Debate on Single Payer
February 13, 2016
Susan Soboroff, M.D., 2/8/16
Debate on single payer, Medicare for All, national health insurance among the presidential candidates is a welcome one. We all want a better system, one that provides access to quality, comprehensive, and affordable medical care for everyone. Reform through the Affordable Care Act has failed to do this. Thirty million people still have no insurance, many millions more can’t afford deductibles and copays, and costs for us, as a nation, continue to rise. I would argue that we must eliminate all the multiple private insurance payers and provide a public Medicare for All plan to achieve this goal.
Critics of single payer say that taxpayers will pay more. In fact, single payer pays for itself. Multiple analyses, including studies by the General Accountability Office and the Congressional Budget Office show that a single payer system would provide universal coverage at a much lower cost, per capita, than what we are spending now. Why? The profit driven private insurance industry spends up to 30% of our premium dollar on, well, profits, advertising, lobbying, denying claims, and more. Medicare spends only about 3% on administration. The estimated $400 billion in savings would be enough to cover everyone comprehensively. Additional savings come from negotiating drug and medical supply prices and from lump sum budget payments to hospitals.
Would we all pay for this through our taxes? Yes, but this tax is fair, graduated and progressive, based on each person’s ability to pay. We already pay 64% of health care costs through our taxes, not only for Medicare, Medicaid, and the Veteran’s Administration system, but also subsidies to private insurers for Medicare plans. Turns out, we now pay more, per capita, than countries like Canada with a universal system. In other words, we are paying for a national health program but not getting it.
With a single payer system 95% of US households would save money on health care. Subtract premiums, deductibles, copays, “out of network” expenses, and reasonable medical costs now denied by insurance. Even property taxes would be lower because counties would not have a Medicaid payment burden, and public employees would all be covered. Imagine no medical bills, no worry about drug costs, job flexibility because health insurance isn’t tied to employment.
Some say that the American public doesn’t support single payer. Many surveys show that almost 2/3 of the US population does, including 60% of physicians, over 600 labor organizations, many civic and faith based groups. Here in Tompkins County several municipalities have passed resolutions supporting a single payer plan in NY State. The NY Health Act passed the State Assembly last year, and its sponsors are working to pass it in the Senate. Like the successful Canadian system, won province by province, NY could begin a nationwide process.
Lastly there is the argument that single payer is not “politically feasible.” Well, Bernie Sanders wasn’t either. He doesn’t take money from the private health insurers or Big Pharma, two of the few entities that stand to lose in a single payer system. The rest of us will win. This is why I hope we’ll continue to debate the issue using the facts, the Canadian system as a model, and our experience as consumers and providers.
David Himmelstein and Steffie Woolhandler, The Huffington Post, 1/29/16
“Doctor’s Group Welcomes National Debate on ‘Medicare for All’,” PNHP press release, 1/22/16
Lots more information and studies at Physicians for National Health Program, www.pnhp.org.
Susan Soboroff is a Family Physician and longtime member of PNHP.