Published on
Atlanta Journal-Constitution

There Is A Cure

Oliver Fein

The report last week that the U.S. economy lost nearly 2 million jobs this year, and 533,000 jobs in November alone, sent shudders through our nation's households. That's the biggest one-month plunge in jobs in 34 years. "Horrendous" was how one economist put it, while others said the number of unemployed, and underemployed, could easily double over the next year.

These job losses spell disaster for our health. Millions of people are losing their employer-sponsored health insurance, joining the 46 million who already lack coverage. Millions more are finding it harder to pay their co-pays and deductibles and are scrimping on their medications and doctor visits. Many go without care, risking their health and often their very lives.

In short, affordable health care has never been more urgently needed. Yet most of the health reform proposals coming out of Washington these days won't get us there.

Sen. Max Baucus (D-Mont.) recently unveiled his proposals for incremental health reform, which largely mirror the ideas of President-elect Barack Obama and Sen. Edward Kennedy (D-Mass.).

However well-intentioned, the Obama/Baucus/Kennedy approaches share a fatal flaw: they preserve a central role for the private health insurance industry.

To varying degrees, they would mandate that everyone buy private health insurance -- the private insurance that is failing us today. Some of these plans offer a Medicare-like, public option that people could buy into, but experience with Medicare shows that the private plans refuse to compete on a level playing field. They cherry-pick healthier patients and insist on more than their share of payment.

Experience with mandate-based plans in Washington state (1993), Oregon (1992) and Massachusetts (1988 and today) shows that they simply don't work, achieving neither universal health care nor cost containment.

As long as we rely on private health insurers, universal coverage will be unaffordable. These companies generate immense overhead costs and force doctors and hospitals to spend heavily on billing and paperwork.

Administration consumes about one-third of every health care dollar in the U.S. By contrast, in countries with nonprofit national health insurance, administrative costs consume only half that amount.

There is a cure, however. Eliminating the private insurance industry would save $400 billion annually in administrative costs, enough to ensure that everyone is covered and to eliminate all co-pays and deductibles.

At this critical juncture, a single-payer plan is the only medically, morally and fiscally responsible path to take.

We already have an example of an American single-payer system that works-- traditional Medicare. It's not perfect, but people with Medicare are far happier than those with private insurance. Doctors face fewer hassles in getting paid, and Medicare has been a leader in keeping costs down, at least until Washington politicians decided to pay private insurance plans to enroll seniors at a cost 12- to 19-percent higher than traditional Medicare.

Single-payer systems give patients complete freedom to choose their doctor and hospital. They also enhance cost containment through global budgeting, the bargaining power of being the sole buyer, and an emphasis on primary care and prevention.

With a universal plan of this type, doctors and other health professionals could return to their main task: caring for their patients.

Single payer, or an improved Medicare for All, is embodied in the U.S. National Health Insurance Act, H.R. 676, sponsored by Rep. John Conyers (D-Mich.) and 92 other members of Congress.

Opponents of single payer often admit it's the best, most efficient and equitable way to provide quality care, but say it's not politically feasible and is therefore off the table in this round of the debate. How so? A solid majority of physicians, 59 percent, and an even higher percentage of the public, 62 percent or more, support national health insurance, recent surveys show. Single payer should be front and center.

Medicare for All is within reach, but only if we are prepared to take on the private health insurance industry. The time is now. It requires only the political will.


Dr. Oliver Fein is associate dean and professor of clinical medicine and public health, Weill Cornell Medical College in New York and president of Physicians for a National Health Program.

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