Physicians Weigh the Evidence for Single-Payer
EconomicDemocracy Coop
responsible for skyrocketing health care costs—doctors and
patients...But blaming doctors and blaming patients ignores the
elephant in the room: private insurance [a system which] contributes
to more than 45,000 deaths in the United States annually.."
" Of every health care dollar spent in the United States, 31 cents is
spent on administration (more than double that of other industrialized
nations). So we are wary of proposals that seek to simply expand
private insurance and in so doing provide a bailout for this
industry..insurance has been likened to an umbrella that melts in the
rain [denied coverage just when you are most sick and most need it]"
------Full article:
Weighing the Evidence for Single-Payer
By Ann Settgast, M.D., and Elizabeth Frost, M.D.
Minnesota Medicine, Nov. 2009
As physicians, we are troubled by the direction of federal health care
reform. Whether via a public health insurance option or an insurance
mandate, the proposals on the table build on the structure of our
broken system—the most costly, fragmented, and bureaucratic in the
world.
President Barack Obama acknowledged in his national address this
summer that a single-payer system is the only way to cover all
Americans. We agree, and we encourage him to re-embrace this solution
to the health care crisis.
Conventional wisdom leads us to believe there are only two culprits
responsible for skyrocketing health care costs—doctors and patients.
Doctors order too many unnecessary tests, and patients demand too much
care. We acknowledge that overtreatment of patients guided by improper
incentives must be addressed. The issue of patients overusing care
also must be confronted. However, the problem of overuse is minuscule
compared with the consequences of underuse. In its most extreme form,
underuse of health care contributes to more than 45,000 deaths in the
United States annually, as revealed in a study by Wilper et al. in the
American Journal of Public Health. But blaming doctors and blaming
patients ignores the elephant in the room: private insurance.
Our unique multipayer financing structure based on private health
insurance produces enormous waste. Of every health care dollar spent
in the United States, 31 cents is spent on administration (more than
double that of other industrialized nations). So we are wary of
proposals that seek to simply expand private insurance and in so doing
provide a bailout for this industry.
Such expansion may decrease our embarrassing numbers of uninsured, but
it will not solve our problems. Private insurance has been likened to
an umbrella that melts in the rain. Consider the disturbing fact that
62 percent of all personal bankruptcies are related to medical bills.
More astonishing is the fact that 77 percent of Americans who go
bankrupt because of medical bills had insurance when they became ill.
Because it is a business, private insurance has, at its core, the
bottom line. The only way to succeed is to selectively recruit healthy
patients or to deny coverage to patients when they become sick. As
professionals who strive to make sick people well, we find this model
for our system illogical and fatally flawed.
Elimination of U.S.-style private insurance has been a prerequisite to
achieving universal health care coverage in every other industrialized
nation. We ask, “What if the rest of the world is right?” Only under
single-payer [read: universal, public, nonprofit care with right to
choose your own doctor, clinic, etc -ED] can we eliminate the
administrative costs associated with billing hundreds of payers and
the sizeable overhead of the private insurance industry. These
overhead dollars are spent marketing, underwriting, lobbying, and
fighting claims—none of which makes our patients healthier.
Elimination of this administrative waste would save more than $400
billion annually.
As physicians, we are obligated to use evidence-based medicine. The
reform debate must be held to the same standard. Ample evidence,
including studies by the Congressional Budget Office and the
Government Accountability Office, shows single-payer can assure
universal coverage while saving money.
For those who say competition among insurers is needed to keep costs
down, we say the experiment must end. It has been tried. It has
failed.
For those who ask whether something is better than nothing (ie,
implementation of a public option), we again look at the evidence. A
number of states have tried to patch their systems with piecemeal
reforms over the past two decades. None has produced universal
coverage while controlling costs.
For those who suggest we would lose choice under a single-payer
system, we ask, choice of what? Choice of insurance plan—yes. Choice
of doctor and hospital—no. A high-quality system is not one in which
our patients choose their insurance plan but one in which they choose
their doctor. Single-payer is the only reform option that actually
expands choice. Bringing private insurance or a public option to more
Americans retains limited provider networks and restricted choice.
For those who say single-payer is socialized medicine and worry that
government bureaucrats will suddenly begin making health care
decisions, they need to remember that single-payer is publicly
financed but privately delivered. Medical decisions should be made by
patients and doctors.
Given the magnitude of these difficult economic times, including a
projected $1.8 trillion federal deficit for 2009 and rising
unemployment, it is high time to reconsider the most fiscally
conservative and financially sustainable option for reform—a single-
payer system.
Ann Settgast and Elizabeth Frost are primary care physicians
practicing in the Twin Cities. They co-chair the Minnesota chapter of
Physicians for a National Health Program.
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More background:
Single-Payer Myths; Single-Payer Facts
http://www.pnhp.org/facts/singlepayer_myths_singlepayer_facts.php