Feb. 15, 2005

Here's brief introduction to
single-payer universal health care
A single-payer health-care system is actually two things. First, it broadly describes health-care systems currently in place in many industrialized countries. Second, and closer to home, it's about proposals to replace the current cost-driven health system we have in Minnesota, and the profit-driven system common in the rest of the United States.

There are two key elements in most single payer health care proposal or system:

1. One agency (a single payer) that handles all payments to medical providers and facilities, saving the health-care system billions of dollars.
   
   The current American health care system has more than 1,500 insurance companies (payers). The result is that clinics and other provider groups have had to hire full-time billing staffs to process each company’s forms following each company’s rules. This increases medical providers' costs and, ultimately, those of their patients. Opponents of single-payer health care rarely mention this feature of our current system. But the insurance and billing bureaucracies add billions of dollars of costs to health care. If cost is a consideration, replacing myriad bureaucracies with a single payer entity will produce huge savings and, as some single payer supporters say, it also should get MBAs out of the health-care decision process.
   
2. Universal coverage, meaning everyone is eligible for health care anywhere in the country.

More than 44 million Americans have no health insurance. One result is that many people get no primary, preventive health care, such as checkups and immunizations, and they go to hospital emergency rooms when a condition or illness gets severe. They have no means to pay, so the hospital -- often a public entity -- has to absorb the expenses. Those costs are paid by higher local property taxes, or they are passed through to paying patients, which raises premiums.

Opponents of single-payer health care claim that it would result in "rationing" health care, and they point to Canada as an example of long waiting times, distant facilities and unavailable procedures. They fail to mention that American health care is already rationed: more than 44 million of us can't get anything but emergency room care. They also fail to mention that a patient who needs sophisticated tests or procedures already has to receive permission (a referral) for many of them, and frequently tests prescribed by primary care physicians are denied based on cost, not health. Once approved, advanced procedures often still require waiting times.

Medicare is a successful single-payer system, and its administrative costs are less than 3 percent of its overall budget. The Canadian system, also a successful single-payer system, has overhead of about 10 percent of its budget. The health-care system in the United States now costs about 15 percent in administrative costs, and that figure is growing. Americans pay for a universal health-care system and a half, but they don’t get it.

In a single-payer system, there is a defined benefit set or covered procedures. This is a form of rationing. No system can afford to pay for every medical procedure everybody wants. But unlike our current system, the rationing is transparent: everyone can see what's covered. In our current system, rationing is hidden, but it happens, depending on what you're insured for and what your personal income or wealth can pay for.

Single-payer health care has been described -- wrongly -- as "government controlled health care." Nothing could be further from the truth. Only the payer may be connected with the government. Health-care providers, such as doctors, nurses, chiropractors and nutritionists, would continue to work where they now do. No provider would be a government employee, unless they work for the Veterans Administration or a state agency.

Health Care Can Be Cured: Here's How (Time magazine, Oct. 11, 2004) presents a proposal that would separate the health-care payer from the federal government. The single-payer agency would be a quasi-governmental body similar to the Federal Reserve Board.

A Single Payer Health Care System for the United States is an excellent explanation and discussion of single-payer health care in the context of the United States ' current health care situation. A comprehensive single payer proposal for the United States was published in the Journal of the American Medical Association in August 2003 (vol. 290, no. 6) and is online at www.physiciansproposal.org/proposal/Physicians%20ProposalJAMA.pdf.