Published on Monday, December 29, 2003 by the San Francisco Chronicle
Time for Single Payer?
by Ruth Rosen
DON'T BE SURPRISED if health care turns out to be the sleeper issue in the 2004 presidential campaign and if a majority of Americans eventually decide that a single-payer system is the most cost-efficient way to provide health care for everyone.
Why? Because our health system -- a fragmented hodgepodge of private and public-health plans -- is broken.
HMOs -- which pay huge amounts for administrative and bureaucratic costs, advertising and skyrocketing drug prices -- no longer can contain costs. They have also turned the health-care system into a blizzard of paperwork.
Physicians who recently resisted a single-payer system have grown increasingly resentful of HMO bureaucrats who micromanage their medical decisions. Inadequate reimbursements are driving some out of business. They also dislike having to consult dozens of drug lists or formularies before they can prescribe medicine for their patients. They'd rather spend time caring for sick people.
Businesses, which seek a level playing field, may also become supporters of a single-payer system. Consider the inequities they face. General Motors, which has a huge group of retired workers, must pay for their lifetime health costs. Newer companies, however, either don't offer health-care benefits to workers or retired workers or don't yet have any retired workers to worry about.
Labor, too, is a natural constituency for a single-payer system. The three-monthlong grocery workers' strike in Southern California against major supermarkets has highlighted the burden businesses now bear for paying for their workers' health care. How can Safeway, which has paid decent wages and benefits, compete with union-busting Wal-Mart, which pays subsistence wages and offers health-care insurance at unaffordable premiums?
It can't. To avoid a race to the bottom, each employer should not have to pay for their workers' health care. Instead, through an equitable tax, they should contribute to a single-payer health system.
And don't forget the 40 million uninsured Americans. Soon after the Medicare bill passed, Senate Majority leader Bill Frist announced that Republicans would next try to address the medical needs of those who lack medical insurance. These are people whose votes could be captured by any candidate who promises to reduce their anxieties about getting health care.
The wealthy, too, may come to view single payer as a better alternative. Why? Because one of the best kept secrets in the United States, according to the American Hospital Association, is that 80 percent of our emergency rooms are overcrowded and the average wait is four hours. The poor, of course, already know this. But when middle class and wealthy Americans with heart attacks or serious injuries discover that they, too, may be diverted from one hospital to another, they may reconsider the value of their "excellent" medical insurance.
The fact is, most hospitals operate with "a just-in-time inventory" that works just fine for an average Tuesday evening in May. But on a Saturday night during the winter flu season, emergency rooms are filled with children and elderly people with high temperatures, along with heart attack victims and people bleeding from knife or gunshot wounds. (Don't even think about what might happen after a bio-terrorist attack, a fire or an earthquake.) Triage nurses must decide who will receive medical attention. When all the emergency rooms are filled to capacity, some patients lie on gurneys in the hall, waiting for an intensive-care bed and monitor.
By contrast, a single-payer system would reduce the burden on emergency rooms by providing everyone with primary care in physicians' offices and outpatient facilities.
A single-payer system would also cost less. The overhead for Medicare is only 2 percent; for private insurance it is up to 25 percent.
Health care is a human right, not a privilege. If you don't believe this now, you might change your mind if and when you find yourself in need of life- saving care in a hospital emergency room.
©2003 San Francisco Chronicle