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Thursday, September 17,2009

Single-payer health care is the answer

By Oliver Fein

President Obama sold single-payer health care short in his speech to Congress. It's actually the only sensible solution to our health care crisis.

Obama said that a single-payer health care system would require us to "build an entirely new system from scratch." Not true. We already have a working singlepayer system.

For more than 40 years, single payer has served millions of American patients in the form of traditional Medicare. In essence, single payer is an improved Medicare for all.

Obama touted his plan as a way to reduce the escalating costs of health care in this country. But he's exaggerating the amount of waste and inefficiency he can wring out of Medicare and Medicaid. And the Congressional Budget Office estimated that his plan would actually end up costing hundreds of billions of dollars.

But if we implemented single payer, the savings would be enormous. Medicare incurs approximately 3 percent in administrative overhead annually, compared to at least five times that figure in private insurance plans. If you factor in all the bureaucracy and paperwork inflicted on physicians and hospitals by the insurance industry, the administrative waste in our present system amounts to $400 billion annually.

By replacing the for-profit insurance companies with a streamlined Medicare for all, that $400 billion could be put back where it belongs: providing health care. The new system would basically pay for itself.

Insurance companies play no constructive role in providing health care.

They do not give you a physical exam; they do not perform your surgery. What they do instead is fight claims, issue denials and screen out the sick, diverting huge sums away from much-needed care.

The savings rendered by cutting out private insurance companies and establishing a single-payer plan would be sufficient to cover everyone who lacks insurance now and to upgrade insurance for everyone else.

Our nation spends twice as much per person on health care as other industrialized countries do, but our health outcomes are significantly worse.

What gives? How can we spend more and get less than the rest of the world? The answer is that most of these countries have taken a fundamental step that we haven't: the elimination of U.S.-style, for- profit private health insurance.

We should take that step. Obama should have proposed a single-payer plan in the first place. Not that the path would have been politically easy. But single payer would have been easier to defend than the expensive, overly bureaucratic, patchwork mess that he is trying to sell to the American public.

It's time for Congress to acknowledge what patients and doctors across the country already know, that single-payer Medicare for all is the only way to achieve affordable and effective health care.

Oliver Fein is a professor of clinical medicine and public health at Weill Cornell Medical College in New York. He is also president of Physicians for a National Health Program (www.pnhp.org). He wrote this for Progressive Media Project, a source of liberal commentary on domestic and international issues; it is affiliated with The Progressive magazine. Readers may write to the author at: Progressive Media Project, 409 East Main Street, Madison, Wis. 53703; e-mail: pmproj@progressive.org; Web site: www.progressive.org. For information on PMP's funding, please visit http://www. progressive.org/pmpabout. html#anchorsupport.

This article was prepared for The Progressive Media Project and is available to MCT subscribers. McClatchy-Tribune did not subsidize the writing of this column; the opinions are those of the writer and do not necessarily represent the views of McClatchy-Tribune or its editors.

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Medicare is NOT a successful program.  I'm sure recipients love getting free health care, but Medicare is slowly (well, really not so slowly) and inexorably bankrupting America.  The health care systems in Canada and the UK are not utopias: those systems are huge money pits (the UK system in particular is a fiscal train wreck) and everybody who can turns to private medicine: Canadians flock across the border to avoid wait times for tests and procedures, and every Brit who can afford private insurance gets it.

People in favor of the euphemistically named "Public Option" tend to think there's only two alternatives: you either support Obama or you're a Rush Limbaugh Republican who thinks it's fine to screw the poor.  This means that economic rationalists who try to point out that we should actually fix our incredibly broken health care system instead of turning it over to the government to make it worse get shouted down.

Yes, the right way to fix health care is hard and painful.  It would require:

- Breaking the medical establishments guild-like control of health care and insisting that outcomes metrics are actually tracked.

- Disabusing ourself of the fantasy that we can make health care "free" and control costs at the same.

- Forcing ourselves to do actual cost-benefit analyses of medical care, instead of believing that every human life is deserving of the best that modern technology can offer, whatever the cost.

- Let insurance actually work like insurance, where your behavior affects your insurance rates.  If we don't let actuaries participate, it's not "insurance" it's just subsidization.

If we could do all of the above the cost of health care would come down radically.  At that point if we wanted to use public money to help the poor with expenses we could do so without just creating another huge trough at which patients and doctors could gorge themselves on "free" health care.



You are absolutly right that the Insurance Companies play NO SIGNIFICANT ROLL  in fact they all need to face criminal charges for denying claims (and giving doctors raises based on how many claims they deny) and costing people their lives and their health.  I'm serious!



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