Can anyone say, ‘single-payer?’

Day after day, I become more certain that we need to scrap our entire health-insurance system, and go to a single-payer national plan. It would cover everyone in a simple and straightforward manner that wouldn’t require a Ph.D. in filling out forms to navigate, it would put enough healthy (for the moment) people into the system to make it affordable for those who need care at a given moment, and would give us a gigantic bargaining bloc (forbidden in Medicare Part D, thanks to Big Pharma) for containing drug costs. In other words, it would make sense.

And here’s the really, truly amazing thing about it. Nobody, but nobody, in the political mainstream will stand up and suggest it. In fact, political candidates go to great lengths, through all kinds of gyrations, to avoid it. This is so even though I have only heard three credible reasons why not to at least suggest it, to get a conversation started:

  • The medical insurance industry doesn’t want it, because it does away with it’s reason to be.
  • Big Pharma doesn’t want it, because if we banded together, it would no longer be able to overcharge for the drugs it pays billions to advertise.
  • The idea of us banding together to act in our common interest offends some people’s ideology.

Yeah, I hear other objections — waits for procedures, reduction of choices — but those will be the features of ANY approach that works in lowering costs. The insurance companies have been telling what treatments we can and can’t have, and which doctors we can see, and which pharmacies and hospitals we can go to, for decades now.

Anyway, this little post isn’t about going into the details; this post is simply about the fact that we’re not even having a national conversation about whether to do this. With the exception of Dennis Kucinich, who doesn’t count because he doesn’t have a prayer of being elected, nobody is out there touting this idea, so that we can at least debate it. And rest assured, we won’t be doing anything bold in this area unless someone is elected with a mandate to do so.

There are people laboring in the field out there trying to drum up support for HR676, which would create a single-payer system, but you don’t usually hear about them. The one advocate of the approach best known to people on this blog is our regular contributor Paul DeMarco, a Marion physician, is a founding member of a group called South Carolinians for Universal Health Care that is pushing for it (I believe, and Paul will correct me if I’m wrong, that the group is affiliated with Physicians for a National Health Program. Some of his fellow single-payer advocates came to see the editorial board yesterday. The video above shows Sabra Smith, a practicing nurse and PhD student at USC School of Nursing, talking about why she got involved with Dr. DeMarco’s group.

25 thoughts on “Can anyone say, ‘single-payer?’

  1. Doug Ross

    Another credible reason it is not discussed:
    It won’t work. It can’t work. And the majority of people who have health insurance now and are happy with it are not interested in changing.
    Until you can give specifics on how the program will work, it’s a complete waste of time.
    Until you can explain what happens to companies like Blue Cross / Blue Shield, etc. and their hundreds of thousands of employees and the rest of the economy that services them, it’s all pie-in-the-sky.
    Just because you don’t like your health insurance, please keep your hands off mine.
    You can’t guarantee me anything approaching what I have now.

  2. Doug Ross

    The plan Dr. Demarco supports requires a 7% tax on employers and a 2% income tax on employees theoretically in place of current insurance costs.
    Translation: those who make more money will pay more for healthcare than others.
    Also, those who don’t work, can’t work, or are retired, apparently will get free healthcare. No wonder the AARP folks support this… they already get subsidized healthcare right now, so why not go for making it free?
    Much like the bogus Social Security system, this single payer system would be doomed by the time baby boomers reach retirement age — and then what happens? That 7% and 2% will be continually ratcheted up to cover the increasing costs.
    Luckily, this has zero chance of ever happening.

  3. Gary Karr

    The first question I’d ask her if I were in the room would be: “You said a lot of these people were poor and didn’t have health insurance. Did your hospital help them sign up for Medicaid? Because if they’re poor, that’s essentially a single-payer system that could help them.” I realize that the state pays about 30 percent of the costs of Medicaid, so it’s not TRULY single-payer, but it does resemble a single payer system.
    And on the notion of single-payer generally, what about Medicare? That’s a single-payer system for health care that we already have in this country. It’s generally popular, so I guess if your rationale for a radical restructuring of the health care payment system in this country is that it be popular with the people who receive the care, then yes, it’s a good idea. Of course, it’s also a system that is going bankrupt soon, and is beset with cost problems in everything BUT Medicare Part D. That part is actually coming in under cost estimates.
    I applaud the call for dialogue, but I say with no snarkiness intended that sometimes people call for dialogue but what they really mean is that they want more people agreeing with them.

