Thursday, May 14, 2009

The Case for Single Payer Healthcare

I covered a conference in April called "Transforming Healthcare," where healthcare experts, physicians, and local officials talked about the reform of our healthcare system. There were a whole lot of news angles to take when writing this story (every story needs a particular angle of focus, especially with something as complicated as the US healthcare system) so I focused on one of the biggest controversies- universal healthcare. In particular, a single payer system that would completely overhaul private health insurance as we know it.

For the pro side, I talked to physician and former Morehead Clinic President Dr. Ewell Scott. He believes not only should there be universal healthcare, but that we should get rid of private health insurance providers altogether. His case is that healthcare should be a basic human right, not a for-profit industry that capitalizes off of other people's illnesses and injuries. He says with one government-funded single payer health plan, we'd save hundreds of billions of dollars a year.

As for cons of universal healthcare, I spoke with Jim Frogue, the Executive Director of the Newt Gingrich Center for Healthcare Transformation. He says universal healthcare is too costly for taxpayers, and that existing single payer systems such as the one in Canada, and partially socialized medicine in France, are failed systems. He says government intervention isn't the answer for healthcare reform, but that there needs to be a movement to encourage preventative measures among individuals. Frogue argues if Americans ate healthier, exercised more, and stopped smoking, there would be collectively less hospital visits, meaning the cost of care would decrease.

Dr. Daniel Mongiardo is Kentucky's current Lieutenant Governor and also a licensed physician. He gave the keynote address during the dinner at the conference. His view of universal healthcare is somewhat pragmatic when compared to the ideas of Frogue, who says no, and Dr. Scott, who gives a definite yes to a single payer plan and for doing away with private health insurance firms.

Mongiardo wants universal healthcare, but isn't calling for a single payer plan. However, one should also take note that Mongiardo is running for US Senate in 2010. And he's got some pretty stiff competition with Jack Conway, Kentucky's current Attorney General (Conway's already been endorsed by Louisville Mayor Jerry Abramson, Congressman John Yarmuth, and State Auditor Crit Luallen). All that being said, Mongiardo knows he can't be too controversial with what he says, because he needs all the votes he can get. Guys like that, you've gotta take everything they say with a grain of salt. All of the advantages of a government-funded plan and money-saving measures would be rendered useless if you kept all the private insurance companies around, too. It's like when McCain said he supported a Cap and Trade system on companies for their carbon emissions, but with no mandatory caps (you need mandatory caps for the system to work). It just doesn't make sense pragmatically. You either do or you don't. My opinion after hearing both sides is that if you're gonna do it, go full out. Keeping around the private health insurance firms doesn't save any money and adds to the problem of too much bureaucracy.

All of us agreed that our system was broken and needed some serious change. During Frogue's presentation, he showed a pie graph with all the major concerns of the current healthcare system in the United States. The figures in the graph were gathered by the Newt Gingrich Center. Surprisingly, cost was the number two issue behind wait time. I'll address both of those issues in this blog, and I hope that by the end, if I haven't convinced you to support single payer universal healthcare, that I've at least made you think about it and maybe you'll do your own research on your own.

An American Single Payer Heathcare System: The Cost Perspective
Right now, healthcare is one of the most profitable industries in western society. There are approximately 1,500 different health insurance providers alone in the United States. Ewell Scott proposes that with a single payer plan, we would save hundreds of billions of dollars a year with the elimination of competition in the healthcare market as it becomes a public service; Frogue believes converting to an electronic system would save hundreds of billions per year in the elimination of bureaucracy and fraud. However, both of them disagree on the implementation of a single payer plan.

Right now, nobody can afford healthcare right now, especially the poor; a bad diagnosis can spell financial ruin for the average family in America. Say there's one person, working at McDonalds who makes $20,000-$25,000 per year, who has a spouse that makes relatively the same amount of money. With a $40,000-$50,000 income, it's absurd to think that these people can afford $15,000 per year for a healthcare premium.

Also, it's been shown that employers have been steadily reducing health benefits in the last ten years while keeping wages either stagnant or at a very slight increase. As of right now, the majority of employer-provided healthcare plans are inadequate for the workforce. There needs to be something besides underfunded medicare and medicaid policies and shoddy employer-provided health insurance. As the years have progressed and the economy has worsened, employers may have given very slight wage increases, but they have drastically cut benefits to save money on personnel costs. This means employer-provided health insurance is still too costly for a majority of families.

