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Single Payer

The Road to Resilience

A single payer health care system makes so much sense, it’s hard to imagine how we got stuck with the system we have.  We all have to take responsibility for our own health, but if somebody is sick or injured, it is in nobody’s interest that they not receive the care they need.  Treating health care as a commodity means that many need to decide whether to buy groceries or go to the doctor.  This is too close to a Monty Python skit.  All developed countries understand this and provide health care when and where needed without the huge expense of trying to decide who gets it and who doesn’t.

After watching Now Is The Time, a documentary on single payer health care shown at the theater a week ago Tuesday, a number of considerations started to come into focus for me.  Although I came in a little late, the tenor of the film seemed to be that the status quo for-profit health insurance companies were making a lot of money for a questionable service.  Single payer advocates make a fairly well-documented claim that health care can be administered much more cheaply with a a single payer (the government) than with the multiple “competing” private sector payers that are the existing private health insurance industry.  We know who pays for health care:  we do, that is, individuals (us), businesses (us), and government (us).

So if these insurance companies are mainly just passing our money on to health providers, what exactly are we getting for the exorbitant share they are keeping for themselves? When we buy insurance, we put our money in a large pool, the larger the better so as to average out the highs and lows of costs to individuals in our pool.  As near as I can tell, the individual companies compete to lower overall health care costs by being the best at stiffing doctors and making sure that the care you get is warranted.  All the negotiations that go on to make sure that no money gets spent unnecessarily actually cost a lot of money—not as much money as it would cost if you were getting paid for all the extra time you put in fighting to get the care you need.  Still, it turns out that we pay three times as much as people in other countries with universal coverage even though 40 million people in our country are not covered at all.

Most of our health insurance is paid for through our employers.  Say what?  There was a time when some employers built houses, schools, civic centers, and hospitals for their employees, so it may have seemed at one time that giving employers the responsibility of providing health care to workers was appropriate.  Please let me know if you work for a “kind father” employer.  Most employers don’t want that responsibility, and many use it as a lever to tie employees to their jobs and to quell complaints.  Worse yet, the terms of coverage are determined by the employer, and they are getting skimpier and more expensive all the time.

But isn’t single payer socialized medicine?  No, it isn’t.  The government serves as the insurance pool that negotiates prices on our behalf and health care providers remain the independent operators they now are.  The government already pays for 64 percent of our health care, so it isn’t like they are taking on more than they can handle.  Since we pay three times more for our health care than many countries with universal coverage, the money is already there.  In the film, they quoted studies that showed we would be paying about 15 percent less for premiums, but that is only the tip of the iceberg when you consider that we would no longer have deductions, copays, or co-insurance.  Did I mention dental?  No dental bills either—it’s all covered!  I repeat:  you will be paying 15 percent less for more coverage, everybody is covered, and no more time wasted choosing coverage or fighting for care.

Implementing a single payer health care system would call for the virtual elimination of the entire private insurance industry.  In other countries with single payer systems, private insurers still operate on the fringes providing higher cost luxury care or cosmetic services, but they are a shadow of what they represent in our country now.   Whenever we look to redistributing wealth and power from the few to the many, setting up thousands of people in new jobs, and eliminating the investments of thousands more, we will need a political system that represents everybody and can arrive at just and practicable solutions to difficult problems.  We have the basics of such a political system, but it is operating really badly.  Our task now is that of the couch potato contemplating running a marathon.  It can be done but we better start exercising those flabby political muscles.

We need much greater effort on all fronts.  As Betty Capehart said after the movie, we need Pramila Jayapal not only to endorse (she has) the single payer bill HR 676, but to hold  press conferences, write op-eds, and rally her colleagues and constituents.  We all need to do that as well.