal health care by wringing the fat and profit out of the present system. Inevitably that means a single payer system like Medicare paid for by additional taxation. For a few dollars a year more in taxes we get total health care security. I don’t think this is Socialism because I understand Socialism would be bad for us while affordable universal health care would create the greatest good for the greatest number. This I believe is the ultimate objective of any democratic society.

Nevertheless, such a change would bring disaster to the HMOs, the health care insurance brokers and other dependents on the present system. The reforms in the automobile manufacturing industry have caused similar losses to the stake holders in that industry. Why should the health insurance industry fare any better?! In the free market system, disaster is what happens to industries that are unable to meet the needs of the public.