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  • Benefits and Myths Of Single-Payer Health Care

    • Posted on Jan 13, 2016
    BENEFITS AND MYTHS  OF  SINGLE-PAYER MEDICAL CARE 
    Dr. James Young
    Scott Cawelti

    America has struggled with providing health care for its citizens for a century and more.  The argument comes down to two fundamental issues:  (1) is health care a right for all citizens, and (2) who should pay?  

     We answer the first question “yes,” as have citizens in all developed countries for decades.   Only in America do we behave as though we’re unsure whether health care should be provided to everyone.   According to T.R. Reid in his book The Healing of America, 85% of Americans agree that all citizens have a right to at least basic health care.  (220) 

    The question then remains:  how much of their health care should individuals be required to pay? If everyone has a right to health care, shouldn’t they receive it regardless of their ability to pay?     

     Americans and their representatives have been arguing about this since the New Deal (and well before, in different forms) when Franklin Roosevelt tried to implement universal health are along with his Social Security plan. 

     We now have a hybrid system, one that combines private insurance with government programs including Medicare and Medicaid.  Government now foots around fifty percent of the overall health care bill.  Creating an improved Medicare for all (also known as a “public option”) makes more sense now than ever.   
    Since the Affordable Care Act’s (ACA) inception in 2010, doubts have grown about its long-term viability. Medical providers struggle with an enormous paperwork load, and for-profit insurance companies struggle with profitability margins, leading some to pull out of the ACA altogether.  

     Indeed, some doctors have set up their own “boutique” practices, where they dispense with insurance paperwork altogether, and others have opted to work only with Medicare and Medicaid patients.   Moreover, with co-pays and deductibles rising, usable health insurance has become less and less affordable.  
    The upshot: we believe that the ACA in its current form is unsustainable. Medicare (for seniors) actually works the way it is supposed to, and Americans are reasonably happy with how it is administered, as well as costs and benefits.  

    Therefore we believe we must move toward creating an improved Medicare for all—a single-payer system.  

     For an excellent overview of issues and solutions, see the documentary film “Fixit: Health Care at the Tipping Point” by Vincent Mandillo and Richard Master.  It’s available for free from their web site: www.fixithealthcare.com.  
    Either Jim Young or I (or both) would be happy to view and discuss it with you.  Contact me at cawelti@forbin.net or Jim Young at jyoung@cfu.net.  

    BENEFITS OF A SINGLE-PAYER SYSTEM
    1. All American citizens would be insured.  Though the ACA has added 17.6 million Americans (as of September, 2015) to the number of insured, there are still millions who live with no health insurance at all, and must depend on emergency care for health needs. This is unacceptable, both for health care providers and patients.  Moreover, in the most developed and wealthy country on earth, it’s unnecessary and shameful.    

    2. Costs will be lower for everyone.   Currently health care costs for insured Americans are on the rise, so much so that citizens may well decide to return to being uninsured.  Deductibles and co-pays make truly usable insurance more and more rare.  With a single-payer system, rates will stabilize and can be controlled more easily.  

    3. Care will be better.  Countries with single-payer systems, such as Canada, Great Britain, and France all provide better care to their citizens than the U.S.  We are currently ranked last among 11 developed countries  (see http://www.commonwealthfund.org/publications/press-releases/2014/) Here is the full quote: New York, NY, June 16, 2014—Despite having the most expensive health care system, the United States ranks last overall among 11 industrialized countries on measures of health system quality, efficiency, access to care, equity, and healthy lives, according to a new Commonwealth Fund report. The other countries included in the study were Australia, Canada, France, Germany, the Netherlands, New Zealand Norway, Sweden Switzerland, and the United Kingdom. While there is room for improvement in every country, the U.S. stands out for having the highest costs and lowest performance—the U.S. spent $8,508 per person on health care in 2011, compared with $3,406 in the United Kingdom, which ranked first overall.

    4. Care will be given more efficiently.  Some doctors, as shown in the documentary mentioned above, “Fix It: Health Care at the Tipping Point” have now opted to see only Medicare and Medicaid patients, since this successful single-payer structure is simplified, predictable, and requires relatively less cost and paperwork to administer.  The current system of multiple insurers, each with different plans and coverage, make for daunting, inefficient, and expensive administration. 

