The Good…

What is single-payer health care?

Universal health care can mean virtually anything you want it to mean: socialized medicine, mandated insurance policies for everyone, or anything in-between. Some very good and some very bad for the public and economy.

“Single payer” means either Medicare-for-all at the minimum, or “expanded” Medicare-for-all (Rep. John Conyers’ HR676) which adds dental and vision. The former requires a 20% co-pay and the latter does not. There are advantages to both.

How does Medicare work?

It’s simple, and that’s why it is the most efficient and least costly. You get sick, you get care, and the caregiver gets paid. Minimal administrative costs.

You use the same doctor and go to the same hospital as before, they just send their bill to the state’s Medicare administrator (a private company under contract to the government). Medicare’s overhead costs are 3.5% versus the typical 17% needed by the 15,000 insurance plans currently in existence.

When the 20% co-pay is required it can be paid directly or you can purchase Gap insurance, as I have, to cover the co-pays. Gap is a crap shoot; more costly if you never use it but it saves money if you really sick. (Gap insurance would not be needed under HR676, which has zero co-pays.)

About 80% of Medicare recipients prefer the “traditional” Medicare system.

For these patients they go to the same private doctor and hospital they have for years, unless the doctor does not participate in the program (maybe 10% of doctors do not). Under single-payer all physicians would participate.

What is Medicare Advantage?

In 2003 President Bush and his Republicans agreed to let private insurers compete with the government system, so many companies jumped in with their own Medicare versions. About 20% of seniors have opted into the so-called “Advantage” systems, but many patients have jumped out as they’ve experienced problems. 

These systems cost taxpayers about 17% more than traditional Medicare (so much for private being less costly than public). Sometimes they have additional services, but these are usually not enough to offset their deficiencies.

Medicare Advantage plans are usually fine, until you get really sick and need care. The Medicare Rights Center found serious problems when, too often, these plans did not provide the care they promise. This has prompted several state attorney generals to sue the companies on behalf of patients.

Could Medicare Advantage co-exist with a single payer system? Perhaps, if the Advantage system is obligated to accept Medicare’s minimum standard of care, accepts its fee schedule, and there are no short cuts or higher costs to the taxpayer. But that kind of system would not have the excessive profits needed to attract private insurers.

With all of this health care can the taxpayers afford it?

Actually, we can’t afford not to do it, especially since we are essentially paying for such a system already.  We’d pay for it in increased taxes versus a more costly insurance system. The savings will be substantial.

The Big Three are making more cars in Canada because it costs them $800 annually per employee there, versus $6500 per employee here. They must add $1500 to the price of every car, and they can’t compete with cars coming in from other countries.

Now multiply that by millions of other US companies that provide health care premiums to employees. Many of them have already outsourced their jobs or manufacturing to other countries that do not burden their manufacturers with these costs. A single payer system would be the best corporate bailout ever, and it would bail out all corporations; not just the wealthy bankers.

See Business Community must get behind single-payer health insurance. Health care premiums are a major jobs-killer in the U.S., though that does not bother those who benefit from the waste .

Who would pay for this system?

Better to ask “who’s paying for the system now?” 

We all are. In cost-shifting when hospitals and doctors shift their costs of bad debt and bankruptcy to the insured, but more so, when employers add the costs of employee health care premiums to the price of their product and we reimburse them at the cash register.

100% of health care costs are borne by 100% of the population, but we are paying for a very inefficient administrative system in the process. We are paying the costs of a single-payer system already, but we aren’t getting it.

For the same dollars we are spending today, we could provide a first class Cheney-care system to 100% of Americans. We’d divert the 31% of insurance bureaucracy waste to patient care instead, and pay for more physicians and nurses and hospitals.

How would we pay for it?

No system is free. We’d pay via our progressive tax system rather than through the inefficient system of for-profit commerce.  31% of today’s health care dollars are consumed by the inefficient insurance bureaucracy without ever laying hands on the patient, which includes billing departments at every hospital, clinic and insurance company.

On top of that we are paying for the insurer’s high CEO salaries and bonuses, high shareholder profits, actuarial and marketing costs, broker commissions, and even their lobbying and campaign contributions that are passed on to the patient. Isn’t it nice to know that your politician is getting a piece of every health care dollar?

Yes it would require an increase in taxes, for some, but the net to the public is a reduction in costs. We’d save $400 billion every year under a Medicare-for-all system.

How would we make this conversion?

No, Mr. President, it’s not a major disruption in the system for anybody but the insurance companies. 

It’s simple.  We’d start by allowing children and Medicaid and SCHIP patients into the Medicare system, and we’d increase taxpayer expenses to accommodate. Three months later we’d add 55-65 year olds, then 45-55 and so forth.

Then we’d start retraining the insurance personnel that were doing the make-work jobs. With 45 million newly insured people we’ll need more medical technologists to do the real work.


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