  4. bud

    “And the majority of people who have health insurance now and are happy with it are not interested in changing.”
    With all due respect Doug, there really aren’t many people in that camp. I’m certainly not. My family has forked over thousands of dollars this year WITH what is regarded as a good insurance plan. The 1/7 of Americans without insurance certainly are not happy. Apparently Brad’s not very happy with his insurance either. If you’re happy with your insurance that’s great but most of us are really baffled and impoverished by the whole mess.

  5. Brad Warthen

    Amen to that, bud. And Gary, it’s interesting you should mention Medicare, because some of the advocates of single-payer speak in terms of “improved Medicare for all.” From what little I know of the particulars of Medicare (not ever having dealt with it directly), it seems excessively complex to me. But the theory is sound — that everyone over 65 should be able to afford healthcare.

    My question is, so how come just people over 65? Why not everybody?

  6. Karen McLeod

    And with what medicare pays, unless you have managed to amass a fortune for your retirement, you might prefer to just shoot yourself and get it over with.

  7. Doug Ross

    You need to get out a little more… there are MILLIONS of people with insurance now who are happy with what they have. My company employs 40,000 people. Our insurance rates for next year went up by $1 per paycheck for the United Healthcare medium plan with $15 copay, $5/$15/$30 generic/regular/special prescription copays, reasonable deductibles, etc. I would hazard to guess that across the high tech industry, this is the norm.
    And if you’re going to do this, let’s see the first GOVERNMENT agency willing to step up to the plate. Start with all of them first and see how that works before forcing this debacle on those the rest of us. Why not start with consolidating all federal, state, and local government workers under a common national plan? If the savings are truly there, we’d see evidence to that effect wouldn’t we? We’d see our taxes drop because healthcare costs for government workers would go down? Right?

  8. Doug Ross

    > And with what medicare pays, unless you have
    > managed to amass a fortune for your
    > retirement, you might prefer to just shoot
    > yourself and get it over with.
    What do you mean? My father had open heart surgery this past year and the out of pocket costs were about $2000 out of $100,000. Seems like a pretty good deal… especially when the hospital probably only got $40,000
    or less from Medicare and had to pass the rest off to people with real insurance.

  9. Doug Ross

    Oh, and while you’re at it, ask a few senior citizens about their prescription drug plan that the government has set up for them. Ask how easy it is to figure out which option to take and how much they expect to pay for drugs next year… my mother spent several hours trying to decode the many pages of instructions before giving up and passing it on to my brother.
    A perfect example of what to expect when the government runs all of healthcare: A multitude of forms, rules, regulations; an endless array of bureaucracies designed to delay treatment, and ample opportunity for waste, fraud, and abuse — all on the backs of the American worker. Brad will say it’s that way in the private sector now, but it’s not. I can’t be the only person in America with a reasonable insurance plan.
    Saw that in the U.K. recently under their wonderful system, a woman was told she would receive her government issued hearing aid in eighteen months. The woman is 108 years old.

