A physician’s economic and moral rationale for single-payer
By Dr. Elizabeth R. Rosenthal
Imagine never having to worry about medical bills, even if you lose your job or get sick or become or disabled. Picture the freedom of deciding which doctors you see, and imagine the ability to get whatever care they deem necessary. For millions of people on the planet right now, these basic freedoms are not mere daydreams. They are reality.
In the richest country on earth, our health and financial stability should not be left up to the imagination. We need to create a new normal for this country, one where every person gets the care they need, when they need it. Period.
We can do it. How do I know? Because over 56% of doctors agree, Medicare for All is the healthcare solution we need. So take some medical advice from me, a retired physician. Single-payer is the future of American medicine. Now, let me tell you why.
A Physician’s Rationale for Single-Payer
As a physician, I’ve seen the human and the financial costs of our broken healthcare system. And I know we can do much better. But mine isn’t just another argument appealing to the morality of our society. I believe a single-payer, Medicare for All system isn’t just a moral choice, it’s sound economics.
I am retired now, but during my years as a practicing physician, I had patients who put off getting basic care for fear of financial ruin, who made the difficult choice (or many difficult choices) of either buying the medicine they need or paying their electric bill. Others lived on the edge, one small accident away from mountains of medical debt. Still more patients stayed with their employers not because they enjoyed the work or felt valued and productive, but because of the insurance benefits. I may be retired, but these problems are not. All of this still happens every day in America.
I grew up in a medical family: father, grandfather and many older cousins were all physicians. I went to medical school to learn how to help people stay healthy. Though I went into the lucrative field of dermatology, I had no interest in turning a profit off of healthcare. Rather, I found great satisfaction in solving the puzzle of a troubling rash or spotting a melanoma in an early, curable stage. During my career I had the privilege of getting to know whole families of patients spanning several generations as my practice was 36 years in the same location.
When I was with a patient, I wanted to concentrate on their problem and how best to treat it. I didn’t want to be concerned with whether or not they could pay for their care. If a diagnostic test was required, I wanted to be able to order it. But in so many cases I could not do that because an insurance plan did not cover it.
My husband, a physician at the Manhattan Veterans Hospital, often tells his patients, “One of the things I appreciate about working here in a public system is that money doesn’t enter into our interaction.” He knows that what he thinks is best for his patients will be covered: office visit, treatments, test and drugs. His patients have less anxiety about affording their health care because there are programs in place to support them.
Single-Payer will be Good for Patients, Good for the Economy
It’s true the ACA required marketplace insurance plans to cover the “10 essential benefits,” but those are a drop in the sea of needs patients go without due to lack of coverage.
In our present system the real losers are the patients. The managed care companies promise that patient care is their primary concern. We all know, however, that is not the case. We know they are in the business to make a profit for their shareholders and their bottom line is their main concern. They waste millions of dollars in overhead paying people to deny care, and paying huge salaries to the CEO, in addition to the profit to the shareholders. For these private companies 15–20% of the total expenditure goes to this overhead. In contrast Medicare spends only 1.5–3% on administrative costs.
Then there is the huge problem of the uninsured. For them medical care is a luxury that they often cannot afford.
But doctors can tell you there’s a better alternative — for the economy, and for your families. By adopting a single payer system, an improved and expanded Medicare for all, we can control costs and give comprehensive health care to all in an equitable way. Instead of propping up our market-based health insurance industry, we can expand on Medicare, a successful government program in place for 52 years which is very popular. How popular? 77% of Americans think it’s an important program (some of the highest approval ratings our federal government will ever see), with 85% of those who are not on a Medicare plan saying they would want Medicare coverage if they ever became uninsured.
But many may ask, “Won’t single payer bankrupt the U.S.?” No, single payer will actually save money by slashing wasteful bureaucracy and adopting proven-effective cost controls like fee schedules, global budgets for hospitals and negotiating drug prices with pharmaceutical companies.
Recently, 2500 doctors researched, wrote, and endorsed a single payer plan that points to some BIG savings. By their estimate, the U.S. could save between $400-$500 billion per year on overhead alone. That’s enough to cover everyone in this country who is uninsured! It turns out that it is much more expensive to keep patients away from health care in our current fragmented market based system than to provide care for all under an administratively simple single payer system. Our set-up is so inefficient, we are paying more for our healthcare than any country in the world, with some of the worst results of any developed nations — that’s just bad economics.
But good news, there is already a bill in Congress, HR676, The Expanded and Improved Medicare for All Act, of Representative John Conyers that has 117 co-sponsors. It would expand Medicare to all Americans from cradle to grave and improve it with more comprehensive benefits including vision, hearing and dental coverage and would have no cost sharing (co-pays and deductibles and co-insurance). You could choose your doctor as almost all doctors would participate as it would be the “only game in town”.
Healthcare will be financed by progressive taxes so that most people, except the very wealthy, will have a modest increase in taxes more than offset by not having any out of pocket medical expenses. There are also provisions in the bill for a smooth transition and compensation and re-training for those who would lose their jobs. When Medicare was introduced 52 years ago (before the advent of computers) it was smoothly in place and functioning in less than a year. We can do even better today, and soon, Senator Sanders will soon introduce an HR676 companion bill in the Senate to make it happen.
Yes, doctors across the country are supporting Medicare for All. But if you are “an apple a day keeps the doctor away,” sort of person, don’t just take this advice from me. Listen to the over 60% of the American public who now say it is the government’s responsibility to provide universal health coverage in this country. Those are big numbers. Numbers that should be making Congress sit up and listen.
So now is the time to move to single payer health care. Incremental improvements in the present system will not solve the problem. For those who have studied the alternatives, it is a no-brainer. In doing so we would join the rest of the industrialized world where one gets the healthcare they need and not just the health care they can afford. We must not let the excuse of not being politically feasible rule the day. Polls have shown that a majority of Americans including a majority of physicians support it. We must make it happen and thereby bring health justice to all.
Dr. Rosenthal, a physician for 50 years is an activist with PNHP and BNC