Model exists to provide health insurance for all - it's called Medicare
The announcement last month by the Census Bureau that the number of uninsured increased last year to a record 50.7 million individuals should come as no surprise to those who understand the uniquely American tradition of linking health insurance to employment.
Combined with the corresponding finding that the rate of employer-based insurance has decreased, the conclusion is obvious: in a declining economy, as unemployment rates increase and employer payrolls tighten, the number of people lacking health insurance goes up.
Why is this? I have never understood why health insurance must be associated with employment. Historically, I recognize how businesses’ response to FDR’s wartime wage and price controls lead to the situation we have now. But I fail to see how a model first applied in the 1940s should continue to operate in the 21st century. Other forms of insurance - car, home, boat, flood, and universal life insurance - are not linked to a job, so why should health insurance have this unique relationship?
Imagine a world where your healthcare coverage would not be predicated on what you did or where you worked, where you lived under a system that provided continual access to care as you moved from job to job or state to state, and guaranteed your health security even if you were laid off or terminated. Picture yourself in such a world where “choice” refers not to your choice of health insurer, but instead to the freedom to choose your own doctor and hospital, based on whatever criteria you and you alone deem to be personally relevant. And imagine a world where more than 95 percent of your contribution to health insurance was actually spent on healthcare, with no substantial contributions to a bloated and mindless bureaucracy.
The good news is that such a model exists. It is called a single-payer, Medicare-for-All program. It is a plan modeled on Medicare, a popular program that is universal, portable, affordable, non-profit, non-discriminatory, and administratively efficient. An expanded Medicare program would sever the link between employment and health insurance for all Americans, and use as its sole entry criteria nothing more than U.S. citizenship. Such a program would drastically reduce the number of uninsured, at a total cost much less than what we are paying now. And, under a single-payer system, private insurance firms would be used for simple administrative functions only, and not for decisions that place greedy corporate profits over an individual’s right to medical care.
And the bad news? The United States remains the only western democracy that does not have universal single-payer health insurance. For illogical reasons, we as a country continue to have blind faith in the ability of the private insurance industry to solve the dual problems of access to care and cost containment. If for-profit insurance has not fixed the problems with healthcare after over 60 years of existence, why would anyone believe it would happen now under the recently passed health care reform act, where private insurance continues to play a dominant role? Clearly, the only logical solution is to insure everyone, and the most efficient way to do that is through single-payer national health insurance.
Dr. James Mitchiner, an Ann Arbor physician, is the former president of the Washtenaw County Medical Society and a member of Physicians for a National Health Program.
Comments
Mick52
Wed, Oct 6, 2010 : 4:38 p.m.
Surprised by this, nobody promotes single payer anymore, it does work and will never be successful (quality) in the US. We have sort of a single payer in Medicare and Medicaid and both are failing. Sure single payer systems could work but only it is well funded to do so and America will take on that risk, especially since 260 million plus have HC and do not want it messed with. And the issue seen globally is quality of care. In other countries where single payer systems have been used, they are looking at our system to fix their problems. Here is a story, well researched on global HC problems: http://www.cato.org/pubs/pas/pa-613.pdf Hope this is not too long. Can't give further details due to prior restraint on here.
James Mitchiner
Tue, Oct 5, 2010 : 11:59 p.m.
First of all, thanks for all your comments on my opinion piece. Second, to Betsy: congratulations on being a cancer survivor! And congratulations also on surviving the insurance bureaucracy!! Your commentary - "When will we wake up to the fact that it is the insurance companies who are rationing care either by pricing people out of the market or by determining what they will or wont cover and when? And does anyone really want bean counters to make their medical decisions? It happens every day." - is spot on. The question we all should be asking is: "What is the marginal value of for-profit health insurance?" Third, to Diagenes and all the other single-payer detractors - please provide proof that "national health care in other countries has failed." Warning: anecdotes don't count. For every story you can tell me about your wife's cousin who waited for 9 months to get her MRI in Canada, I can cite examples from my ER of patients who had anything but the "greatest health care in the world" - Like the woman with advanced metastatic breast cancer because she couldn't afford the mammogram, the uninsured patient with a stroke because he couldn't pay for his antihypertensives, the young man who lost all his teeth by age 26 because he didn't have dental insurance, etc., etc. And by the way, single-payer would not exclude people from buying supplemental insurance on their own. Yes, Canada does have private insurance but it is SUPPLEMENTAL, and the overwhelming majority of Canadians would prefer to keep their national health system over converting to American-style medicine. The other point to keep in mind about Canada is that, by American standards, Canadian health care is underfunded. So the problem in Canada is not the system, its the money. In the USA, its the other way around.
talker
Mon, Oct 4, 2010 : 5:37 p.m.
