Why Single Payer?

When Bernie Sanders entered the presidential race, he proposed universal health care as a basic human right.  This has been envisaged as a single payer health care system, that is, a system in which the many private health insurance providers we now have would be replaced by a single, public payer, as it is currently done in Medicare.  Obama, as well, campaigned in 2008 to institute universal coverage, but had to settle for the Affordable Care Act, aka Obamacare, as a first step toward the solution to the health care crisis.  The Republican Congress, claiming gross government overreach, has tried to repeal it 69 times. In the meantime, single payer advocates have been critical of Obamacare’s reliance on the private health insurance industry, which they claim to be one of the main drivers of high health care costs.  Nobody can contest the fact that Obamacare has allowed 15 million new people to access medical care, but it is still far short of universal coverage as 11 million still remain without.  Obamacare has increased access to insurance but, as currently configured, is not likely to greatly change any of the dynamics driving health costs.  Sanders does not claim that Obamacare is a failure as has been claimed; he is just saying that Obamacare will not control costs without eliminating the for-profit insurance industry and allowing a single entity to bargain down prices.

What do we get from Obamacare?  We can’t be denied coverage because of preexisting conditions, young people can stay on their parent’s policies until they are 26, and there are moderate subsidies available for low income folks.  Aside from that, all the hassles of private insurance apply:  limited choice of doctors, costly deductibles and coinsurance, limited choice of drugs, etc.  If we aren’t as attentive to the minefield of stipulations we are required to observe, we may get ourselves embroiled in a lengthy appeal or maybe a lawsuit in an often vain attempt to save ourselves from a bankrupting expense.  Also, plans offered range from bronze to platinum, hardly equal care for all.

My wife has insurance through Obamacare.  Even with a subsidy, she could only afford high deductible “catastrophic” coverage that doesn’t pay for anything until she has spent thousands of dollars, not counting the thousands she is paying in premiums.  Next year, if premiums on plans available to her double again as they did this year, she will be forced to drop health insurance and pay the fine.

The drug companies are making a killing.  We pay as much as a hundred times as much for some drugs than in countries with universal coverage.  With multiple insurance companies purchasing drugs, there is less bargaining power and plenty of opportunity for kickbacks and price concealment.  Since we pay for all our drugs and medical services through our insurance companies, we are insulated from the actual charges at the time of delivery, but are paying them indirectly through our premiums.  Every attempt is made to make sure that we don’t notice what we are being charged nor have any way to contest it directly.

Let’s compare that with universal coverage.   You get sick or have an accident.  You find a doctor that you want to see, and you are taken care of.  Other than minimal forms for you or your doctor to fill out, and for an insurance worker to examine and approve, that’s about it.  Even Medicare will be better.  I have found that some doctors put a strict quota on the number of Medicare patients they will see because other private insurance plans often pay more.  This is directly the result of having multiple payers.  With single payer there would be one payment for any given service and no reason to prefer one patient over another.  Let’s not forget dental coverage, which currently doesn’t figure in as required care.

Much of Bernie Sanders’ credibility as a candidate rides on the viability of his promise to deliver affordable healthcare to all.  All the discussion thus far has shed far more heat than light.  Although the status quo is generally agreed to be unacceptable, the political and economic implications of overturning our current deficient system appear to be too threatening to allow for a reasonable discussion.  The threat, of course, is that the suppliers of healthcare, the insurance companies, and the drug companies stand to lose a lot of money.  For all their outrage and alarm about Obamacare, the Republicans have not yet presented an alternative. The fact that we pay three times as much as single payer countries and still fall far short of universal coverage is an uncomfortable situation that seems to leave everybody dumbfounded.

The problem is really very simple to understand, but difficult to take on.  We need to have the courage to admit that the system that so many have a stake in doesn’t work.  Having resolved to replace it, we have to come up with an alternative and a plan to implement it with the least discomfort to all involved.  We need to elect Bernie Sanders President as he is the only candidate that has the courage to face the problem and is not beholden to the current system.

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terry@vashonloop.com