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Healthcare Reform: Single-Payer vs. Public Option

Posted by ajspage on June 12, 2009

For the record, I have in the past touted a competing public plan, including writing to Eshoo about it.  I no longer believe it will work.
The reasons a competing public insurance plan won’t work are legion, but the most significant are:
1)  Having a competing plan will do nothing to eliminate the huge bureaucratic structure that burdens our health system to the tune of $450 billion a year, largely because of private insurers.  Doctors and hospitals will by necessity continue to maintain largely the same levels of paperwork structures to deal with private insurers that remain.
2)  This is such a monumental fight because of private insurance interests.  Leaving them at the table will mean they will not only eat our lunch again — they have already figured out how and have implemented some of those measures in the event of the most likely reforms.  They are not sitting around waiting for new rules to fight back, they are an adaptive, negative force in the system.  Their incentives do not and cannot coincide with the public interest.  If we want to be able to make incremental improvements in the future that are in the interest of the public and our nation, we need to fight this battle now, while we can, to WIN it.
3)  If insurers are forced to compete with a public option, they will find easy ways to sue the government (i.e., the US taxpayer) for anticompetitive practices.  And wearing opponents down with the legal system is insurance companies’ stock-in-trade.
4)  Philosophical opponents of reform (such as ideological right-wing) do not differentiate between any of the proposed reforms, they oppose them all.  We should be pushing the only one that has a chance of really WORKING, not setting ourselves up for failure after all this work.
I now believe a government run single-payer coverage within a private health delivery system is the only reform that can save significant costs and allow us to improve quality.
Some of the best arguments FOR single-payer can be found on http://www.pnhp.org Physicians for a National Health Plan.  Read the articles and testimonies by Dr. David Himmelstein, the Harvard doctor and professor whose group did the work that found that now over 60% of personal bankruptcies in this country are from healthcare costs and that the majority of those people had health insurance.  They have also looked at the different reform proposals to see where the cost savings are, and concluded that only single-payer coverage (within a private healthcare delivery system) will result in dramatically decreased costs while allowing universal care and improved quality.
I think the biggest fear people have in moving to single-payer (even though the care delivery system would be the same), is the fear of losing choice in their care.  Right now, choice is really the only power patients have to control quality.  You can tell them all you want that they won’t lose that, but they’ll continue to fear it unless the proposed reform demonstrates it in an obvious way.
I think we should move to single-payer with a three-tier cost/coverage structure:  the first tier that covers everyone and provides for all reasonable healthcare coverage that anyone could envision in a plan, a second tier that covers “extras” and allows more latitude to patients in choosing the avenues of their care, and a third tier that is far more expensive, but allows people even more discretion with their care choices.
In the proper implementation of the single-payer system, the first tier should actually cover everyone so well, that the other tiers eventually become unnecessary.  But some people will cling to them anyway.  And if the system isn’t implemented properly (if we get cheap and start rationing), the people who have the most fear of rationing will be able to avoid it, and still we will get the enormous savings and universal coverage overall.
I think this kind of structuring would appease much of the fear around a single-payer plan, because some people know they can always pay for “more” — and at least we will get the savings of single-payer.  And if we run up against problems, all of us in the public and medical profession can as a whole identify and demand improvements, instead of lone, sick patients and overburdened doctors fighting numerous well-armed profiteers.
A.J.

President Obama, who had the courage to stand up with a small minority of lawmakers and oppose the war in Iraq — knowing that his patriotism would be savagely attacked at a time when he had Presidential ambitions — this fearless and principled leader is for political expediency touting a watered down version of healthcare reform.  I hope he will reconsider and stand up for what is right, instead of forging a Frankensteinian-mashup that has no hope of ever running well:  tacking a public option onto the existing system.

For the record, I have in the past touted a competing public plan, including proposing the idea to my Congressional Representatives about it.  I no longer believe it will work.

We need to move to healthcare on the model of fire and police departments — any sector of the economy where citizens are uniquely vulnerable (such as when they are sick or in a life-threatening emergency) should not be subject to profiteering, because it’s just too easy to shake them down.