Do you remember when a foe of the health care bill used Professor Hawking as an example of someone who would have died under the type of national health available in the UK? Then the truth many of us knew came out. The amazing professor is a citizen of the UK and attributes his survival to the wonderful health care he has received.
Klayton
Mon, Oct 4, 2010 : 12:30 p.m.
@Betsy Thank you for sharing your story. I have a feeling that most of the comments made by people who don't want a national plan or one-payer system have never had to deal with an illness such as yours and battle the health care industry for every test, follow-up, and new treatment. I wish you continued health and please keep sharing your story.
bugjuice
Mon, Oct 4, 2010 : 9:49 a.m.
Here in the USA we're so ready to sya cost be damned when we go to war, but for some reason become stingy penny pinchers when it comes to health care. Since when is it so wrong for all of us ( we the people, for the people, by the people etc) to be responsible financially and socially, for all of us when it comes to health care? E pluribus unum.
David Briegel
Mon, Oct 4, 2010 : 9 a.m.
Betsy, your story is a perfect example of what is wrong! The insurance companies are only in business to make a profit and the best way for them is to deny care. They have no noble purpose. The only person between us and our doctor is an insurance company bureaucrat/denier!!
Betsy de Parry
Mon, Oct 4, 2010 : 7:58 a.m.
As someone who was diagnosed with an incurable form of non-Hodgkins lymphoma nearly 9 years ago, I have come face to face with the health care and insurance industries, and I can say from experience that their own self-interest puts profit over people. Take my case. I was refractory to two types of chemo, was rescued by a new therapy in September 2002 and have been healthy since. The total cost of that new therapy, including all the required tests, scans, etc. was $36,929. The cost of everything that DIDNT work was $162,410. All this was in a period of slightly less than a year. The new therapy, however, has not been embraced by the medical community because doctors dont make money on it. They do make money by prescribing chemotherapy drugs, which are known to be less effective, and they are obviously more costly. This has been well documented and, in fact, I wrote about it on the 8th anniversary of my last treatment. See: http://www.annarbor.com/health/cancer-911-every-2-days/ Thankfully, I remain healthy, but as anyone whos ever had cancer knows, followup tests become part of our lives, and the insurance company dictates when I can have them not my doctor who knows best. When will we wake up to the fact that it is the insurance companies who are rationing care either by pricing people out of the market or by determining what they will or wont cover and when? And does anyone really want bean counters to make their medical decisions? It happens every day. Just talk to people whove had any major illness and youll hear horror stories like the man whose insurance company had gladly accepted his premium payments for 10 years while he was healthy, and then cancelled his policy for a pre-existing condition when he was diagnosed with lymphoma. Worse, they cancelled it after he had high-dose chemotherapy in preparation for a stem cell transplant, thus putting his life at even greater risk than the procedure. This is not an isolated case. My fellow cancer survivors in Canada and Europe have gotten excellent care without the waiting periods that we are led to believe, so I suggest we get all the facts before we dismiss other models of care. And frankly, illness and accidents strike people of both political parties. Its time to stop the partisan bickering and finger-pointing and work toward real solutions that can help mothers and fathers, sisters and brothers, husbands and wives and of course children who are, after all, our future.
Speechless
Sun, Oct 3, 2010 : 10:55 p.m.
Over the decades, various false claims about the supposed "failure" of universal, single-payer health care in Europe, Canada, Japan and other countries have been continually spread throughout this country. Such claims gain a certain following in part because the U.S. mass media has resolutely ignored doing fair, detailed reporting on universal care programs elsewhere in the world. American are largely unaware of how it works, to the benefit of those who profit handsomely from our cruel excuse for a medical system. A couple years ago, the National Health Service in the UK had its 60th anniversary. In a feature news article, the BBC noted the growing historical crisis in private health care that led to the founding of the NHS in the late 1940s, which had clear parallels to the predicament in the U.S. today. Whatever their opinions, good or critical, about the NHS, few among the British would ever consider returning the former system based on private, market-based medical services — that would be beyond the pale. When describing the evolution of health care in the U.S. and the eventual, inevitable arrival of Medicare For All, I like to deploy the following quote: "Americans can always be counted on to do the right thing... after they have exhausted all other possibilities."  — Winston Churchill
Diagenes
Sun, Oct 3, 2010 : 8:06 p.m.