The paradox is that the more well-off you are, the healthier you are; you have money to buy and cook healthy food, the money for a gym membership, and thus have low health insurance premiums. The same applies for the poor, except vice-versa. The poorer you are, chances are, the worse off you'll be healthwise. The people who need care the most aren't getting it because they aren't insured, or they just don't have the money. In most cases, it's both.

Indeed, Jim Frogue believes that preventative measures taken by individuals would mean collectively less hospital visits, thus citing less demand, driving the price of healthcare down. Basic economics. However, this is under the assumption that everyone will quit smoking, and that Americans will suddenly become proactive in living a healthier lifestyle as they eat less fast food and cook more, and take the initiative to exercise at least 30 minutes a day. This is wishful thinking at best, considering our obesity rate is the second-highest in the world. (33% of our population is considered obese; Saudi Arabia is #1 at 35% of their population) Instead of crossing our proverbial fingers and hoping everyone will do the right thing, our government needs to be proactive and realize that everyone has the right to get taken care of when they're sick, rather than suffer. Moreover, private health insurance companies who pick and choose the areas they cater to and who would rather make the most money than get people the care they need contribute nothing to society.

Ewell Scott goes so far to say that healthcare is a basic constitutional right. As we have the right to life, liberty, and the pursuit of happiness, healthcare involves the issue of life. If you're sick or injured and lose your life because you couldn't afford adequate care, that serves as a testament against the entire privatization of the healthcare industry, as corporate profit gets between you and one of your basic constitutional rights under the bottom line of the private health insurance industry.

Some things are meant for industry, free market, and competition. Restaurants, stores, and manufacturers having some healthy competition with one another and avoiding monopoly is a huge help for the populace; it divides demand evenly and keeps prices low. But some things are more important than profit, and when the greed for profit keeps needy people from their essential rights to life, that's when the government needs to intervene. It just isn't right for someone to make money off of someone else's suffering; in essence, that's what happens when healthcare is made into a business instead of a public good. Take a look at one of the many free public goods we take for granted everyday; firefighters.

Did any of you know that firefighting used to be a privatized industry? You had to pay to have an emblem of a particular unit on your home. If your home was on fire, and a rival firefighting team saw that burning home with another emblem, they would just drive on by. That's a prime example of profit coming before the good of the people. Just like the private healthcare industry. Some things are just better socialized- as a public good, profit is not an issue, but rather the well-being of the people. Sometimes, people getting what they need is more important than making money.

Critics of the single payer system point to Canada; they say it takes months to wait for an operation, and that systems are so backed up with people making unnecessary hospital visits and abusing the free care system. Critics also say eliminating the private health insurance industry would leave a great deal of people out of a job. However, this all too often spouted opinion is based on information that is wrong, or nonexistent. I mean, how many people do you know go to the hospital for kicks? Certainly given the ratio of doctors to residents in rural areas (1 to 100 in Eastern Kentucky) the emergency room is the only option for most people. And considering a lot of people don't have the money for health insurance, and considering private health insurance companies often refuse to serve rural areas for the lack of money available, that leaves people further and further in the dark.

For example, Canada's healthcare system has half as much money as we put into ours. We can do a single payer system better, because we have the people, the money, and the technology necessary. Combining a single payer healthcare system with a completely digital health database would be the first system of its kind; a system without unnecessary bureaucracy and wait. In Canada, nobody has to wait for emergency care, and nobody has to wait for urgent care. The only wait time is for operational procedures like knee or hip replacements. While you may have to wait three or four months for that hip replacement, most of the time, that replacement was needed for a condition that had been exacerbated over a period of five years. If care is free, then what is a few more months time?

While eliminating the private health insurance companies would leave people jobless, it's simply a matter of priority. One has to ask a poignant question to oneself; is it more important to give Americans the care they need, or is it more important for to keep pointless jobs available that only serve to deprive people of care for purposes of profit?

Eliminating Healthcare Bureaucracy
In January, my right hand needed $13,000 worth of surgery to fix a hole from a mishap I had on New Years' Eve. This was for the anesthesia, the operation, the pre-op, and for the labor. I can honestly say that 90% of the time I spent in the hospital wasn't on my operation, x-ray, pre-op, or post-op. It was in the paperwork, in calling and confirming my being on my mom's health insurance plan, calling her to get her social security number and birthdate to verify it all, and other such nonsense that could be avoided very easily if done digitally.