  10. Brad Warthen

    It’s really fascinating to see the degree of vehemence that Doug brings to fighting the idea of pooling our resources to come up with an affordable system that could benefit everybody.
    It’s classic libertarianism: “I’ve got mine, and you can’t have it!” coupled with the absurd belief that we can’t, and MUST NOT, work together to solve a problem as a nation.
    This is enormously destructive.
    In any case, watch this space for an understanding of why we, unlike other civilized countries, don’t have a national health plan. It’s because any time reasonable people start to say, “Hey, why don’t we…” folks of Doug’s persuasion start screaming “NO! And there’s no such thing as WE!” at the tops of their lungs, repeatedly and without tiring, and eventually the folks who brought it up wander away and end up backing some pathetic excuse for “reform” as most of the major presidential candidates’ plans — which (to oversimplify, if you’ll forgive me) in the aggregate consist of going to unbelievably complex work-around lengths to bring the “uninsured” into the same overpriced, inefficient, grotesquely wasteful system that the rest of us are in.
    Seriously, if I were a libertarian, I think I’d go defend supermarkets or some other example of free markets actually WORKING, and stay away from health care.
    But hey, they keep loudly defending our crazy system, and, amazingly, they succeed, time and again, in preventing change. The rest of us must truly be idiots to keep accepting that.

  11. Ellis

    Our government is incapable of meeting the expectations of our middle and upper middle classes when it comes to health care.
    The present systems of Medicaid and Medicare are complicated, very expensive and have niche markets. The needy and senior citizens are accepting of the poor service, but those added on to that system will not tolerate what the government hands out to those sections of the public that have no other choices.
    Brad refuses to acknowledge it, but as someone that is in government, I can say without a shadow of a doubt…the US Government is unable to meet this task. Period. Without reform, the government simply cannot do it.
    Now, if the State Newspaper wrote damning exposes on government wastes, fraud and abuse, perhaps government would change. But absent that…it simply will not change and therefore we cannot and will not have a single payer medical system.

  12. weldon VII

    Doug, my wife didn’t just spend a few hours trying to figure out which option to take. She spent several days trying to make sense out of it and finally decided to pick the option most similar to what she has now, just because she has some idea how that works, not that she knows all the ins and outs by any means.
    But first, trying to decipher the whole mess made her into a nervous wreck.
    Contrary to that true-to-life picture, Brad wants health care to be simple. If you get sick, the government pays to get you well.
    If it could be that simple, wouldn’t Medicare, and Medicaid, be that simple now?

  13. Don McCanne

    Doug Ross may not be interested in the tens of millions of Americans who have impaired access due to the financial barriers of uninsurance and underinsurance. But he should be concerned about the impaired quality of health care that even the well insured are receiving, due to the consequences of our dysfunctional, fragmented system of financing health care. Many like him are exposed to excess high-tech health services that significantly increase costs without improving outcomes and often resulting in impaired quality. And overcrowded emergency rooms are delaying urgent care even for those with the best of insurance. Libertarians should be concerned since assuming responsibility exclusively for their own needs does not provide the structural reform that only a rational method of health care financing can bring us.

  14. Doug Ross

    It’s because when you say “we” you mean “me”.
    I already pay more in property taxes, income taxes, Social Security taxes, Medicare taxes, and just about every other tax known to man than the average person does.
    Now you want me to pay more taxes for everyone else’s healthcare, too… Why? Because you don’t think it’s “fair” that my company offers its workers a reasonable healthcare plan and yours doesn’t.
    I also contribute approximately 5% of my NET income to my church and to charity… so I’d like to see how you rationalize that aspect of my supposed selfish behavior. That’s the Libertarian aspect of my view of the world – giving versus having it taken from me.
    You ignore every single real life example of situations where the government fails to provide efficient, cost effective service. You ignore every single real life example of private sector healthcare providers far exceeding the capabilities of government systems.
    You ignore facts, statistics, and all data that proves a single payer system cannot work, will not work, and will never get off the ground.
    Here’s a simple task for you: call up someone from Lindsey Graham’s office and ask them to provide you with a copy of the Senator’s health insurance coverage provided to him by taxpayer dollars. Then ask when he plans to provide the exact same coverage to every American at the same cost.
    Or call up one of your buddies at the McCain campaign and ask them to justify this quote made yesterday by Senator McCain.. it sure sounds like a Libertarian view of the situation… it also sounds like the typical partisan rantings of a guy trying to win a Republican primary:
    The Arizona senator said he would focus on making insurance more affordable rather than requiring universal coverage as some Democrats have proposed.
    “Sen. Clinton and the Democrats want to raise your taxes, and they want a government mandate system. I’m not going to mandate that every American have health insurance. I’m not going to mandate that every American have a home. I’m not going to mandate that every American have a college education,” he said. “But I’m going to make them all affordable and available.”
    McCain, who has proposed a $5,000 per family tax credit to help people purchase health insurance, said costs also would come down if doctors were reimbursed for their time spent treating patients instead of according to how many tests they order.
    “Every time we see an increase in medical technology, which gives them a better ability to take care of you, at the same time costs go up,” he said. “Every time there is a technological advance here at Goss, there’s a decrease in costs and an increase in productivity.”

