I am a registered nurse. Virtually everyone I talk to about American health care has a horror story about paying their medical bills. Yet why is it that most of these same people are resigned to the idea that quality care requires insurance companies who supposedly are looking out for our best interests?
Why are we so accepting of underinsurance with the ever-increasing high deductibles, copays, coinsurance and premiums, of the ever-present worry of physical and financial catastrophe, of limited provider networks, of having to fill out the same paperwork over and over again, of having to seek and wait for pre-authorization, of having to appeal denied claims, of incomprehensible insurance jargon, of having to renew coverage annually, and of multimillion-dollar executive management salaries?
No other country in the developed world has to deal with this kind of deception and abuse and neither should we. While the Affordable Care Act has made a few improvements, cost control was definitely not one of them, and it prompted a merger mania that now has health care conglomerates approaching monopoly status. Managed corporate care has been a colossal failure despite numerous reform efforts. Fortunately there is an alternative.
That alternative is explained in detail in the June 2016 issue of the American Journal of Public Health (available online at www.pnhp.org/nhi). This call for single-payer health reform was prepared by a working group of 39 physicians and endorsed by more than 2,200 physicians from across the country, with more endorsements arriving every day. It is an updated version of a similar physicians’ proposal written in 2003 from which Bernie Sanders has based his health care reform plan.
The key feature is the removal of all financial barriers to medical care primarily by eliminating the nearly 1,300 health insurance companies with their $500 billion in administrative overhead. Instead, the much more successful Medicare program would be expanded to cover everyone as was originally intended (instead of just those over age 65), and its weaknesses would be corrected.
Private insurers’ overhead currently averages 12 percent, compared with only 2.1 percent for fee-for-service Medicare. Numerous studies conducted since 1991 have shown that Americans are already paying way more than is necessary for a universal single-payer system without getting it.
According to more than 40 studies by the Government Accountability Office, the Congressional Budget Office and several prestigious actuarial firms, think tanks and economists, the administrative savings possible with a single-payer system are enough to cover all of the 27 million uninsured people and to upgrade coverage and eliminate all out-of-pocket costs for the underinsured without any increase in total health spending and without restricting the patient’s choice of providers.
The program would be federally financed and administered by federal, state and regional boards, which would determine global budgets for hospitals, set equitable reimbursement rates for providers, negotiate drug prices and improve health planning.
Additionally, modest new progressive taxes would be needed, but these would also reduce income inequality, another cause of poor health. While a payroll tax might be appropriate in the short term, ultimately employers would be freed from the burdens of providing health insurance for their employees. This would greatly facilitate entrepreneurship and increase the global competitiveness of American business.
Importantly, however, any new taxes would be fully offset by the elimination of premiums and other out-of-pocket costs such that the vast majority of Americans would have a substantial increase in their disposable income while being free from the worry of a financial catastrophe related to an unexpected health crisis.
All unrealistic pie-in-the-sky, you say? It’s not, when you talk to the people from other countries who have enjoyed this type of system for decades. Admittedly these other countries did not have an entrenched private insurance system to deconstruct; nor did they face a fanatical capitalism with its oversold faith in free market competition that claims health care as a commodity instead of a right; nor did they have to deal with segregationists who steadfastly refused to provide universal care that would include “Negroes.”
However, the Expanded and Improved Medicare for All Act (HR 676) was recently reintroduced in Congress and now has 62 co-sponsors. Fourteen states, including Colorado (with Amendment 69 on the ballot for this fall) and Washington (HB 1025, 1321 and SB 5132) have pending legislation to develop statewide single-payer health care systems.
And thanks to the Physicians’ Working Group and to Bernie Sanders, the tide is finally starting to turn toward pairing health care with justice.
Cris M. Currie, of Mead, is a registered nurse and member of Health Care for All - Washington.
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