The reasons a competing public insurance plan won’t work are legion, but the most significant are:

1)  Having a competing plan will do nothing to eliminate the huge bureaucratic structure that burdens our health system to the tune of $450 billion a year, largely because of private insurers.  Doctors and hospitals will by necessity continue to maintain almost the same levels of paperwork structures to deal with private insurers that remain.

2)  This is such a monumental fight because of private insurance interests.  Leaving them at the table will mean they will not only eat our lunch again — they have already figured out how and have implemented some of those measures in the event of the most likely reforms.  They are not sitting around waiting for new rules to fight back, they are an adaptive, negative force in the system.  Their incentives do not and cannot coincide with the public interest.  If we want to be able to make incremental improvements in the future that are in the interest of the public and our nation, we need to fight this battle now, while we can, to WIN it.

3)  If insurers are forced to compete with a public option, they will find easy ways to sue the government (i.e., the US taxpayer) for anticompetitive practices.  And wearing opponents down with the legal system is insurance companies’ stock-in-trade.

4)  Philosophical opponents of reform (such as ideological right-wing) do not differentiate between any of the proposed reforms, they oppose them all.  We should be pushing the only one that has a chance of really WORKING, not setting ourselves up for failure after all this work.

I now believe a government run single-payer coverage within a private health delivery system is the only reform that can save significant costs and allow us to improve quality.

Some of the best arguments FOR single-payer can be found on http://www.pnhp.org Physicians for a National Health Plan.  Read the articles and testimonies by Dr. David Himmelstein, the Harvard doctor and professor whose group did the work that found that now over 60% of personal bankruptcies in this country are from healthcare costs and that the majority of those people had health insurance.  They have also looked at the different reform proposals to see where the cost savings are, and concluded that only single-payer coverage (within a private healthcare delivery system) will result in dramatically decreased costs while allowing universal care and improved quality.

I think the biggest fear people have in moving to single-payer (even though the care delivery system would be the same), is the fear of losing choice in their care.  Right now, choice is really the only power patients have to control quality.  You can tell them all you want that they won’t lose that, but they’ll continue to fear it unless the proposed reform demonstrates it in an obvious way.

I think we should move to single-payer with a three-tier cost/coverage structure:  the first tier that covers everyone and provides for all reasonable healthcare coverage that anyone could envision in a plan, a second tier that covers “extras” and allows more latitude to patients in choosing the avenues of their care, and a third tier that is far more expensive, but allows people even more discretion with their care choices.

In the proper implementation of the single-payer system, the first tier should actually cover everyone so well, that the other tiers eventually become unnecessary.  But some people will cling to them anyway.  And if the system isn’t implemented properly (if we get cheap and start rationing), the people who have the most fear of rationing will be able to avoid it, and still we will get the enormous savings and universal coverage overall.

I think this kind of structuring would appease much of the fear around a single-payer plan, because some people know they can always pay for “more” — and at least we will get the savings of single-payer.  And if we run up against problems, all of us in the public and medical profession can as a whole identify and demand improvements, instead of lone, sick patients and overburdened doctors fighting numerous well-armed profiteers.

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3 Responses to “Healthcare Reform: Single-Payer vs. Public Option”

  1. Sarah said

    Hi I think this is a fantastic blog, keep up the good work…

    • ajspage said

      Wow, thanks Sarah!

      With this article, I was trying to atone for writing my Member of Congress suggesting a public option a few years ago. I’m not saying my letter was in any way the impetus for that push — in the same breath, I suggested they disallow insurance companies from deducting legal and administrative expenses beyond the nominal, and that unhappy customers be allowed to transfer, oh, a hundred years of premiums with them if they aren’t satisfied with one insurer and have to switch. (Which I also suggested wouldn’t work because insurance companies would game that system, too.)

      But mea culpa — I wonder which other hopeless idealists (MoveOn.org) wrote their Senators thinking the government could just compete the insurance companies out of racket?

      Coming soon, economic commentary: “Everything I needed to know about the economy I learned getting my teeth chipped on a rusty teeter totter.”

  2. […] Healthcare Reform: Single-Payer vs. Public Option […]

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