Health care: the single payer vision

By Dr. Garrett Adams, M.D., M.P.H.
State Coordinator – Physicians for a National Health Program — Kentucky
From The Louisville Courier-Journal February 17, 2006

America has wonderful hospitals, clinics, and doctors. We conduct brilliant research. But there is a missing link: access to health services.

Some day, however, financial barriers to health care in America will be removed, and, finally, we will provide health care for all. Every resident will have affordable, high quality comprehensive health care. Infant mortality rates will fall, immunization rates and life expectancy will rise, and the World Health Organization will rank the efficiency of American health care first, instead of 37th. Health care will be disengaged from employment, freeing millions of health care hostages to pursue jobs they want, rather than jobs they take for health benefits.

Self-employment and entrepreneurship will become financially feasible. American business and manufacturing again will be competitive with countries that have national health plans. Without health benefits as a hiring issue, small businesses will compete equally with large ones for good employees. Medical bankruptcies — now half of all bankruptcies, and especially affecting the middle class — will vanish. Ninety-five per cent of Americans will pay less for health care than they do now.

Malpractice issues will diminish. Physicians will spend more time with patients and people will choose physicians and hospitals freely, rather than being forced into a market network. Money will not change hands between patients and providers, again improving doctor-patient relationships and leading to fewer claims. Since 60 percent of current settlement costs are for future medical care and everyone already will have medical care, settlements will go down and professional liability insurance costs will go down proportionately. Overhead in doctors’ offices will plummet because of vastly simplified billing to a single payer. Primary care physicians will be valued and reimbursed accordingly.

There will be no Medicaid crises, no unreimbursed care for doctors, hospitals or other providers, and no cost-shifting. Health-related issues associated with natural disasters, such as hurricane Katrina, or pandemic influenza, will be managed seamlessly.

A national electronic medical record system will detect medical errors quickly. Half a million Kentuckians are uninsured, 85,000 in Jefferson County. The dire straights of unhealthy Kentuckians have been dramatically portrayed in The Courier-Journal. Uninsured people forego doctor visits and necessary medicine; they postpone medical attention until illness is far advanced, more expensive to treat, and some cannot be helped.

Eighteen thousand Americans — six 9/11 bombings — die every year because they cannot afford medical care.

Privatization of traditional Medicare is a Trojan horse bringing more pain to a critically ill American health care system. Health insurance companies increase profits by raising premiums, reducing benefits, shifting costs to consumers, and providing coverage for only the healthiest.

The Medicare Prescription Drug Act specifically prohibits negotiation for volume discounts and requires private administration. It is an example of the difficulties of mixing profit-taking with health care delivery. It provides lucrative profits to insurance and pharmaceutical industries; but a high cost is borne by the American people. Dr. Oliver Fein, New York City internist, says: “I was outraged when one of my patients required hospital admission after stopping her medications, because she couldn’t afford the $45.57 co-payment demanded by [her new plan].” Health Savings Accounts, tax credits, consumer-directed health care, voucher sytems, etc. are Band-Aids for a failed experiment in health care delivery; they cannot control costs effectively, and they will not provide comprehensive universal affordable health care.

We have the highest health costs in the world, more than twice that of other developed nations that provide care to all of their citizens. We spend more, but we get less. We have the money now to provide excellent health care for everyone. A bill in the U.S Congress, HR 676, describes the details of a single payer national plan. The majority of American citizens support a national health program, and data indicate that the majority of physicians do so as well. We need non-profit single payer health care reform now.

State Coordinator
Physicians for a National Health Program — Kentucky