Nice try Dr. Mitchiner. Government run health care has failed every where its implemented. The costs are uncontrollable unless care is rationed. European countries offer a private system for people who have insurance. Canada cannot sustain its single payer system and is moving to privatization of some services. If you want everyone to have health insurance give each person a voucher to buy a base level of coverage in the private market that is guarentee issue. If they want additional benefits they pay for it themselves. Its there insurance and they can take it anywhere and is not tied to employment.
David Briegel
Sun, Oct 3, 2010 : 7:05 p.m.
Heardoc, it wasn't the far left Dem's. It was just rality attempting to notify you!
timjbd
Sun, Oct 3, 2010 : 5:29 p.m.
Should add: 1. In Japan, the system is private insurance but the companies engaged in health care are not allowed to make profit so the effect is the same as if it were run by government. (I think that's right..) 2. Medicare could be fully funded if companies paid into it what they now pay to private insurers on behalf of employees (or LESS than that, actually) AND... politicians were allowed (forced) to raise taxes to cover actual costs. If people stayed healthy, they'd then be able to CUT taxes. But it would reflect ACTUAL costs. See? Easy. Could even take the burden entirely off of companies and have taxpayers pay directly into the system like they do with Social Security. That way, health insurance costs would never be an impediment to hiring. Bargaining with drug and equipment companies as one big nation would bring a huge bargaining advantage which is now lost to individuals. Unfortunately, Republicans have made it impossible for any politician to suggest raising taxes (or collective bargaining) and so the country is on its way to being ungovernable. Thanks to Ronny Raygun and his acolytes.
timjbd
Sun, Oct 3, 2010 : 5:14 p.m.
Murea: "I work for a doctor would could not afford to stay in practice if all of his patients were Medicare patients. And Medicare is underfunded. I'm not entirely sure how that makes it an ideal model." The Medicare rates could be adjusted to reflect actual costs of treatment. That's the way they do it in Japan and it works great. They have a panel that sets rates every year. The MODEL of Medicare is not set in stone. It is a starting point that can be adjusted to work better as needed. The fact that it isn't now does not mean that it cannot be. There is also massive fraud within the Medicare system which artificially skews the numbers far away from where they should be. That does not have to exist either but fixing those things takes political will. Right now the political will to make Medicare work properly does not exist. Politicians- being water carriers for the health industry- are very happy to be able to point at Medicare as a fraudulent, unwieldy and wasteful behemoth that people should fear because that's what their paymasters tell them to do. And that's an easy case to make when people do not take time to find the facts for themselves.
talker
Sun, Oct 3, 2010 : 2:33 p.m.
Please remind your friends a single payer system is far less intrusive than profit driven insurance companies that have canceled policies when people get sick and refuse to insure anyone with a condition that costs money to treat. The new health care bill requires companies to cover all, but couldn't pass Congress with price constraints. Also, some Republicans have vowed to even rescind the important parts of the bill or even the entire bill. At least we have a health care bill that precludes insurers from denying coverage to those with pre-existing conditions from C-sections to high blood pressure. But the price could be exhorbitant just because someone used their medical insurance! I'm reminding people without pre-existing conditions who are satisfied with the current system that anyone is a day away from a diagnosis that could deny them insurance at normal rates (except in the largest groups). This includes people who have been more profitable customers for many years. Please don't ignore the fact that people with normal weight, who eat healthfully and exercise regularly still get serious, costly diseases. Even lung cancer strikes some people who have never smoked or lived with a smoker. There is no evidence that we have personal control over cancers from leukemia to prostate. There is no evidence that the person who isn't diagnosed with a disease today will have lower medical costs in the future than someone with a scary diagnosis. (Type 1 Diabetes isn't caused by lifestyle) and even if lifestyle contributed to Type 2 Diabetes, who among us deserves to be smug and expect that person to pay twice as much for health insurance or not get health care, when we might get a costly diagnosis in the future? We can take the "holier than thou" approach or look at the economics of the situation. The fact is people who don't have health insurance get care and we pay for it in fees and insurance premiums, often more because victims delay care that leads to costly complications. Also of every additional dollar we pay in premiums to cover the uninsured, about 15 cents (and has been higher) goes to health insurance companies instead of health care. I wonder if some "public" complaints against laws limiting insurance company profits are planted by those paid to promote higher profit health insurance policies.