  15. Doug Ross

    I’ve made my suggestions on how to improve (no fix) the healthcare system several times here:
    1) Reduce drug patent lengths to allow competition from generic makers
    2) Require insurance companies to offer coverage that is portable, not revokable under any circumstance, and restricted in the percentage increases in premiums to a limited range across all policies
    3) Abolish HIPAA rules that only add expensive overhead costs to the system
    4) If healthcare for all is a national concern, pay for it by cutting government costs in other areas rather than simply adding another tax on top of the waste already built into the government. The money is there already to easily cover every one who doesn’t have insurance.
    5) Go back to the days where drug companies could not advertise on TV, radio, or print media. All that marketing cost gets passed onto consumers. I really don’t care if I ever see another commercial for Viagra, Ambien, or any other product that has “oily discharge” as a frequent side effect.

  16. weldon VII

    Brad, it’s really fascinating (pardon the plagiarism) to read your belittling of Doug Ross’s arguments, in the midst of which he actually provided FACTS, while you offer only generalities including your admission you don’t know much about government-paid health care now:
    “From what little I know of the particulars of Medicare (not ever having dealt with it directly), it seems excessively complex to me.”
    Well, do tell! It’s too complex? But you want all of us to depend on the bureaucracy that made it so complex to offer up single-payer health care. Could you tell me how that might work when you don’t know how Medicare works?
    Furthermore, you wrote, “Everyone over 65 should be able to afford healthcare” and “how come people over 65? Why not everybody?”
    Probably for the same reason everybody isn’t car-pooling or taking a bus to work. Lot of people want better than the least common denominator, but that’s all single-payer health care would ever provide. It would rob the diligent to mollify the rabble, punish the best of us to reward the worst of us.
    And if it were to happen, you’d just end up writing columns about how it poorly it works, how unnecessarily complicated it is, and how the taxes we pay for universal health care are just too high. You yourself wouldn’t even be better off then than you are now.
    Why? Because your income percentile is too high. You’d end up having to pay more for everybody else than you’re paying for your family now.
    And the quality of the care would be worse.

  17. Gordon Hirsch

    Just because Doug’s happy, everybody should be happy? I work for a high-tech employer too. They even pay 100% of my plan cost. And I still am unhappy. Why? Because the plan’s deductible and out-of-pocket thresholds are so high, I still end up paying for most of what I need. Meanwhile, the “non-profit” insurer’s profits keep breaking records:
    COPYRIGHT 2006 The Herald-Sun
    Byline: Jeff Zimmer
    Mar. 4–Profits are up at Blue Cross but that won’t translate into lower premiums for its 3.3 million members, company officials said Friday.
    The nonprofit insurer continued its three-year streak of record results in 2005 with a $167.6 million profit on revenues of $3.5 billion, Blue Cross reported Friday. It was a $34.2 million fourth-quarter profit — the highest fourth-quarter profit ever for the company — that helped boost the insurer’s bottom line to its second highest amount ever.
    The company’s 2005 performance exceeded the $155.9 million profit Blue Cross produced in 2004 ….

