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Single Payer National Health Insurance,

Better Health, and More Cost Effective Care Providing System

See the testimony of Dr Jonathan Weisbuch - HR676 The right plan for health care in America

See a summary of HR 676 - the Single Payer bill in the U.S. House of Representatives

Our current health care system is the most costly and least effective of all industrialized nations: 

  • A large part of the money (31%) goes to the insurance companies.  These  include the salaries of the legions of administrators and attorneys charged with approving/denying claims, advertising, client signup bonuses, etc.  Insurance company profits and the pay of their executives are outrageous.  In contrast, Medicare administrative costs are 3%!

  • Drug costs are substantially higher than in other countries.

  • Physician pay (particularly for specialists) is high.  Part of that is justified by the outrageous cost of malpractice insurance.   The cost of physician education is another salary justification.

  • Hospital care is too costly. Hospitals compete rather than work together to develop efficient "best practices".  There is little incentive for reducing costs; they simply charge and get higher prices.  Despite their protests, most hospitals are flush with money.  They build elaborate new facilities, often reducing the number of beds available.  They donate sports facilities to our high schools.  We pay for all of that in our high health care costs.

  • Unnecessary tests are run as directed by the hospital legal staff to avoid potential law suits.

  • There are shortages of physicians and other medical practitioners.  Many have left the profession due to high malpractice insurance.  See my discussion of the shortage of professionals.

  • More than 47 million Americans have no health insurance.  They still get emergency care as a hidden cost to the hospitals.  When they finally go to a hospital, their conditions are often more serious and more difficult and costly to treat.

  • A current related issue is the common practice of hospitals and attending physicians charging uninsured patients three or more times the rate they charge an insurance company for the same treatment.  This should be outlawed.

While the Affordable Care Act is a good step forward, a single payer national health system is the answer:

  • A single public agency makes health care insurance available to all while the delivery of care remains largely private.

  • Government administrative costs under a single payer system will be on the order of the 3% with Medicare.  The system will avoid the high insurance salaries and profits, and the administrative costs centered on claims denial and legal defense of unsavory practices.

  • Drug costs can be negotiated on a large scale basis.  (In this we must be cognizant of the legitimate costs of the drug companies.)

  • The justifications for exorbitant physician pay can be reduced.  Malpractice insurance can be very substantially reduced.  See my discussion of civil suit control.  As is currently done by the Armed Forces, physician (as well as nurse, nurse practitioner, and physician assistant) education can be subsidized in exchange for years of service at reasonable pay.

  • Control of litigation will also restrain the conduct of unnecessary medical tests which are required by hospital and HMO attorneys to avoid law suits.

  • For several years at the start of this century, the Veteran Affairs hospitals provided superior care at a much lower cost than civilian hospitals.  Bush administration cost cutting has hurt the VA since, but the methods the VA demonstrated still show what can be done.  Under a new administration the VA will be able to recover.  The VA methods can be shared along with other "best practices" with all hospitals. The cost reductions achieved by the VA can be used for guidelines for reimbursement.

  •  Best practices development is needed along with electronic medical records.  The state of the art in this area must be codified so that all medical facilities can implement this technology.  It is estimated that this technology will save the economy $77 Billion annually.   Electronic records using a standard format can be used for statistical research to find the most successful and the most cost effective treatments for patient conditions.  

  • Another needed improvement is a graphically enhanced phrase catching system for physician (and technologist) notes.  Such a system would save a substantial amount of medical personnel time and improve the clarity and accuracy of medical records.

  • With universal health care, everyone will be covered.  Preventive health care will be available to everyone and costs to the system will be lower.   This is another case where doing the morally right thing is doing the cost effective thing.

  • Like all financial matters, this is a zero sum situation.  To reduce the cost of health care for the nation, we must reduce the amount of money being stolen by insurance CEOs, overpaid physicians, drug companies, and others.  We should strive for the American dream of decent health care for all.  We should not strive to satisfy the unbridled greed of a relative few.

I envision a system in which people will pay premiums to the system as they do now (but lower) with co pays for drugs and visits.   The system must be set up to prevent abuse by both patients and providers.  Computer analysis will be used to detect patterns of abuse.

Universal health care is a moral imperative.  But, it will also improve the economy.  The current excessive cost of health care, though not part of the Federal budget, is still a drag on the economy.  With a lower total cost of health care, money will be freed for other essential services.  With the burden of employee health care removed, American businesses will be more competitive with foreign companies which currently do not have to absorb those costs.

See the Single Payer Top Ten list from Physicians for a National Health Program.

Go to Physicians for a National Health Program web site.