Jim Frogue made a very good point in that after Hurricane Katrina, millions of paper records were lost with the damage from the storm. He used the Jiffy Lube example; if someone from New Orleans drove to Houston for an oil change, Jiffy Lube could pull up your last visit on their computer with just your name, see exactly what they did, how much it cost, and what procedures they used. However, if someone from New Orleans drove to Houston who had cancer, Houston hospitals wouldn't have the faintest who that person was. In this sense, Frogue is right on; this is exactly backwards from where we need to be, especially as we move into the next decade of the 21st century.

This isn't a cost-saving measure; the real cost-saving comes from doing away with private insurers. Indeed, this alone would save us $400 billion each year in taxpayer dollars. And as we saw with the computerization of records by banks, money wasn't saved, but financial procedures have now become much more streamlined and efficient. Most other practices have now computerized their records, making wait time for clients almost nonexistent. Considering healthcare is such a necessity, why haven't healthcare records been computerized? With a single payer system that makes healthcare a right and not a commodity available only to the rich, and a digital system that eliminates wait time and paper clutter, the quality of healthcare would improve drastically.

Imagine if doctors could spend their time being doctors instead of insurance couriers! If nurses could spend their time caring for patients instead of filling out unnecessary paperwork! If people could get the care they need for free without having to compensate for losing a valuable day of work or wasting time they don't have waiting or filling out paperwork! What's not to like about this system?

Why the Obama administration is wrong about healthcare reform
Private insurers follow a bottom line of making the most money and earning as much profit as they can, not getting people the care that they need. In businesses like manufacturing, food service, and retail, profiteering and private ownership is encouraged in our economy as it allows for competition, low prices, and everyone always striving to make the best quality products for as little a cost as possible, meaning the people reap the benefits. There's nothing wrong with capitalizing off of consumer goods.

However, capitalizing off of human illness and debilitation is inherently wrong. We all deserve quality care when we're sick and injured, and making money should never come between someone living and dying; any sensible person would find profiteering from the misfortune of others to be entirely immoral. However, this is the primary goal of the private health insurance industry. Private insurers have no qualms with denying the uninsured the care they need if it doesn't suit their corporate interests, or if they see no profit potential. Private health insurance companies contribute nothing worthwhile to society.

Barack Obama proposes a free, government-funded insurance plan to all those who want it, but he's doing nothing about existing private insurers, whose sole purpose is to make money, not provide for those who need it. All of the cost-saving measures that would take effect in a single payer system would be nonexistent if private insurers are allowed to stick around.

If we want affordable, quality healthcare for all citizens, and if we want to eliminate unnecessary bureaucracy and wait time, then a single payer healthcare system is the only true reform. Eliminating private insurers and computerizing healthcare records are the first steps to take. Obama needs to put his re-election hopes aside, man up, and challenge the private health insurance once and for all by allowing a single payer option on the table in his vision for universal healthcare reform.


  1. From what I've heard about Socialized Medicine, doctors are told what they can and cannot do, emergency cases could be dragged out for years, and those in need would not get the care and treatment they deserve. England and Canada are prime examples! Doctors would be prohibited from ordering the tests and services necessary to diagnose cases properly. The American people would suffer in the long run. Private health care is still the best way to go! The bedside manner of physicians means more to me than becoming just a number in a faceless society. I want my doctor to be able to spend as much time as he needs to diagnose my problem. Socialized medicine would put a stop to that! Well, that's all I have to say at the moment. Jim

  2. Canada puts half as much funding into their healthcare system as we do. Half as much. And they still rely on the paper system. If we switched to single payer and computerized all of our healthcare records, going to the hospital would be as simple as giving the desk clerk your name, showing a form of ID, and being admitted to see the doctor.

    As stated in the article, healthcare quality would skyrocket as doctors would finally allowed to be practicioners of medicine instead of insurance couriers. 80% of the time spent at the hospital isn't in the actual operating room, it's going through needless insurance bureaucracy and silly paperwork.

    And Jim, what you've "heard" about socialized medicine has been lies purported by the massive lobbying efforts done by the private insurance sector in Washington. The corporate healthcare establishment is scared to death of a potential national plan, as they should be.

    If a national plan goes into effect, those private companies will suddenly be forced to stop extorting their clients for all they can afford to have an annual healthcare premium. They'll have to provide better coverage at a lower cost, to keep their customers from switching to the government option.

    Because people would rather be insured for free than for the cost of a new car every year, the private health insurance industry will soon begin to become irrelevant and will phase itself as everyone switches to the gov't plan. Maybe then America will have a true single payer system.

    Literally, the only people who would lose out in a single payer system would be the private insurance companies, who contribute nothing at all to society in the least. They and their endless red tape are the reason healthcare is so screwed up right now.