    5. Prices will be fair for everyone.  Because prescriptions will be based on a
    formulary, they will generally be less expensive unless patients opt for brand names.  Currently, the Veterans Administration pays 41% less for drugs than the rest of us. Also, “Canadians pay one-quarter to one-half the price Americans pay for the same pill made by the same drug company.” (T.R. Reid, The Healing of America, 135) 

    6. Coverage will be more comprehensive. Currently, insurance companies make health care decisions based on cost/profit for their company.  They must show profitability, and therefore accountants and actuarial data play a major role in the company’s decisions of what and when to cover.  With a single payer, coverage will be comprehensive and decisions made by medical personnel.   

    7. Money now spent administering can be better spent on improving quality and availability of care.  The system could save billions that are currently spent on administration.  This is because approximately 20% of premiums go directly to administering health care—far more than in any single-payer system in the world.  (Administrative costs for Medicare run around 5%.) 

    8. No rationing of health care.  Severe rationing of health care occurs now in the current system based on ability to pay. We have the most rationed health care system in the world—with insurance companies doing the rationing based on their profit margins.   Wealthier citizens with more costly insurance get better care, while some citizens get little to no care at all. Such inequality is growing intolerable, and a single payer system would offer treatments based on need, not cost or ability to pay.   

    9. No bankruptcies due to health care costs. Of the one million bankruptcies in the U.S. yearly, 60% are due to health care expenses.  Around 700,000 Americans per year now declare bankruptcy due to medical costs. (T.R. Reid, The Healing of America, 22) This compares to none in other developed countries.  

    MYTHS ABOUT SINGLE-PAYER HEALTH CARE
    1. It’s a government takeover of health care, and therefore socialist.  “Socialist” has been demonized as a term from its association and history with the Soviet Union—Union of Soviet Socialist Republics. Most recently, it has been called “statist” because it evokes images of an all-power state in charge of everything.  Yet these are not accurate terms for a single-payer system, which simply means a not-for-profit organization that operates in the best interests of all its members rather than shareholders.   Medicare and Medicaid are the closest examples of this system.  Instead of a private, for-profit system, whose main goal is maximizing profit for its shareholders, these agencies exist to maximize health care for citizens. 

    2. It will be an inefficient bureaucracy.  We have one of the most inefficient bureaucracies running health care now—a competing group of insurance plans, each with thousands of employees who are paid to do nothing but administer health care.   Twenty cents of every health care dollar goes to insurance bureaucracies.  

    3. We have best health care in the world; why change it? Our current health care system works well for the wealthy, who can afford whatever health care they prefer, and for seniors over 65 on Medicare—a single payer system.  For those under 65 with moderate incomes, it’s among the worst in the world.  As T.R. Reid asserts in The Healing of America, “ . . .every industrialized country has fairer access to health care and lower costs for health care than the United States . . .Most of the world’s wealthy countries have longer life expectancies than we do, too.” (252) 

    4. Doctors will be under the control of non-health care centralized bureaucracy.  Not true.  Independent physicians and hospitals will continue as is.  It is only the payment mechanism that will be centralized, resulting in major savings.

    5. Patients will not be able to see the doctors of their choice.  Again, not true.   Patients will be able to see the doctor of their choice.   The narrow physician choices (“in network”) currently offered by some insurance companies will no longer exist.

    6. Doctors will lose income and emigrate to other countries to make better incomes. Though doctors in the U.S. are among the best paid in the world, there is little evidence that doctors are seeking to move to America to enhance their incomes.  Because they enjoy more control over patient health and are burdened with far less paperwork, and because they pay little to nothing for their extensive medical education, and far less for malpractice insurance, they are happy to remain where they are.  (See T.R. Reid’s anecdotal information throughout The Healing of America.) 

    7. It will result in long waits for crucial care.  Actually, urgent and emergent medical problems will be treated quickly, as they are now.  In Canada, a "single payer" country, there are some waits for non-emergent services (e.g. knee or hip replacement) but not so for emergent problems.  By way of contrast, a Commonwealth Fund study found that in 2014, 66 million people (36% of Americans) reported delayed or foregoing medical care due to cost.

    8. It will remove the patient’s responsibility for personal health care.  Currently, patients are often delaying or foregoing care because of cost.  Increasing deductibles or co-pays (both increasing with current insurance products) only make this worse.

    9. It will lead to rationing of health care.  We currently have the most rationed health care in the industrialized world.  Insurance companies dictate what procedures and tests they will or won't cover.  This means that insurance company bureaucrats choose who gets what treatments, not medical professionals. Added to this, those without insurance are severely rationed for all but emergency care. 

    10. Private for-profit insurance means competition in the marketplace, therefore lower prices.  Competition between insurance companies has done little or nothing to control insurance costs.  In a state like Iowa, where one company controls roughly 75% of the market, there is little incentive to keep rates low.  Even with more competition, for-profit insurance companies must make a profit, keeping health care costs higher than they need to be, and currently higher than any other country in the developed world.  

