Friday, February 3, 2012

The Best Argument for Single Payer

The recent flap from the Catholics over paying for contraception in the new healthcare bill got my brother thinking about paying for healthcare overall. He shared his thoughts with me, and with his permission, I’ll share them with you.

I’ve struggled for a long time to understand why we make health care the responsibility of the employer. I understand historically that this grew out of the original labor strife that caused the rise of the unions, and got some employers to offer it as an incentive. From there it grew to an essentially universal perk, and begat the incredibly powerful insurance industry that is lobbying hard to keep it that way. I get that.

But this system creates a host of problems:

• people without a job have limited access to health care
• employers are forced to care about the health issues/habits of people whose only relation to them is their employment
• people make job choices based on the health care plan, not on the merits of the job or their career aspirations
• companies in financial difficulty through no fault of the employee create health and/or financial concerns for their employees
• pension plans are burdened with health care for an aging population that many simply can’t meet.

And so on. These alone make, for me, a powerful argument for a single-payer system. But alas that’s not enough for some conservatives.

Then today, I heard about the Catholic Bishops chafing against certain health care rules on NPR. The rules require employers to provide a health plan that includes family planning assistance, with birth control. Of course these rules don’t require the church to do that for church employees, as that is a self-contained enterprise. But they do require it of their hospitals or other services that serve the public.

I understand both sides of this issue. Why should the church be forced to pay for services they find morally reprehensible? And yet why should employees be forced to agree with all their employer’s philosophical positions? Do we want employers having a moral litmus test for each employee? Clearly not. And still there is clearly some minimum standard of health care we as a society should encourage, provide, even enforce, especially when it comes to issues as vital as this.

None of this would be an issue if the employer wasn’t involved in the health care system. If we had a federal single-payer system, the hospital would be free to offer (and not offer) the services they choose. They could hire the best people to provide those services without regard to their personal morality or health needs. And employees could be insured a consistent high level of care regardless of where they work.

Simple, isn’t it?


Let me throw in a couple of thoughts. I think we can all agree that the United States will never have a sole single-payer healthcare insurance system. Not only would it face the opposition that we saw in 2009 and 2010 when “Obamacare” was being debated and there were screams about “socialism!” and “death panels” (despite the fact that the bill that was passed doesn’t get anywhere near the single-payer model), it would require an entire re-wiring of the system if we were to start from the ground up. Besides, as long as there is a profit motive in healthcare, it will never change more than it already has. Capitalism always wins.

But that doesn’t mean that the two cannot co-exist. We already have a good model of single-payer healthcare up and running, and it has been for nearly fifty years: Medicare. Despite its size and despite the flaws that have been found — no system with that much money floating around is going to be without thievery — it has a lower administrative cost and higher efficiency return than many for-profit insurance plans. The Veterans Administration healthcare system too is a comparative model of efficiency. For large government bureaucracies, they do pretty well, and they deliver: just try and talk a senior citizen or veteran out of their medical care and see what happens. As the apocryphal Tea Party sign goes, “Keep Your Government Hands Off My Medicare!”

One solution would be to provide a Canadian style health insurance system: publicly funded but privately administered. Doctors are not government employees, and the system does not pay for everything — coverage varies from province to province — and private insurance to provide for services beyond the basics is available. It’s essentially a version of U.S. Medicare but without an age limit. That could be the foundation of the healthcare system, providing services to all citizens regardless of income or employment. For those who want more and can afford it, private health insurance would be available, much like the Medicare supplement, but the bottom line would be that no one in this country would be denied medical treatment because of their inability to pay or a lack of employment.

Centuries ago this nation decided that education was so essential to the growth and well-being of the population that we made it mandatory and free. I would be the first to admit that public education has its flaws and problems, and I could write any number of posts about what’s right and what’s wrong with it. But the idea of we the people providing for the general welfare of the country through something as basic as keeping people alive and healthy is just as essential as education, if not more so.