Currently, the U.S. health care system is outrageously expensive, yet inadequate. Despite spending more than twice as much as the rest of the industrialized nations ($7,129 per capita), the United States performs poorly in comparison on major health indicators such as life expectancy, infant mortality and immunization rates. Moreover, the other advanced nations provide comprehensive coverage to their entire populations, while the U.S. leaves 47 million completely uninsured and millions more inadequately covered.

The reason we spend more and get less than the rest of the world is because we have a patchwork system of for-profit payers. Private insurers necessarily waste health dollars on things that have nothing to do with care: overhead, underwriting, billing, sales and marketing departments as well as huge profits and exorbitant executive pay. Doctors and hospitals must maintain costly administrative staffs to deal with the bureaucracy. Combined, this needless administration consumes one-third (31 percent) of Americans’ health dollars.

Single-payer financing is the only way to recapture this wasted money. The potential savings on paperwork, more than $350 billion per year, are enough to provide comprehensive coverage to everyone without paying any more than we already do.

Under a single-payer system, all Americans would be covered for all medically necessary services, including: doctor, hospital, long-term care, mental health, dental, vision, prescription drug and medical supply costs. Patients would regain free choice of doctor and hospital, and doctors would regain autonomy over patient care.

Physicians would be paid fee-for-service according to a negotiated formulary or receive salary from a hospital or nonprofit HMO / group practice. Hospitals would receive a global budget for operating expenses. Health facilities and expensive equipment purchases would be managed by regional health planning boards.

A single-payer system would be financed by eliminating private insurers and recapturing their administrative waste. Modest new taxes would replace premiums and out-of-pocket payments currently paid by individuals and business. Costs would be controlled through negotiated fees, global budgeting and bulk purchasing.

Single Payer Health Insurance

Dr. Rocky White, a former Republican, has become a leading advocate of single-payer, national health insurance.

You wouldn’t know it from the candidates’ debates or reports on the major television networks, but a majority of Americans favor a government-run health insurance system similar to Canada’s.

Those lining up to support single-payer health care include medical professionals, business people, and many Republicans. Dr. Rocky White has been all of those things.

White is a former Republican, from a conservative, evangelical background, who got interested in health care reform nine years ago when his own medical practice slipped into the red. His research into the health care system led him to conclude that the problem wasn’t just in his practice— the health care system itself is broken, and a single-payer program is the most efficient way to fix it.

Under the single-payer system, doctors’ offices and hospitals remain private for-profit or non-profit institutions. But the federal government covers the bills for patient services, with funds coming from taxes. The patient gets the health care they need. Paperwork and billing are kept to a minimum. Employers no longer have the difficult task of choosing, administering, and paying for health insurance for employees. Everyone is covered.

The current setup is as complicated as single-payer is simple. Today, the discerning consumer must wade through a complex system of pre-existing condition exemptions, co-pays, and deductibles—if they have coverage at all. Arguments over billing among doctors’ offices, insurance companies, patients, and their lawyers eat up millions of dollars. An estimated $25 out of each $100 spent goes to paperwork, profits, and executive pay and bonuses. And disagreement over medical coverage is one of the most common sources of labor disputes for employers who have seen insurance premiums double since 2000.

With these inflated costs, it’s little wonder that in 2006, the last year for which government figures are available, 47 million Americans had no insurance at all, including 8.7 million children, or that 68 percent of bankruptcies in the U.S. come as a direct result of medical expenses among people who do have insurance.

A CNN/Opinion Research Poll last year showed 64% of Americans would be willing to pay higher taxes for a national health care system.

When White learned about Physicians for a National Health Program and their plan for a single-payer health care system, he saw it was similar to his own idea and he joined their effort.

Other medical professionals have had a similar reaction. The American College of Physicians—the largest organization of medical specialists in the country—endorses single-payer health care as does the California Nurses Association, the largest organization of registered nurses.

And so do 55 percent of Americans, according to a CBS News poll conducted in September. In another poll, 64 percent said they would be willing to pay higher taxes for a national health care insurance program.

