Considering a single payer model for health reform

The Patient Protection and Affordable Care Act is in the process of being rolled out, however many questions remain.

Will it guarantee universal coverage? Will it stand up to the many court challenges? The private insurance industry will receive an estimated 400 billion in taxpayer money to subsidize the purchase of these plans. Is this the best way to spend our money?

Many of us in the health field remain skeptical of the program. The Physicians for a National Health Plan estimate that approximately 23 million people will remain uninsured. Many more will find themselves underinsured with high co payments and deductibles. They will have insurance coverage that still leaves them at risk of financial ruin in the event of serious illness. Medical expenses are now a leading cause for personal bankruptcy, often occurring in families that have health insurance. It simply does not offer them adequate coverage.

America spends $2.4 trillion a year on our health care expenditures, more than any other advanced country. Yet this higher spending does not translate into better health status. Americans have a lower life expectancy, higher infant mortality and poorer access to care when compared to most industrialized nations. In a 2002 report, the Institute of Medicine estimated that eighteen thousand patients die annually due to a lack of health insurance.

Where does all the money go? The private insurance health plans consume approximately thirty percent of their expense in administrative costs, profits and CEO salaries. These costs do not directly benefit the patients, instead keeping insurance unaffordable for many Americans.

One reform proposal gaining momentum across the nation is single payer health. Vermont recently passed a single payer plan after their legislature commissioned Harvard economist Dr. William Hsiao. His analysis determined that a single payer model would be 25% cheaper than continuing the current model that depends heavily on private insurers. In signing the bill, Vermont Governor Peter Shumlin emphasized health care as a right, not a privilege; a feeling shared by many of us working in the front lines of health care.

Under a single payer plan, physicians and other health care institutions would operate independently and collect payments from a single entity, which would significantly reduce the expense and challenges of collecting from a variety of payers. It would also reduce the administrative costs and the profits that motivate major insurers. This model was not seriously considered during the national health reform discussions. The tide is turning however; recent surveys of physicians have found 59% favor a national health insurance plan. As we continue to move forward on the path of reform, it is crucial we understand where we have been and consider all our options, including the single payer model.

Aldebra Schroll is a family physician.

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