Opinion Columns & Blogs

Single-payer works in other places, why not here?

Every three months there appears in my mailbox a 50-page magazine entitled PNPH Newsletter, the official publication of the Physicians for a National Health Plan.

The magazine is filled with comments and observations of America’s healthcare system. PNHP is strongly committed to the proposition that our system is excessively expensive, ineffective, unfair and should be replaced by a “Medicare for All” program.

Known also as the single-payer system, such plans are common in other industrialized nations. In virtually every instance, they out perform the American system in terms of cost, access and medical outcomes.

Among the many observations in the 2017 Spring edition:

▪ Obamacare, whatever the problems , reduced America’s uninsured population by 41 percent.

▪ In 2017 our healthcare spending is expected to rise by 5.4 percent to $3.5 trillion. That represents 18.3 percent of our gross domestic product, or $10,832 per person. Among other nations the highest GDP expense (Canada and Switzerland) is approximately 11 percent with average cost-per-citizen of about half ours – all while covering all citizens with medical outcomes better than ours.

▪ American employers are shifting healthcare costs to their employee. Deductibles have increased 63 percent from 2011 to 2015. Coinsurance costs for hospital care were 19 percent of charges.

▪ A RAND Corp. study of Oregon’s health system found that overhead costs would be reduced by $600 million by shifting to a single-payer system. A similar RAND study found that with a national single-payer system, the total national costs would be reduced $121 billion (administration costs would fall $556 billion, but medical costs would increase by $435 billion). Coverage would be 98 percent of the entire population.

▪ Longevity is related to economic status. The life expectancy gap between the richest 1 percent and the poorest 1 percent of America’s population is 15 years for men and 12 years for women. Meaning if you’re wealthy, you are likely to live that much longer than your impoverished cousin.

▪ The 8 richest people in the world – six are American – have global wealth equal to the poorest 50 percent of the world’s population.

▪ The five largest commercial health insurance firms made profits of $65 billion from 2011 (when Obamacare began) through 2015. Despite this, the largest firms have cited losses for their withdrawal from the individual insurance market.

▪ The pharmaceutical industry spends nearly $20 million per month lobbying Congress, far more than any other industry. The average profit margin for major drug firms in 2016 was 21.4 percent, far higher than the 7.5 percent margin in all other industries.

▪ Pharmacy firms spend more on administration and marketing than on research. (Novartis 2016 sales $49 billion, profit 36 percent, marketing and administration 29 percent and research 18 percent. For Gilead 11 percent for administration and marketing and only 9 percent for research.)

▪ Sixty percent of Americans say the government should be responsible for ensuring health care coverage for all Americans. The support was 80 percent of Democrats and 32 percent of Republicans. But of Republicans with incomes below $30,000 a year, support rose to 52 percent. All categories show an increasing support for universal healthcare coverage.

Given the failure of President Trump to overturn Obamacare last month, and his promises for “great health care” and a more “simplified” system” that provides “much better numbers,” and “lower deductibles,” and “insurance for everybody,” one might ask if he was thinking of a single-payer system. And if not, why not?

C.V. Allen is a semiretired Modesto physician active in health care reform issues. He wrote this for The Modesto Bee. Send comments or questions to columns@modbee.com.