Monday, September 08, 2008

Single-payer Health Care Would Benefit All

By JAMES J. BARBA

Times Union
Wednesday, September 3, 2008


When the topic of universal health care for all Americans is discussed, I have often felt that the space separating the United States from the rest of the industrialized nations, all of which have universal coverage, is occupied by a brick wall. The wall symbolizes ignorance — not merely ignorance of the benefits of insuring all citizens, but ignorance of the component parts of a universal system: parts that can make a critical difference in how we can establish one; in what it will cost and in the issue of convenient access to care.

Dr. John Bennett, the new CEO of Capital District Physicians' Health Plan, is to be commended for his Aug. 22 op-ed piece, "Is single payer the right Rx?" He answers that question by asserting that universal coverage is the ideal all of our citizens. While Dr. Bennett doesn't believe the country needs to move to a single-payer system to get there, his concession in supporting universal coverage all but knocks that wall down.

Why? First, saying universal health care is ideal moves away from the shibboleth that such coverage is socialized medicine — which, by its very term, must be evil. Next, to have a physician of Dr. Bennett's stature adopt this position marks a departure from the days of old when the American Medical Association fought such coverage. And, finally, it is the giant political step that, once taken, leaves the remainder of the debate to mechanics: how do we pay for such coverage; what is the mechanism for such payment and how we phase it in.

Against this significant concession, the issue of a single payer versus a multiplicity of payers is an easier matter, and I think that we can resolve it rather quickly. There appears to be no debate whatever that our current means of delivering health care has become cripplingly expensive. To devote more than 16 percent (and climbing) of our gross domestic product to a single service, no matter how important, is not sustainable. Once we decide that we will have universal coverage, the only approach that will allow actual and substantial savings is a single payer. There are many reasons for this:

Multiple payers have multiple rules for authorizing services, billing and the supply of requested data on the care actually delivered. A single set of rules, which everyone in the provider community follows, will eliminate most of this costly bureaucratic expense.

A single information system would allow all providers to manage and supply data to the payer. The current system, whereby each payer requires health care providers to spend significant resources on billing information systems in order to get their bills paid, is extraordinarily expensive and wasteful.

A single-payer would have a single set of protocols for negotiating fees for services and for supplies, including drugs. Providers do not, as Dr. Bennett suggests, resent the federal government setting such fees as much as they object to having little ability to negotiate each year with dozens of private payers, each one of which has its own agenda and its own bottom lines to support. Allowing a single payer to establish reimbursements that flow from drug negotiations and similar competitive market actions can satisfy the providers and eliminate substantial expense.

Finally, and most important, nothing in Dr. Bennett's article addressed the issue of the uninsured. Unless we are willing to deal with those 46 million citizens, we have no real hope of taking the largest single cost out of American health care.

Far too many of uninsured individuals receive no preventive care, and, instead, crowd hospital emergency rooms when their health issues have become aggravated — and much more expensive to deal with. Our experience with managed care payers over the last 20 years has demonstrated that they are incapable of providing preventive care and/or disease and case management in any meaningful way, evidenced by the fact that premiums continue to rise. A study done five years ago, indicates that if the nation were to move to a single-payer system, the cost savings would be in the $200 to $300 billion dollar range. From that savings, the highest estimate I have seen for giving adequate health insurance coverage to all uninsured Americans is $125 billion.

A single payer can both create a rational and universal system for all Americans and save significant amounts of money. Whether we call that system "Medicare" or something else is not relevant. Whether we can afford to deliver access and care to every citizen is.

Dr. Bennett has conceded that universal coverage for all citizens is "the ideal." I know of no cost-effective way of reaching that ideal other than through a single payer.

James J. Barba is president and chief executive officer of Albany Medical Center.

The original op-ed by Dr. Bennett can be found here.
Read in full