The health care debate has taken on an enigmatic quality for me. From President Obama to Senator Baucus to the Republicans to callers on C- Span I hear how proposed legislation will result in "health care reform"- --or NOT. How much the President and Senator Kennedy's plan will cost the taxpayer over the next 10 years according to the Congressional Budget Office--$1 trillion. And, Senator Baucus' plan--$1.5 trillion.
The labels of "socialized medicine"- and "government control"- are freely used in an effort to intimidate and thus preserve the intricate, multifaceted structure of corporate power and the insurance industry. Single-payer plans are either denigrated, "off the table"- or ignored.
There is little discussion of how any new plan might be funded to ensure comprehensive coverage for all Americans.
What are they talking about? I ask myself.
I would like to clarify a number of misleading positions. In my opinion what is being discussed is not Health Care Reform; it is a modest change in how health care is funded in order to provide and afford universal coverage. The plans that are being given serious consideration in the Congress all leave the insurance industry with their bloated bureaucracy intact. Then there is the "public plan"- which relies on some yet to be defined government sources of funding which could include taxes on health care benefits and reductions in Medicare and Medicaid. That approach has a paradoxical quality, i.e., take the money from those who need the services in order to fund reduced services for those same people.
A single-payer health care plan, as embodied in H.R. 676, is what it says it is--it is a plan to fund universal health care by extending Medicare to all Americans. The primary role of the federal government will be to collect and disburse funds, a task it does well. This will be accomplished by accessing the following sources of funds which will end our current "regressive" funding system with a "progressive" one that is far more equitable and humane:
- current health care line-items in the federal budget
- repeal of the Bush tax cuts for the wealthy
- closing of tax loop holes for corporations
- five percent surcharge on annual income of more than $184,00 and a 10 percent surcharge on annual income of $280,000 or more
- 0.25 percent transfer tax for both buyers and sellers placed on all stock and bond sales
- 4.75 percent payroll tax paid by employer and employee
- a health care tax paid by those not taxed as an employee and who can afford to pay
- significant savings in overhead costs (up to 25% compared to insurance premiums)
Today employer and employee together pay more than $13,000 to provide insurance for the average family of four where the employee makes $50,000 with insurance providing far from comprehensive medical coverage. Under HR 676, employer and employee together will lay out $4,750 to cover that same $50,000 employee and family. In addition a single-payer plan will have no deductibles or co-pays, thus further reducing the costs to individuals and families and simultaneously increasing the level of coverage for millions of Americans.
Under a single-payer plan the health care delivery system remains intact. This means that Americans will be free to choose their providers and use the facilities of their choice. Those who like their current health care providers may choose to continue. Those whose current coverage restricts choice of providers will be free to choose providers and facilities.
Under HR 676, consumers will go to their provider of choice--not be restricted to a list provided by an insurance company. Bills for service will go to the federal government and be paid by the government. Health care will be complete and portable. We will not need some new bureaucracy to arbitrate payments between insurance companies and consumers since in this system there will be no insurance companies standing between the patient and the provider.
Passage of HR 676 will unleash a wave of entrepreneurial spirit in this country as companies have additional capital and workers are healthier and more productive. Individuals can start businesses without fear of leaving their families unprotected, and family farms will not need a family member working off-farm just to have health care coverage.
Small businesses will benefit significantly because the cost of providing a health benefits for employees will be a smaller percentage of payroll than is currently the case; the percentage will remain constant. Companies will have stability in their health care costs. Workers and employers will no longer have to juggle cost-of-living increases and health care benefits at the bargaining table.
Health care providers will also benefit as a consequence of huge reductions in overhead and time consumed as a result of not having to employ large numbers of clerical and bookkeeping staff to deal with the myriad of insurance companies--and to cope with denial of coverage by insurers.
Hospitals will also benefit by the significant reduction in the use of Emergency Rooms by the currently uninsured for what would normally be an office visit to a primary care physician, significant reductions in staff devoted to coping with multiple insurance forms, and more reliable reimbursement based on annually negotiated budgets distributed quarterly.
There is no question that health care delivery needs to be improved. Single-payer is an important step in this process. The funding for and emphasis on preventive, dental and eye care should result in increased levels of wellness for Americans.
However, health care providers and hospitals need to be more effective in identifying those practitioners and systems whose care is below standard and hold them accountable. It is possible, as physicians find that they are able to spend more time with patients, the number of malpractice claims will be reduced. This additional time will become available as the pressure to operate a "factory"- for income purposes is relieved as a consequence of significant reductions in overhead costs, reduced time in advocating for reimbursement with insurance companies and lost income from denial of coverage. Physicians and other health care providers will be able to spend more time healing and thereby contribute to a higher level of well-being in their patients.
Much has been made of a "public plan"- coexisting with the current insurance dominated plans and that this will produce "competition with the result of lower premium costs.' The likelihood is that the for profit insurance companies will "cherry pick"- the healthiest customers and leave the higher risk customers to the public plan. This will allow the insurance companies to charge lower premiums. However as a result of the risk not being equitably distributed, the "public plan"- will end up with higher costs per patient and require greater subsidies from the U. S. taxpayer. As the profits increase for the insurance companies, the costs increase for government--a situation designed for failure. This scenario will be exacerbated because congress is also planning to make it mandatory for the 47 million currently uninsured to purchase insurance.