http://www.amsa.org/hp/sp.cfm#single (AMSA is the Med Student Association)
Also reported on CNN
http://www.cnn.com/2003/HEALTH/08/12/national.insurance.ap/index.htmlAug 13, 2003
A Single Payer Health Care System for the United States
A Primer written by and for medical students
David Hackney and Debra Rogan
• Introduction
• Single-payer Health Insurance
• Problems of Socioeconomic Inequality in the United States
• Canadian-American Health Care System Comparison
• Conclusion & Opportunities for Activism
INTRODUCTION
The United States the only industrialized nation in the world that does not guarantee health care to all of its citizens. Current attempts at health care reform in this country only seem to have worsened the problem. While most people agree that it is a basic human right to have health care, many disagree on how to provide such in America today. AMSA (American Medical Student Association) believes that health care is a basic human right. After reviewing many other universal coverage proposals, AMSA adopted a single payer system as their choice for how to implement universal coverage in the United States. The single payer system was adopted as a Principle in 1989 in the Constitution and Bylaws &. Structure, Functions and Internal Policy & Preamble, Purposes and Principles.
After the Clinton health reform proposal was defeated in 1994 and the United States continued to stall regarding a decision about reform, the market forces have made the decision for them. Although an organized 'reform' has not been implemented, the changes that are taking place are becoming pervasive throughout America. Additionally, the pool of uninsured and underinsured continues to grow by hundreds of thousands each year, while health care costs have not been adequately controlled.
This primer describes what a single payer system is, how it works and how it would solve the major problems facing the United States' medical industry, including our lack of universal coverage. This information has been presented in the most unbiased manner considering its intrinsically directive intentions. The primer concludes with informational resources and contacts for individuals who desire a more in depth knowledge.
What is Single Payer Health Insurance?
A general definition would be the financing of health care expenditures for a nation's entire population through a single source, presumably the government, with funds collected through progressive taxation of citizens and businesses. It is important to differentiate between the terms, 'single-payer insurance,' 'socialized medicine,' 'managed competition' and 'universal health insurance.' 'Socialized medicine' refers to the direct government ownership of hospitals and clinics and control over the daily operation of the health care industry. This differs from single payer health insurance where the government collects and distributes money for health care but interferes minimally with the actual practice of medicine. Some form of social medical insurance exists in every European and Pacific rim nation as well as Canada, Australia and New Zealand. In fact, the United States in the only nation in both NATO and the twenty-four nation Organization for Economic Cooperation and Development (OECD) that does not extend medical coverage to all of its citizens.
Another source of confusion is the difference between 'managed competition,' the model proposed in Clinton's 1994 health care reform effort, and Canadian-style, single payer insurance. Under managed competition, the proliferation of managed care organizations (MCO's) would be encouraged, costs would be contained through both increased competition and consumer cost-consciousness and coverage would be expended through employer mandates and the pooling of self-insured individuals into Public Sponsor Agencies. Having never been tested and highly dependent upon business and market forces, it is not known to what extent managed competition would have reduced expenditures or extended coverage. Finally, the term 'universal health coverage' describes medical care that is provided to all a nation's citizens and is not exclusively descriptive of single payer health insurance.
Most single-payer health insurance proposals, such as that endorsed by Physicians for a National Health Program and AMSA, would allow individuals to consult any physician they desire and receive all tests and procedures deemed medically necessary with no out-of-pocket expenses. Most physicians would be reimbursed on a fee-for-service basis, i.e. they would report which services they rendered to which citizens and then receive compensation according to a previously established fee schedule. Separate funds would be established for capitol improvements, such as the construction of new hospitals or diagnostic centers. Elected officials instead of corporate executives would oversee the system and costs would be contained through global budgets and sparse administrative requirements.
This proposal is based upon the health care system implemented in Canada between 1968-1972. Figure 1 dramatically illustrates the cost containment Canada achieved relative to the United States through the establishment of a National Health System (NHS). An extensive study by the U.S. General Accounting Office found that the streamlining which would occur in a single payer system would immediately generate $34 billion dollars in savings from insurance overhead alone. It went further to conclude that, 'If the universal coverage and single-payer features of the Canadian system were applied to the United States, the savings in administrative costs alone would be more than enough to finance insurance coverage for the millions of Americans who are currently uninsured. There would be enough left over to permit a reduction, or possibly even the elimination of co-payments and deductibles! <snip>
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