  18. slugger

    I worked in the medical field before Medicare and Medicaid. The hospitals took care of the indigent patients with money paid yearly by the taxpayers.
    The doctors treated the uninsured and those without any means to pay in their office. If the patient had a dozen eggs or a bunch of collards, they would bring them as a thank you.
    The day that the federal government (which is made up of you and I and those elected by us) decided they needed to take over a system that was not broken is when we started the downward spiral to the point of no return.
    There is no way that we can expect anyone except an outsider without any monetary gain or voter recognition to try to bring about an acceptable solution to this problem. If you leave the politician and the money grabber in the mix to solve the problem, it will only be more of the same.
    How can one turn around a train that is running full speed on a track to help destroy this country financially? We need a brakeman.
    Insurance for EVERYBODY. It could happen but you do not want to know the price.

  19. Doug Ross

    If you want to see what Federal government employees have for health insurance options, look here…
    Looks like we taxpayers pick up two thirds of the cost of each Federal employee’s health insurance cost. And they have a number of options that seem to be reasonably priced.
    So, why not open up those choices to everybody – with no exclusions and no ability for the providers to revoke the insurance.
    For people who can’t afford the rates, cut some other government spending.
    Easy solution. Doesn’t require any new bureaucracy or taxes. It could be done by next year if someone had the political guts to do it.

  20. Brad Warthen

    Doug, are you feeling all right? You’re actually OK with a plan for everybody underwritten by the taxpayer?
    I mean, hallelujah if you are; I’m just taken aback.
    As for your five suggestions above, from shortening patent periods to barring drug advertising, I’m with you on most, if not all, of them.
    The only one that causes me to hesitate is the first one, just because I don’t have a good feeling for what length of time is a fair chance to get reimbursement for development costs.
    What’s crazy about this (in a good way) is that I’m taking the libertarian view on that (concern for intellectual property), and you are not. That’s cool.
    I’m also surprised that a libertarian could want to do away with privacy rules (HIPAA). Of course, the STATED reason for HIPAA was to protect consumers’ ability to get insurance, which is related to your second suggestion. I prefer your way of going about it.

  21. Brad Warthen

    Oops, sorry — I was so eager to agree, I looked right over number 4. Of course, everyone agrees that it would be great if one could identify and trim enough “waste” to pay for this. I just don’t believe it’s possible.
    Now, before you all start bombarding the comments section with YOUR lists of what could be easily cut, realize that I could just as easily compile such a list. But remember that neither you nor anyone else gets to be an enlightened despot in our system. In a representative democracy, such decisions are made collaboratively.
    That fact lies at the heart of so much libertarian distaste for our system of government: Because the deliberative process leads to decisions other than the ones they would choose, they get angry at the system.
    Anyway, I felt obliged to point that out. Scratch No. 4 as an area of agreement.

  22. Doug Ross

    >> Doug, are you feeling all right? You’re
    >> actually OK with a plan for everybody
    >> underwritten by the taxpayer?
    No, I’m suggesting that all employers have the same options as the federal government at the same price… but also have the option to negotiate their own agreements with private insurers.

  23. Lee Muller

    A good first step to true reform of medical insurance would be to abolish employer-provided benefits. Let the employee pay for their own policies. If the employer provides insurance, it should be, like a car or housing, taxable income to the employee.

  24. Brad Warthen

    You’re thinking small, Lee. Why not be bold? Why not require copays of $100,000 per doctor visit? That would REALLY limit health care to the deserving rich.
    I mean, that IS what you’re trying to do, right?

  25. Lee Muller

    Brad, why can’t your discuss the topic you raise without being silly? A $3,000 deductible is normal for a smart insurance policy.
    Would you buy car insurance to pay for oil, tires, and other normal maintenance? Of course not, but that is the sort of silly purchase many people make in their medical insurance.
    Even more naive is the notion that they are getting some of it for free by their employer. The employer has a total labor cost he can pay. Any benefits, FICA and Medicare taxes come out of that, right out of the worker’s take-home pay.
    If they had the 18.3% they waste on Social Security and Medicare, and the salary reduction the employer used to “give” them medical insurance, they would have about 29% more income to use for intelligent purchases.

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