Single Payer Health System could save Billions

ROCHESTER, NY (By Peter Mott, democratandchronicle.com) December 8, 2008 ― Because of the current financial crisis, many observers see no point in discussing an expansion of health care coverage this year — either federal or state.

Indeed, it is true that the current crisis is adding greatly to our public debt. And it is true that total health costs in the United States are already twice as high per person per year as those of any other nation and rising faster. If we were to start paying to insure our 50 million uninsured — plus an estimated 40 million Americans who are underinsured — costs would escalate hugely.

Believe it or not, there is one proposal that could cover all Americans for all needed services and save money. And it is now that we must explore that proposal. Studies have shown that national savings would amount to $350 billion per year.

At the national level, this proposal is called Medicare for All, and it is embodied in Congress as Bill HR676. In New York state, it is called Single Payer New York, and it is one of the options now being studied by the governor in Albany.

The propagandists call it "socialized medicine." But it is not — because most doctors and hospitals would be private and working in their own facilities.

How could covering more people decrease total expenditures? The difference is in "administrative costs." Private insurance companies have such costs totaling 15 percent to 30 percent. Medicaid is at 5 percent and Medicare at 1 to 2 percent. "Administrative costs" include advertising and shareholders' profits, as well as the billing and collecting costs of hospitals, doctors' offices, labs and X-ray facilities. These become a nightmare as patients change among a variety of insurers, or when they lose insurance by changing or losing their jobs.

HR676 is an expanded Medicare for All, and it is brief, simple, uncluttered: Everyone in the country is covered. Everyone has one card. Present costs disappear completely. The patient may go to any doctor or hospital. The entire health system is paid for by taxes on corporations and a progressive income tax. It is administered by a public or quasi-public body. Health providers do their jobs and receive a fee for service with the fee scales negotiated annually.

Do private insurance companies suffer? Yes. Their roles would be limited. That part is controversial, and that's where the fight begins. Many feel that it's impossible to beat the insurance industry. But if this is truly a democracy, who should decide such a basic public policy as this? The people or the corporations?

My own opinion, after 40 years of organizing to change the health care system, is that the private insurers have had decades in control. They have had their chance, and they have left us in a mess: We're ranked 37th in the world by the World Health Organization for health care delivery; one-third of our population is uninsured or under-insured. Costs are higher than in any other nation; many parts of our population have worse care, higher morbidity and mortality rates than any other developed nation. It's time to fight! President-elect Obama's health proposal is not close to Medicare for All. But he is a good listener who encourages the grass roots to speak up.

Mott, a retired professor of medicine at the University of Rochester, is a member of the Interfaith Health Coalition of the Greater Rochester Community of Churches.