Single Payer...or Bust

[McCamy Taylor]

Sad, the way that the national dialogue has degenerated. Not so long ago, we were debating the relative merits of single payer versus our current patchwork insurance system---the one will all the holes. Now, the press has us convinced that we will have scored a major victory if we create another insurer to add to the 1001 we already have. The so called public option is supposed to be Congress’s gift to the American voters, to sugar coat insurance industry friendly legislation which will likely give private insurers a massive windfall, while leaving half of the nation’s uninsured still uninsured.

Congress, the corporate media and the nation’s private insurers have conveniently forgotten the real issue. How do we reform a broken health care system that spends twice as much person as it should and gives results that would make Eastern Europe blush? We all know the answer. We have known the answer for years. We either adopt a western European style single payer model----or we go bankrupt.



I. Albatross

The health insurance industry is spending a lot of time and money this year telling Americans that they do not make money. Google “health insurance industry profit margin” and you will see a list of industry generated pr pieces which describe the precarious financial status of our nation’s private insurers. Articles like this one:

http://www.healthinsurancecolorado.net/blog1/2009/06/08/profitability-and-the-health-insurance-industry/

The (insurance) industry as a whole chalked up a profit margin of more than 10% in 2007, but that was carried by the life insurance side of the industry. Health insurance companies don’t fare nearly as well when it comes to making profits. Far more of their revenues are eaten up by claims, which continue to grow year after year as health care costs increase.

Health insurers hope that if we hear this message often enough, we will start to think: Oh my! Who knew that running a health care plan could be such a miserable job? Guess we don't want taxpayers burdened with the financial responsibility....

But wait! If administering the nation's health care is such a money sink, Why the hell are private insurers spending so much money trying to keep things the way they are? Don’t they want to get rid of that great, big fat financial albatross that is hanging around their neck?

II. The Goose that Lays the Golden Eggs

In fact, a whole lot of people are making a whole lot of money from our health care dollars. They just don’t call it profit. Instead, hundreds of billions of dollars are wasted each year in inflated overhead and administrative costs. A 2004 New England Journal Medicine article estimated that if the U.S. switched to a Canadian style single payer system, we would be able to cover all the nation’s uninsured with the money that would be trimmed from overhead.

http://www.medicalnewstoday.com/articles/8800.php

In 2003 bureaucracy will consume at least $399.4 billion ($1,389 per capita) out of total health expenditures of $1,660.5 billion ($5,775 per capita).

Look at that second dollar total closely. In 2003, almost $1,400 was spent per person in this country to pay for overhead. Now look at this Common Wealth Fund report from 2003 about per capita health spending in different countries.

http://www.commonwealthfund.org/Content/Publications/In-the-Literature/2005/Jul/Health-Spending-in-the-United-States-and-the-Rest-of-the-Industrialized-World.aspx

Note that in most industrialized countries with universal coverage, total expenditures per person were around $2,500. That means that we spend over half as much as sensible countries do just to pay overhead . You know, the salaries of the people whose job is to find sneaky ways to deny coverage for legitimate medical expenses. And the multimillion dollar bonuses that insurance company CEOs are paid. People who would be on Douglas Adams’ B Ark, along with the telephone sanitizers. Then there are the computers, software, extra employees that medical providers must have if they are going to get paid by the nation’s private insurers, each of which has a different system and a different set of hoops that must be jumped through before they will pay out claims or authorize services.

Or, look at it another way. For those Americans who can not afford any health care at all, that $1,400 could mean the difference between life and death, if it were spent to control high blood pressure and diabetes in order to prevent a heart attack.

III. Let’s Talk Turkey

Here is more from the NEJM story above:

The potential savings are equivalent to at least $6,940 for each of the 41.6 million Americans uninsured in 2001.

These potential administrative savings are far higher than recent estimates of the cost of covering the uninsured. For instance researchers from The Urban Institute estimate that covering all of America's uninsured with an "average" private insurance policy would cost $69 billion annually (Hadley and Holahan, Health Affairs, May/June, 2003). Thus, the $286.0 billion in administrative savings could cover all of the uninsured, with $217 billion left over to upgrade coverage for Americans who are currently under-insured - e.g. to offer first dollar drug coverage to seniors.

$6,940 is more than enough to buy every uninsured American health care---which should not be confused with a private health insurance policy. These savings can only be generated if we switch from a patchwork of private plans to a single payer. The good news is that in countries which have adopted single payer, universal coverage average health care costs tend to go down while medical outcomes tend to improve, as more people get timely, preventive care.

It is our choice. We can have a Thanksgiving celebration in which everyone is invited to enjoy a nutritious, satisfying new single payer health care model----or we can suffer the fate of the Ancient Mariner, who is saddled with hundreds of billions of dollars of health insurance industry overhead and waste each year.

[annabanana]

1. Bust, indeed

We can't afford to do anything less, really. The costs of a half hearted reform will crush us.

[Norrin Radd]

2. kr

[lwcon]

3. K&R! n/t

.

[clear eye]

4. Thanks, Dr. Taylor for doing your homework.

I've been meaning to tell you that I appreciate the time you took to study the issue. You are an excellent communicator. Pictures and all!

The other issue outside of the drastic direct reduction in costs is the night and day difference in the effect on the economy of taking the cost of health care from businesses and paying for it from income taxes, preferably by restoring a higher top rate.

What I think could bring this back into the realm of possibility would be if this catches on as a cause celebre among college students and other young people. They're the ones who'll do the sit-ins, etc. How 'bout some facebook posts?

[lildreamer316]

5. I want single payer so badly I can taste it (and that turkey! Yum!). Is there any hope?

There has been so much back and forth that I am left scrabbling in the dust like a chicken for a grain of hope that this could still happen. Any good signs?
Yes, I have written/called my congresscritters several times.
Thanks for the clear and concise post; bookmarked and copied for future reference.

[lildreamer316]

6. Kick

[lildreamer316]

7. Kick again!