In Congress, HR 676, the “Medicare for All” bill introduced by Representative John Conyers, Jr. of Michigan, currently has 90 co-sponsors—more than any other health care reform proposal—and the endorsement of the U.S. Conference of Mayors.

Republicans for Single-Payer

Support for single-payer health care is not just strong among progressives. George Swan, for instance, is a health care administrator, self-described “Purple Republican,” and a founder of Republicans for Single Payer.

“It’s about being American and doing what’s right,” Swan says. “What’s right is not paying a 30 percent premium to the insurance system and receiving sub-standard health care.”

Business owners are also supporting single-payer health care. For 25 years, Jack Lohman owned a company that provided cardiac monitoring services to hospitals. Today, he’s a co-founder of the Business Coalition for Single Payer. A “lifelong Republican,” Lohman argues that conservatives should support single-payer because it’s pro-business.

“For the same 16 percent of GDP that we are spending on health care in the U.S.,” he says, “we could provide first-class health care to 100 percent of the people.” And single-payer would “get health care off the backs of corporations so they can be more competitive with products made overseas.”

John Arensmeyer spent 12 years running an e-commerce company with 35 employees. Then he founded the Small Business Majority to advocate for the interests of small businesses, particularly on health care issues. Sharp rises in health care costs for small businesses are hurting their ability to survive, Arensmeyer says. “It’s antithetical to what we’re all about as a country, which is to allow people the freedom to go out and start new enterprises.”

Small business has often been portrayed as opposing health care reform, but SBM’s research shows that small businesses are interested in being part of the solution—even if it means paying higher taxes.

Walter Maher, former vice-president of public policy at the DaimlerChrysler Corporation, sees the problems in similar ways, although he looks at health care costs through the lens of large corporate employers.

General Motors, he says, is paying people to leave their jobs so they can hire replacements at 50 cents on the dollar with reduced health benefits. “It’s sad,” he says. “You have a giant albatross around your neck because you choose to provide a good standard of living for your employees.”

Money in Politics

If the current system is so unpopular among medical professional, patients, and business owners, what’s keeping it in place? Most advocates for single-payer agree that money in politics is the greatest obstacle to change. During the 2006 election cycle, the health care industry spent $99.7 million on campaign contributions. Lobbying on health care issues topped $446 million in 2007.

For Jack Lohman, that’s the crux of the problem. “Both McCain’s and Obama’s plans for health care are lousy,” he says. “Although both claim they’re not taking lobbyist money, somehow this money is getting through. They are each supporting health care that keeps the insurance industry involved.”

And all that money can buy a lot of misinformation and scaremongering. Rocky White says he finds that people get interested in the single-payer approach if they understand what’s actually being proposed: “When people realize that all that it is,” he says, “is a publicly owned insurance company, all of a sudden business people start to lose that fear that ‘Oh my God, we’re going to become the Soviet Union.’ Even Republicans say, ‘This really makes a lot of sense.’”

While White would like to see reform happen on a national level, he believes it’s more realistic to work at the state level for now. And for him, that means Colorado. White sits on the board of Health Care for All Colorado, a nonprofit, volunteer-run group with 250 members that includes Democrats, Republicans, physicians, business people, college professors, and economists. And he is running for a Democratic seat in the state legislature to add “the voice of medicine” to the debate.

“Any time a state has studied it, they find that single-payer is the most cost-effective and covers everyone,” White says. His proposal for a single-payer system in Colorado is being studied by a blue ribbon commission created by the Colorado Legislature.

In May, the 6,000 delegates to the Colorado Democratic Party Convention endorsed a pro-single-payer resolution that will be forwarded to the national convention in Denver in August.

If one state can make a single-payer plan work, White believes, it could start a cascading effect similar to what took place in Canada during the 1940s and ‘50s.

“People are discouraged, they’re angry, they’re upset,” White says. “But politics is the process that drives policy, and if we don’t get involved in the political process we’ll never make a difference.”