By: Paul Smart
One term haunts all our talk about healthcare and insurance, whether it’s said out loud or not. Single payer. What exactly does it mean and why are so many afraid to talk about the term that defines how most of the world approaches the financing of healthcare?
The term defines the financing of healthcare, and not its delivery. But by that definition it implies several key things about a nation’s or community’s health policy.
To put things simply, Single Payer is about negotiation. Instead of having a panoply of payers for a service, which now exists with the mix of private insurers, government entities such as Medicare and Medicaid, and personal investment via co-pays and deductibles covering the costs of one’s medical procedures and medicine, one entity oversees delivery of funding to healthcare practitioners.
Look at it like this: Now, your doctor’s office, or hospital, has to hire a phalanx of front office employees to cover the accounting elements of healthcare. Is that necessary? It’s not the fault of any governmental plan, but of the mixed-up way in which healthcare gets paid for.
In addition to inefficiency at the point of healthcare delivery, multiple-payer payment makes it harder for any one entity to put constraints on costs. Ever wondered why drugs cost more here than anywhere else, or standard medical procedures from MRIs to check-ups? There’s no single entities calling the shots.
Single-payer system countries draw the money needed to pay for healthcare through taxation. Some require compulsory contributions, akin to the ACA has tried to do, which our own Supreme Court said was pretty much the same thing. Others work with large insurance pools overseen by quasi-public, strictly non-profit boards.
In all, the entity overseeing the disbursement of funds regulates how they are spent, which allows for a stronger negotiating stance when it comes down to delivery costs, be it for doctors, pharmaceuticals, or supplies used in key procedures.
Medicaid, which saw great expansion under the ACA, provides coverage for most things, but not all. Elective surgery still costs. If you’re getting covered for dental work, you can forget about getting your back teeth worked on if you’re over a certain age. The same is true, to a lesser degree, for Medicare. Why? The nation’s seniors are a more potent political force than those needing a financial boost.
One of the reasons Single Payer systems have such negotiating clout is the size of the pools of people represented. The other is the iceberg they could be called the tip of: established national health policies that set standards for minimal healthcare, costs, and delivery standards. There’s an underlying recognition that you cover the high costs tied to the start and end of life, along with catastrophic illness and precautions against pandemics and other such phenomenon, by sharing them.
That’s one of the basic ideas behind all insurance, an industry that’s still only about a century and a half old. It started off that you paid for accidents that could happen before they did. Then you covered the higher costs of greater problems by sharing them across large pools of people. Employers became part of the equation when they were convinced that healthy or recovering employees were better than absent or brand-new employees. Governments got into the insurance act when they recognized the costs associated with care for a society’s older or poorer members.
So why all the fuss about the term Single Payer?
Most nations that use Single Payer systems of some sort also utilize some form of Universal Healhcare that ensures all its citizens have not just access to, but the rights to utilize healthcare delivery systems beyond emergency rooms, which all medical practitioners require as part of its ages-old Hippocratic Oath. Which in turn, means the adoption of a national health policy, a position that the United States has struggled with for nearly a century now.
Breakthroughs were made when Medicare was pass a half century ago, building on the success of Social Security’s promise to our nation’s elders that we cared about their health as well as their basic incomes. They were compounded when Medicaid gave backbone to the War on Poverty promises which followed Civil Rights breakthroughs.
Arguments against a Single Payer system, along with Universal Healthcare and even the setting of a national health policy beyond the vagueness of our Declaration of Independence and Constitution, have been largely political, reflecting underlying dogma.
Delivery of healthcare gets muddled with the ways in which it’s paid for, and how much its costs are tied to poor negotiating stances. People talk about loss of elective procedures they’ve grown used to expecting, from hip and knee replacements to cosmetic surgery, and forget that most single payer and universal systems world-wide still allow supplemental insurance to cover such procedures, just as they do for Medicare. Moreover, the lobbying power of the large industries making large profits off U.S. healthcare are quick to amplify any problem that’s ever arisen with overseas’ healthcare, while the insurance industry chimes in about how good they are at incentivizing people to take better care of themselves for economic reasons.
How do things move forward? Maybe that simpler idea of health policies, to begin with, which seem to be gaining steam in specific states, from New York’s creation of Family Health plans that built on concerns for children’s health to California current push towards a single payer system.
Of course, once new means of addressing our people’s health get established, along with ways to better it across a state’s or nation’s population, come returns to concerns about other social insurance plans beyond their economics. Think of what others have done with pensions, unemployment, occupational training, and financial support for students, not to forget housing, cultural enrichment, and the sticky subject of equality for all.
One thing at a time….