Muria
Sun, Oct 3, 2010 : 2:02 p.m.
I work for a doctor would could not afford to stay in practice if all of his patients were Medicare patients. And Medicare is underfunded. I'm not entirely sure how that makes it an ideal model. I have often wondered if the best idea would be to offer a Health Savings Account (HSA) equal to the amount employers pay for health insurance that would NOT roll over at the end of the year, but, like HSA's, could only be used for medical expenses. The account would go with the employee should they change jobs, and the employee could contribute additional funds to it (preferrably pre-tax) if they chose to, also only spendable on health costs. Have catastrophic coverage set up like car insurance. Keep some sort of Medicaid for those who need it. It would give people an idea of how much health care actually costs, and keeping it from rolling over at the end of the year would enable people to save up, either if they do not want to use their catastrophic coverage, or if they want a medical procedure that is generally not covered by insurance (corrective eye surgery, braces, glasses for people without vision coverage, etc.). Also, if you become unemployed, you'd have the remainder of your account until you could find new work. There must be something wrong with the idea, but I'm not seeing what it is.
timjbd
Sun, Oct 3, 2010 : 2:01 p.m.
The reason we will never have the healthcare system we clearly need is because the insurance, drug, for-profit hospital and medical equipment industries find it so easy to grab ahold of the minds of people who believe the following: "The United States remains the only western democracy that does not have universal single-payer health insurance -- is that we are the most successful, richest and most benevolent country this world has EVER known is because we do things different than any other country on the face of the earth-- it is called American Exceptionalism. That is why we have the best healthcare in the world. We have the strongest military in the world and we keep peace in the world because we are unique in every way." Add to that the ease with which our representatives in the congress can be bought and then go on to do the bidding of the health industry in direct opposition to the will of their constituents; and the reluctance of people in general (who would LIKE a system like that) to actually organize for it, I don't think it can ever happen here. If their ever WAS actual American exceptionalism, it has long since tarnished in reality and in the eyes of everyone outside the tea party. Question: If the health industry (for-profit hospitals and drug companies) makes more money off their customers being sick (but not quite dead) than they do off of their customers being healthy, what outcome do you suppose they will push for?
sandy schopbach
Sun, Oct 3, 2010 : 1:03 p.m.
Wonderful article, with a clear explanation. I agree with everything that was said. Especially as I benefitted (and still benefit) from the French universal health system, having worked all my career in Paris. Now that I'm back in the States, I have no health insurance. Luckily, I'm in good health. Unfortunately for universal healthcare, those I know who are against it don't like the fact that the government would be overseeing it. They want less government, not more. And they say the government messes up. I don't agree with those concerns. But that is the boulder that we have to roll uphill. And the upcoming elections are going to either push it further up the hill or let it roll back down to the bottom. Every voter should remember that.
Klayton
Sun, Oct 3, 2010 : 12:40 p.m.
Bravo Dr. Mitchiner! I for one am more than happy to pay more in taxes if it means that ALL Americans have access to health care coverage (and don't have to go bankrupt when they get cancer or some other terrible disease).
Anthony Clark
Sun, Oct 3, 2010 : 12:34 p.m.
To Heardoc and the others drinking the right wing republican kool aid: the United Stated does have the best health care in the world. IF you are rich enough to be able to afford it. Us working class stiffs can't afford to get sick. Where I work, we have two options. A plan I can afford that would leave me bankrupt if I ever had to be hospitalized. Or a plan that actually provides adequate coverage, but is so expensive that I couldn't pay my other bills if I signed up for it. Our wonderful system only works for the wealthy. The greatest nation in the world deserves something that works for everyone.
Heardoc
Sun, Oct 3, 2010 : 12:26 p.m.
Wow! The far left of the dem party is alive and well.
David Briegel
Sun, Oct 3, 2010 : 10:51 a.m.
