What does single-payer mean?
1974: Richard Nixon proposes healthcare reform
It is one of history’s greatest ironies that had Richard Nixon not run afoul of the Watergate scandal, Americans might long ago have obtained universal health care. But thanks to Watergate, Nixon found himself on the path to impeachment and resigned his office. His “sweeping new program” for “comprehsive health insurance” lay dead on the table.
It is another of history’s ironies that Nixon’s successor, President Jimmy Carter, did not have the clout to push through a similar program. We recall sitting with a friend in a bar in New Jersey the same night that John Lennon was shot. A German was expounding on an issue we had never considered before.
“The thing you have to understand about American presidents,” he intoned in his Teutonic accent, “is that they always do the opposite of what you expect them to do. It was Nixon who opened the door to China, and Kennedy and Johnson who got us into the Vietnam war.”
He was claiming, in effect, that a Democrat could get away with sponsoring a program or course of action that, were a Republican to attempt it, would arouse cries of “Nazism.” And a Republican—such as Nixon—is more likely to be successful pushing through a program that, were a Democrat to attempt it, would be called “socialized medicine.”
A tale of two presidents
We happen to think that he was right. And as a consequence, both Jimmy Carter and Hilary Clinton were doomed in their attempts to change our healthcare system. We personally were opposed to Hilary’s attempt and wonder if it is the times that have changed, or have we merely begun to see through the smokescreens that hid the truth from our eyes in former years?
Certainly we have become wiser by experience. We no longer view with suspicion government-sponsored health insurance. In fact, along with a growing majority of healthcare professionals, we have come to see it as the only realistic recourse for a system that is badly broken. Treating health care as a privilege available only to the few who can afford it is simply not a reasonable course of action, in our opinion. We would hope that a humane approach to health care would be an acceptable alternative to a majority of Americans.
We should mention too that we are entirely sympathetic to those who fear that government involvement might bring lowered health care standards. Indeed, we would heartily agree were it not for the fact that private industry has already set the bar so low that even the government can provide better bang for the buck.
Like many conservatives, we wax queasy when others speak of “Medicare for all” as if Medicare were some sort of laudable standard for heath care. Indeed, it is not. There is much to be improved in Medicare, and most of the incursions by Congress into that realm in recent years have been disastrous. (Investigate Medicare Part D if you doubt us.)
Everybody in, nobody out
But getting back to the stated theme of this piece, the essence of a single-payer system is the motto, “everybody in, nobody out.” This is the crux of the matter. When everyone—congressman, senator, doctor, lawyer, president, tax-payer, homeless war veteran—becomes entitled to the same health care, we think government health care standards will markedly improve. Certainly the care meted out by Veterans Administration hospitals is no standard to emulate for the rest of us. But who more deserves the kind of coverage and care afforded to Federal employees and elected officials than those who gave their bodies to defend those same exalted healthcare standards while defending our freedoms? Should we deny any veteran—whether or not she can now afford a home—the very best health care?
We think not. But our system does, daily. And this is unfair.
Health care for patients, not profits
Unfortunately, those who stand to profit from the status quo—mainly health insurance and pharmaceutical companies—have sought to address the discussion of this issue by kicking up dust. They have filled town meetings with loud lackeys who seek to block meaningful discussion.
But this does not mean that the rest of us cannot both study and discuss the issues. The billions of dollars of industry profits are not fiction and they are not funny. If that money were going towards health care in a single-payer system, we would all be receiving better care without higher taxes.
Keep in mind that those industry profits are paid for by those of us who pay out for health care, whether through health insurance premiums for policies we don’t use or through emergency-room visits that we pay for out of our own pockets. If you pay any money at all towards health care, whether you use the healthcare system or not, you are supporting it. Your taxes go towards Medicare and Medicaid, systems for people that private insurers do not cover because it is not in their best economic interest to do so.
Insurance coverage for the rest of us
A government system that cares for everyone, on the other hand, would operate the way insurance companies should in theory, but don’t in practice. That is, the premiums paid by the healthy would go to pay for the needs of those who are sick. Most of us are lucky enough to start out our lives healthy, though most of us gradually develop more need for health care later in life.
Real insurance systems are designed to deal with these disparities among individuals and could do so quite well, we think, were not billions of dollars annually drained from the coffers to pad the pockets of health-insurance CEOs.
A Harris poll taken last fall showed that only 1 in 14 Americans trusts health insurance companies. Yet, Obama and the Democrats in Congress seem to be trying to put together a system that everyone—including Republicans and the insurance companies—will feel good about. We think that goal is as impossible as it is unwarranted. So long as some of those billions in excess profits floating around the health care industry are donated to politicians to get them to support the existing system, there will be those who are not aligned with our common interests. We can’t expect them to be happy about eliminating all that waste when they are the beneficiaries. Obama himself has received massive amounts of money from the healthcare industry, which might explain his recent restraint in pushing for a single-payer program.
Eliminating unnecessary costs
costs
We need a system that provides everyone good and equitable health care. That should be our first priority. Dr. Sidney Wolfe, a physician and acting president of the non-partisan group Public Citizen, has stated repeatedly that eliminating the current healthcare industry would save $4 trillion over the next 10 years. That’s in contrast to offers from the health insurance industry—now faced with possible extinction—to save up to $2 trillion in costs over the same period.
Why would we want to pay an additional $2 trillion to sustain current inequities? What is intrinsically desirable about paying high premiums and high deductibles for health care, much less having a significant portion of our population under- or un-insured? Are we really afraid that going to the doctor will surpass going to the mall as a form of family entertainment in our society?
It is time to set aside emotion in dealing with this issue. Shouting and name-calling are simply not constructive. Now more than ever, Americans need to focus on what is truly desirable in a healthcare system and to stop thinking in terms of what we have done in the past. We have the opportunity to create something new, a system that is designed to serve all our people. We should not waver from that goal just because it will require some politicians to roll up their sleeves and do some work.
Stop the interference
“There’s no way we are ever going to have good health insurance for everyone so long as there’s a health insurance industry in the way, obstructing care,” says Dr. Wolfe.
“In Canada, you can go to any doctor, any hospital you like,” explains Dr. David Himmelstein of Harvard University, founder of Physicians for a National Health Program. “Canadians have better choice than we do,” he adds, while “[they] spend half as much per person as we do on health care.” Himmelstein admits that if we wanted to cut our healthcare expenditures in half to match the Canadians, we would have to put up with longer waits than we do now. But, he says, if we are willing to maintain our current per capita level of spending on health care, “we could cover everybody with terrific access to care” and still not have to pay copays, deductibles, or insurance premiums. (In other words, our health care would be covered by our current level of taxes and would be better care than most of us receive now.)
His statements have been confirmed by the Congressional Budget Office (CBO) and the Government Accountability Office (GAO). These are solid figures, not empty promises.
Keep your doctor, keep your hospital
And note that there is nothing here about having to give up your favorite doctor or be refused procedures your doctor legitimately thinks you need. That is one of the primary reasons distinguished physicians such as Drs. Wolfe and Himmelstein are behind single-payer. It simply promises us a better system of healthcare for a given amount of money.
Perhaps the best part is that we can eliminate thereby interference in healthcare decisions by non-doctors who are simply trying to amass profits. Insurance companies currently hire hundreds of individuals whose job it is to say “no” to legitimate healthcare decisions made by doctors simply because the insurance company would have to pay to cover those benefits. In a healthcare system in which doctors have the final say on medical decisions, patients are better served. In such a system, doctors are not trying to set aside money to be paid out as profits to CEOs and shareholders, they are simply trying to provide healthcare to their patients.
And isn’t that the point, after all?
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