    In conclusion, three facts about our current health care system stand out: 
    (1) Americans suffer an enormous number of bankruptcies or at least financial hardships due to personal medical expenses.  This does not happen in other developed countries.   
    (2) In overall quality of health care, America ranks 47th in the world in terms of life expectancy at birth, and 24th in terms of “Disability Adjusted Life Expectancy,” or DALE. We sit far below other developed countries on both of these measures.  See T.R. Reid, The Healing of America, Appendix.
    (3) Between 20,000 and 45,000 Americans die each year due to a lack of health care insurance. (See “Facts About Obamacare” website.  These people would probably be alive if they lived in other developed countries with single-payer health care systems.   


    Dr. Jim Young is a retired family practitioner who practiced in the Cedar Valley for 32 years. 
    Scott Cawelti is a retired English Professor who taught at UNI for 40 years.  
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  • Word for 2016: Balance

    • Posted on Jan 03, 2016
    Here's today's Waterloo Courier column; seems like there's a word that we need to remember for every year.  A pondering on that idea, and the word for 2016.  

    +++++++++++++++++++
    Looking back at 2015, a word emerged for me that kept coming back.  I remember it because it seemed so present, so much a part of my day-to-day world.  

     A mantra-word, if you will. 

     The 2015 word?  Gratitude.  Partly due to my colleague and friend Len Froyen’s book, “Gratitude:  Affirming One Another Through Stories,” and partly due to seeing how many people I needed to thank, gratitude seemed like a year-long focus for me.  

     It’s a wonderful concept.  It requires paying attention to who needs thanking as well as maintaining personal humility.  You didn’t do it all by yourself.  And gratitude also requires affection, since gratitude rarely flows toward an enemy.   

     So thank you, 2015.  You were a good year for gratitude.  

    Now that 2016 has arrived, a different word has already arisen.  It refers to a concept we sorely need, and will need even more as politics take center stage.

     What’s the 2016 word?  Balance. Without balance we fall over cliffs, crash into walls, hurtle into chasms—literally and metaphorically.  Politics always risk imbalance taking over.   

     Consider conservatives and liberals.  Conservatives value tradition, hierarchy, and authority.   Truth be told, these are critical features of any society, and true conservatives work to preserve what’s good from the past, judging what’s best and worst, and what’s needed to keep order.  Tradition, hierarchy, and authority. 

    In some ways, we’re all conservatives, since we rely on these to make sense of our lives and keep our sanity.   Without them, we’re soon lost in the wilderness.  
    It’s only when tradition becomes hide-bound, clinging to the past out of habit, as in “we’ve always done it” that it becomes out of balance.  

     Or when conservatives insist that certain people are better than others and deserve more attention, more wealth, more everything just because they’re a certain color or believe a certain way.   Out of balance again.    

     When an electorate seeks and gets power without checks and balances, letting authorities do whatever they will, everything goes dark.  Ultimately, it’s fascism—
    power unleashed, which has destroyed whole cultures.  

     Nothing makes sense until over-powered authority gets overthrown and balance returns. 

     The same need for balance applies to liberals, who value equality, rights, and justice.  These are the values that make a country worth fighting for, and have garnered admiration and loyalty over the ages, since all three broaden possibilities for everyone, rather than a select elite. 

     However, when equality gets interpreted as “everyone deserves the same no matter what,” it gets out of balance, removing incentives for people who want to do more.  At its best, equality means equal treatment before the law, not a denial of individual talents and skills.  

     Rights too can be abused, as has in fact happened in the U.S. with gun ownership, and the out of balance results appear constantly in mass shooting headlines.  Clearly not everyone should have that right.       

     Finally, justice also can go too far, getting unbalanced enough to become injustice. “Too much justice” sounds absurd, but most of us break the law daily by speeding, jaywalking, ignoring environmental laws against illegal disposal of toxic substances, and so on.  If all laws were constantly enforced, we’d spend most of our time with lawyers and in court.  That’s out of balance. 

    When looking at our whole political climate, we must remember to maintain a balance of tradition, hierarchy, authority, equality, rights, and justice.

    Conservative and liberal values together,  in other words—and fully in balance.   Then we prosper. 

    So let’s keep balance in mind as we watch and listen to candidates make their cases.  I’m searching for those candidates who understand balance, and who seem most balanced themselves. 

     Which candidates would those be?  Stay tuned.   
     






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