The single-payer solution

Posted on Tue, Mar. 20, 2007 In Philadelphia Inquirer

The single-payer solution
By Linda Hunt Beckman


It is no secret that health care in this country needs a fix. About 47 million people don't have any health insurance, including more than a third of families with incomes of $40,900 or more.

And for those who can get a policy through their jobs, premiums are sky-high, with cutbacks in benefits. Many jobs don't provide health insurance anymore, and the cost of private insurance is prohibitive. Americans pay more for health care than people in any other country, and there is a reason: Administrative expenses, created largely by the many layers of the health-insurance system, and insurance-company profits take one out of every five health-care dollars.

Many Pennsylvanians welcomed Gov. Rendell's announcement in February that he had a health-care plan. What many did not know is that there is another plan our state legislature could pass and that it offers a cheaper, better fix. Senate Bill 300, the Family and Business Health Care Security Act, would provide single-payer universal health care to all Pennsylvanians (there will be a counterpart House bill). The national bill, H.R. 676, providing single-payer coverage for all Americans, has been in Congress for several years; it may be easier to pass the state bill first.

Single-payer health care in Pennsylvania would be much like Medicare for all (but better, because it would cover all costs; offer medications at a fair price; provide dental, optical, and mental-health care, and allow a relatively straightforward and just settlement - within the system - for malpractice). Just as senior citizens get almost all of their health care through a publicly funded, privately delivered system, the Family and Business Act would mean you could go to a doctor or hospital of your own choosing, and these physicians and facilities would not be working for the state or run by it (it would no more fit the negative notion Americans have of "socialized medicine" than does Medicare). The term single payer means that the money for the health-care system would come out of a single tax-supported fund, just as the money for Medicare does. And if we compare Medicare with the administrative expenses created by health-insurance industry, the overhead on our Medicare system is less than 4 percent.

Why don't we know about the option these bills provide? Health care is excellent in countries - including Canada, France, Australia, Denmark and most other developed nations - with single-payer plans. These programs are accessible to everyone, regardless of income; simpler to understand; less troubled by bureaucratic complications and expenses, and, most important, offer affordable care of high quality. We in the United States are unfamiliar with the single-payer option because tremendous amounts of money are spent by the medical-insurance and pharmaceutical industries to keep us in the dark. They would lose big bucks if we chose to go this route.

That health care elsewhere is less expensive is easily established: The United States spent an average of $6,102 a person on it in 2004, according to the Organization for Economic Cooperation and Development, while Canada spent $3,165 a person, France $3,159, Australia $3,120 and Britain just $2,508. Medications offered by those systems are affordable because those governments, unlike ours in running Plan D for those on Medicare, can negotiate with pharmaceutical companies for lower prices.

We could be as healthy and spend as little. S.B. 300 calls for funding by a 3 percent income tax on all citizens and a 10 percent tax on employers. These taxes, unfortunately, cannot be progressive because the Pennsylvania Constitution mandates a flat tax. Still, 3 percent of income is far less than most of us pay now for health insurance (with more spent out of pocket), and the legislation would offer the same services to people who have no income.

The governor's plan would not cover even nearly everybody, would not pay for medications, would not be as comprehensive in kinds of care provided, and would cost the state far more. Rendell's plan, like other supposedly universal health-care plans now in operation in Massachusetts and Maine and proposed in California, would be far more expensive because health-insurance companies, which require costly layers of administration and demand large profits, are the middlemen.

The corporate opposition to single payer exaggerates flaws that some systems have, or had, ignoring the fact that our health care is rationed by income. If you are poor, you may well get inferior health care all of your life. We could learn from problems elsewhere and thus develop the best truly universal health-care system of all.

Linda Hunt Beckman (beckman5@verizon.net) is a professor of English at Arcadia University and a coordinator for Neighborhood Networks.