Single-Payer Health Insurance: Not Dead Yet?

Last weekend (May 22, 2009) I watched the PBS TV program Bill Moyer's Journal on the topic of health care reform, and it gave a lot of information about the single-payer option and the fight to have it be considered by congress. I had just published a brief article comparing a single-payer option to private insurance, so I found this program very interesting and it revealed some things that made me favor even more a single payer plan. At the same time it made me angry about the lack of attention being paid to this option in Congress. I want to summarize and comment on some of this info here, but if you are interested you can get the program summary or even the complete transcript at the program's website.

One interesting thing shown was Barack Obama speaking in favor of a single-payer plan about six years ago, saying: "I happen to be a proponent of a single-payer universal health care plan... We may not get there immediately, because first we've got to take back the White House, and we've got to take back the Senate, and we've got to take back the House. Well now that all those things have happened and he himself is the president, he has taken that option off the table. He now says that if we were "starting from scratch" he would favor single-payer, but he rejects an immediate shift to it because of the "disruption" it would cause: "Given that a lot of people work for insurance companies, a lot of people work for HMOs. You've got a whole system of institutions that have been set up..."

Obama's statement seems to imply that everyone working in the industry would lose their jobs if we went to single-payer, but that need not be the case. First of all, many companies that offer health insurance also offer other kinds of insurance that would still be around and so they would not disappear entirely. Secondly, a government-run plan would need a lot of employees to administer the system and process claims. But instead of hiring a lot more government employees for this we could contract it out to private companies. They would be doing the administrative overhead work, but would not profit from collecting premiums and minimizing payouts like they do now. Actually, many insurance companies do this now for some states and large corporations who "self-insure" their employees-instead of taking on the risks and profits of paying out claims themselves, the insurance company (e.g. Blue Cross Blue Shield) simply processes the claims on behalf of the employer who actually funds it. So I don't think it would be that disruptive.

It was quite interesting to hear the view on Obama's "disruption" statement from the doctors being interviewed who are activists fighting for single-payer. They think such disruption is a good thing and they would favor completely eliminating the private health insurance industry! Dr. Sidney Wolfe says "When you hear the word "disruptive" what you're really hearing is code for 'it would disrupt the health insurance industry.' And that's exactly what needs to be done." Dr. David Himmelstein adds: "And for doctors, patients, nurses, it's not disruptive. It actually frees us to do our work. But for the insurance industry, for people making $225,000 a day as CEOs of insurance companies, yes, it's disruptive for them."

The guests on the program spoke of how much extra costs are involved in having a private insurance industry. Donna Smith stated that up to 30 percent of the costs going for health care now "have nothing to do with healthcare at all and everything to do with fueling the health insurance needs." Dr. Sidney Wolfe said "The amount that can be saved over the next ten years by just eliminating the health insurance industry is $4 trillion, in one fell swoop." They claim that the amount of money that is currently wasted in 1 year is enough to pay for the cost of those currently uninsured.

So why is the Senate Finance Committee that invites representatives from the insurance and pharmaceutical industries to their health care reform hearings not even letting anyone speak about the single-payer option? Well, consider the amount of money that these industries pour into lobbying and donating to powerful congressmen. It's huge, and guess what is perhaps not surprising: Senator Max Baucus who chairs the committee has gotten more money from pharma and insurance companies than anyone else in congress (Ed Schultz, MSNBC). Baucus has used the term "uniquely American solution" to describe the kind of health reform he seeks and has said that he believes America is not ready yet for any form of single payer health care. Interestingly and perhaps not coincidentally, this is the same term used by the insurance trade association America's Health Insurance Plans (AHIP) to fight against public options like single-payer. When asked why single-payer is not on the table, Baucus said "It's not on the table because it cannot pass." Well of course it cannot pass while you are in the pocket of businesses that might be hurt by it!

The program addressed the question of whether a single-payer plan would mean no choice of doctors, a common fear propagated by the insurance companies (which actually limits choice now through their "network" restrictions!). They pointed to the often-maligned Canadian system and said that they actually have more choice than in the US: Canadians can go to any doctor or hospital in the country.

Another common misunderstanding is that Medicare costs a lot more so we shouldn't turn over the rest of the country to such a system. Well the fact is that Medicare covers anybody over the age of 65, so it takes on the older and less-healthy patients so of course the costs per person are more than for the others. In fact, when the private Medicare options were introduced, those companies took steps to screen out the unhealthy patients to keep their costs down. Though illegal, they found ways around that. For example, Himmelstein said "the private insurers have all kinds of tricks to avoid sick patients, who are the expensive patients. So, you put your signup office on the second floor of a walkup building. And people who can't navigate stairs are the expensive people."

One of the positive things I learned from this program is that there are many people working hard to get the single-payer option considered fairly. Some of these were arrested trying to get their voices heard at a hearing that Senator Baucus held. I am disappointed that it does not get more coverage in the "mainstream" press however. But it is good to see that the idea is not dead yet. One of the guests appropriately quoted Winston Churchill: "You can always count on Americans to do the right thing-after they've tried everything else."