Heardoc refers mostly to the mythology of America. What we were taught and what we wish America would become. We aren't the best at much of anything. Except maybe puffery. Our healthcare is great for the haves. Not so great for the 50 million and growing have nots. Those European Socialist style system have better outcomes in most aspects of healthcare. Of course, our system produces wealthier doctors. Infant mortality? Collateral damage to that myth! Education? Dropping fast! Military? We haven't won a war since the big one unless you count Grenada. Of course Dr Michiner is correct. Ask Betsy, and Johnnya2. And Heardoc won't answer Modeltim or MLK!
bg
Sun, Oct 3, 2010 : 10:44 a.m.
@Heardoc: I would not take pride in being the 'exception', especially when it comes to healthcare in this country, when 50 million people are uninsured - this is far from an acceptable statistic to be proud of. Being from Canada, and with family still living there, I have heard few complaints - particularly when the doctor makes house calls on weekends. Part of the reason why our healthcare is so expensive is because insurance companies have to pay employees to review claims and deny them...for-profit insurance companies are a conflict of interest.
modeltim
Sun, Oct 3, 2010 : 9:05 a.m.
"American Exceptionalism" is pure hokum, dare I say something that is associated these days with the unbalanced, radical right wing. The doctor said nothing about a single-payer system being free. Of course, it will be paid for by taxes and if administered properly will reduce current insurance overhead cost (overruns) drastically. Healthcare coverage in the U.S. today is completely unfair and maladministered. Of all the forms of inequality, injustice in health care is the most shocking and inhumane. - Martin Luther King Jr.
rick ireland
Sun, Oct 3, 2010 : 8:53 a.m.
Nonsense; the same "blind faith" that Dr. Mitchiner rails against on one hand, he blithely accepts on the other. Medicare is rolling in bureaucratic nightmares as it is! Billions on fraud, millions of claims a swamp their systems; underpaid and politically motivated civil servants overseeing personal medical histories. Single-payer, multi-payer, employment-based policies None address the root cause of run-away healthcare costs. (Hint: The answer lies at the back of the mirror) Test this yourself: Ask random people how much it costs them to go to the doctor; more times than not, they mutter about their co-pay or standard office visit fee Not the actual cost out the door. Healthcare is a market; the market is wildly out of balance because there is zero competition, and the consumer is left in the middle, suffering at the hands of those on whom he depends, Insurance companies are playing a shell game with us and we must have the power and autonomy to say, No, thats too much; Im going somewhere else!
johnnya2
Sun, Oct 3, 2010 : 8:51 a.m.
@heardoc What YOU fail to understand is that the US does not have the greatest healthcare in the world based on the evidence. In every statistical category the US is behind other countries. You also fail to realize that the ".. strongest military in the world" uses a pure single payer, single provider health care. People in the military are taken care of by employees of the US Government (being in the military is a government job by the way). After they leave the military they are covered under the VA, another single payer/provider system. The results of the VA are better than any private insurer in the country. AND, the customers have continuously rated it higher than any other insurer in the country. Is your position that we should take the military off the VA and "socialized" medical plan they are on? If "private" insurance can do things more efficiently or cheaper, I wonder why you are not calling for an end to it in the military. Let's let the so-called free market do its thing, and have every member of the military get their own insurance through a private insurer.
Heardoc
Sun, Oct 3, 2010 : 8:31 a.m.
What the good doctor fails to understand is that his comparison of our country tot he rest of the world with his statement : The United States remains the only western democracy that does not have universal single-payer health insurance -- is that we are the most successful, richest and most benevolent country this world has EVER known is because we do things different than any other country on the face of the earth-- it is called American Exceptionalism. That is why we have the best healthcare in the world. We have the strongest military in the world and we keep peace in the world because we are unique in every way. That includes health care. So from one doctor to another -- Look at what you are trying to impose - A british style healthcare system that has already failed in Britain, Canada, France and every other country that has a single payor plan. Please, as a doctor myself, a doctor should not delve into things that are not within their specialty, please refrain from this in the future as you and I both know, your viewpoint is in the minority in the health care field.
SonnyDog09
Sun, Oct 3, 2010 : 8:17 a.m.
"Other forms of insurance - car, home, boat, flood, and universal life insurance - are not linked to a job, so why should health insurance have this unique relationship? " So, is the good doctor proposing that after the government offers "free" health insurance to everyone, that it then move on to offer "free" auto, home, boat, life and flood insurance to everyone, too?
Betsy de Parry
Sun, Oct 3, 2010 : 6:26 a.m.
Well said, Dr. Mitchiner....