Colleen Lyons: Single payer improved Medicare for all
March 6, 2019
What?! U.S. taxpayers pay more ($6,500 per capita) than any other nation to provide healthcare to just two-thirds of our citizens (elderly, disabled, public employees, veterans, etc). And yet, unlike the other 15 highly developed nations, who provide care for all their citizens, we don't get the national, universal, quality healthcare they get. In fact as of 2018 data, we spend another $4,200 for every man, woman and child in this country for a total of $10,700 for each and every one of us. For all this money, we get the worst care, as well. Study after study finds the U.S. ranking last among developed nations on overall health system quality, while some of the developing nations frequently rank better than America on numerous quality measures.
What is going on?! Three major things: 1) other nations have a single system of care verses our half-dozen plus; 2) other nations have healthcare systems that are NON-profit; 3) all other nations have far more primary care physicians than the U.S. does. They understand the importance of primary care and have a physician workforce compromised of 50-70 percent primary care physicians (family doctors, pediatricians and internists) versus the 30 percent we have in the U.S.
In America we keep chipping away at the problem of getting medical care. First, the Veterans Administration was created for our veterans who suffered military-service related injuries or illnesses, then Medicare for the elderly and Medicaid for the extreme poor and disabled in the mid-1960s. These were followed by CHIPS for children falling through cracks and FQHC clinics for urban and rural underserved areas. Most recently, "ObamaCare" (Affordable Care — ACA) has required insurance companies cover pre-exiting conditions, eliminate lifetime limits and cover our kids through age 26. The ACA, also, allowed states to expand Medicaid coverage for their citizens, which Nevada did, and provided the working poor and self-insured with possible subsidized insurance coverage, in the hopes of making insurance affordable. Of course, we do need to keep in mind health insurance isn't actual healthcare, as so many people have experienced and can attest to.
Physicians for a National Health Program (PNHP.org) has proposed America adopt a "Single Payer Improved Medicare for All" program similar to what Canada adopted in the mid-1960s. A system of publicly funded, but privately provided care. Canada currently provides healthcare for all of its citizens at a cost of $4,800 per capita. PNHP's plan eliminates the 15-20 percent cut our FOR-profit health insurance industry takes off the top from our premiums. Further, by essentially eliminating the health insurance industry, Canadian hospitals and doctors spend half what U.S. facilities and providers do to get paid with administrative expenses of 12 percent versus America's 25 percent of revenues. Additionally, a single payer system has the leverage to negotiate significant discounts in the price of medications and medical devices, for an estimated savings of $116 billion a year. A mere savings compared with the $476 billion saved by eliminating the insurance middleman and the For-profit motive, while creating a single system of care. Enough savings to care for the one in three Americans who have no insurance or lack adequate insurance. Enough savings to improve our current Medicare, in which 20 percent of seniors forego care due to the associated costs. PNHP's plan eliminates co-pays, deductibles, and the need for co-insurance, while covering the addition of dental care and long-term care, which aren't currently provided by Medicare.
The Institute of Medicine estimates medical errors are the third leading cause of death in the U.S., due in large part to a lack of a coordinated single system of care. "Single Payer Improved Medicare for All" as proposed by PNHP.org would create a single national system of care. Thus, when you travel out-of-state, you won't be out-of-network.
Colleen C. Lyons, MD, FAAFP, is a family physician and member of PNHP.org.