The single-payer alternative

[IndianaGreen]

The single-payer alternative

September 28, 2009

The politicians declared one plan for health care reform “off the table” from the beginning: a single-payer system that would cover all Americans and cut out private insurance. But as Dr. Andy Coates explains, it remains the only alternative that can solve the crisis of the health care non-system.

Coates is a member of Physicians for a National Health Program (PNHP), co-chair of Single Payer New York and a steward in the Public Employees Federation in New York. He talked to Ashley Smith about what’s been missing from the health care debate in Washington.


WHAT IS the nature of the reform that the Democrats are proposing?

THE HEART of the reform is a mandate that individuals purchase health insurance--to criminalize the uninsured.

In exchange for accepting some new regulation, the insurance industry will get the government to coerce people into buying their product. Because working people don't make enough money to buy the product, tax money will be used to subsidize the private insurance premiums. The Los Angeles Times called this "a bonanza" for the health insurance industry.

THIS IS exactly what Massachusetts did. What has been the impact there?

YES, MASSACHUSETTS mandated that everyone buy health insurance. And this hasn't made premiums affordable. To reduce premiums, policies have things like very high deductibles and large co-pays. In the case of a single person making just over $30,000 a year, if you add up the premiums and deductible, she or he will have to shell out over $5,000 before any insurance kicks in. This simply isn't affordable.

Massachusetts subsidizes insurance premiums for everyone who makes less than 300 percent of the federal poverty line. This guarantees a constant flow of money into private health insurance companies, while it exacerbates the state's budget deficit.

And to address the deficit, Massachusetts has cut safety net health care! They have taken hundreds of millions of dollars out of programs that would have helped poor and low-income patients--the very people most need the care and whom the reform should have most helped.

In addition, Massachusetts has a feature like what's in the proposed federal reform--a brokerage house called the Commonwealth Health Insurance Connector. It's supposed to help people get private health insurance. But it's yet another layer of bureaucracy!

The Insurance Connector alone employs more people than the province of Ontario has working for its Medicare program. Medicare in Canada costs 1.3 percent of health spending. The Insurance Connector adds 4.5 percent in administrative cost to each policy it brokers. And the province of Ontario has twice as many people as the state of Massachusetts.

The Massachusetts model doesn't work. It doesn't lower costs, and it doesn't cover everyone. It forces people to buy defective, unaffordable insurance. And when you lose your job in Massachusetts, you still lose your health insurance.

http://socialistworker.org/2009/09/28/single-payer-alternative

[jeanpalmer]

1. If they're not going to do real reform

I'd rather they just left it alone. They're just going screw it up more. They're going to facilitate a scam that will dwarf Bernie Madoff's ponzi scheme. Wall St. skimmed off a lot of America's wealth, and now the politicians are going to empower the insurance industry to take the rest.

No thank you.

[Vinca]

2. If they aren't going to have a public option,

they ought to pass laws (for zero dollars) that prohibit insurance companies from discriminating against people for age and illness and dropping ill people. They should also regulate insurance companies like public utilities, setting rates and approving plans.

[Yo_Mama]

3. But that will raise costs too

Insurance companies are already regulated by states.

If you mandate that insurance companies cover pre-existing conditions and accept every applicant no matter how ill, insurance payouts will soar and insurance premiums will skyrocket. This will make millions of people who are healthy drop coverage, and insurance premiums will rise again. That is essentially what is happening now.

You can't mandate that insurance companies cover everyone and not raise rates, because then the insurance companies will go broke and won't be able to pay claims.

You can't do reform piecemeal. It needs to be a whole package.

There are two main sources of inflating private health insurance premiums. The first is the aging of the general population, which increases per capita medical costs. The second is rapidly increasing coverage in Medicaid and Medicare. Both of these programs do not pay the full cost of physician or hospital treatment. In order to make up the deficit, physicians and hospitals charge everyone who isn't covered under government insurance far higher charges. Because Medicare might pay a hospital < $300 for a scan, the private insurer is forced to pay $1,800 or $2,000 for it.

Profits in private insurance companies are not the issue at all. Not that I don't despise private insurance companies, because I do, but I also understand why Congress is leaning toward expanding private coverage with a mandate. Private insurers are really paying for Medicare/Medicaid coverage.

Since coverage under Medicare/Medicaid is due to keep rising, we also don't have an option not to reform. The private insurance system is already breaking down under the load.

If everyone gets covered under Medicare, Medicare payments for hospitals and physicians must be significantly increased - more than doubled in a lot of cases, or many hospitals will simply not be able to provide care. You might be able to get a bed and an X-ray, but they might not be able to provide much in the way of sophisticated treatment.

I think single payer would work better, but it will not lower overall costs at all. It will increase overall costs unless we stop covering a lot treatments.

The MA program has been a dramatic failure, and that is why I don't favor the current plans. I would prefer expanding Medicare, but people are highly unrealistic about what it would cost. We would have to impose a payroll tax of between 17.5-20%. If people aren't willing to pay that, then what are the remaining options?