Is Universal Coverage enough?


by Ann Settgast, MD • The upcoming change in administration has brought optimism and hope to the American public. Now is the time to demand meaningful healthcare reform rather than a replay of past failures. As a physician, I know that offering a placebo in place of known effective treatment is unethical. Hence, while I applaud the good intentions of Senator Tom Daschle, the Healthcare for America Now (HCAN) coalition, and others, I advise against their proposals to extend a system that is fundamentally flawed. In these times of economic uncertainty and crisis, single payer is the only fiscally responsible option for reform…and it is the only solution that will actually work.

Cabbages and Kings is a multi-author TC Daily Planet blog that offers space to interesting but hard-to-categorize blog submissions, in the sole discretion of the editors.

Many physicians agree that the largest limitation to providing quality care to our patients rests in the structure of our current system. In an April 2008 survey in Annals of Internal Medicine, 59 percent of U.S. physicians said they would support government action to establish national health insurance.

Most Americans believe lack of health insurance is a “serious problem” (NPR/KFF survey, Feb 2008). Current reform proposals claim to be the way forward. However, expanding our flawed system will not solve the serious problems we face – rising costs and lack of coverage (for uninsured and underinsured). Unfortunately, having coverage in our system does not guarantee care. One-fourth of the insured go without needed care due to cost; three-fourths of individuals bankrupted by medical bills had insurance when they became ill. Is this a system worth perpetuating?

Reform efforts such as those proposed by HCAN and outlined by Senator Daschle maintain a central role for private insurance companies, and are thus doomed to fail because they cannot control costs. They increase coverage only by increasing cost. These proposals duplicate key elements of reform efforts that have consistently failed: Massachusetts in 1988; Oregon in 1989; Tennessee, Minnesota and Vermont in 1992; Washington State in 1993; and Maine in 2003. In each case, rising costs foiled the reform effort, and none durably decreased the number of uninsured. Similarly, the 2006 Massachusetts law, which represents a mandate model of reform, is threatened by rising costs. While the number of uninsured MA residents has fallen modestly, 14% of residents in 2007 remained uninsured at some point in the year. Many MA residents cannot afford the “required coverage”. A 56-year-old making $30,000 annually must spend $7,164 in premium and deductible alone. Today, hundreds of thousands of MA residents remain uninsured. Relying on government subsidies that cannot be sustained, and requiring people to buy insurance they cannot afford, is no solution. Such “reform” expands the role of wasteful private insurers, does nothing for the tens of millions underinsured, and relinquishes the colossal savings that would be achieved under single-payer.

Administrative costs in the U.S. health-care industry are a whopping 31% – more than double that of most industrialized nations. The administrative costs of our private insurers are drastically higher than those of our current single payer (Medicare administrative overhead is less than 2%). This excess is squandered in medically unnecessary activities such as marketing, underwriting, and profit-making. Providers also have unnecessarily high overhead as they struggle to deal with hundreds of different plans. By eliminating this waste, a single-payer system will save our country an estimated $350 billion a year – enough to provide comprehensive health care for all at no additional cost.

In conclusion, I urge the reader to be wary of doomed efforts that focus on lack of insurance and ignore the broader problems of access, affordability, and skyrocketing costs. Single-payer insurance is not socialized or government-run medicine. Care will be provided by private physicians and hospitals, just as it is now, but patients will have increased choice of providers because there will be no insurance meddling. They will also have comprehensive coverage coupled with freedom from the fear of financial ruin due to illness. H.R. 676, the U.S. National Health Insurance Act, has more than 90 co-sponsors in Congress – more than any other health reform proposal. Successful implementation will effectively fix our broken system.

Ann Settgast, MD, is the co-chair of Physicians for a National Healthcare Program – Minnesota Chapter. Originally published on 1/19/09

One thought on “Is Universal Coverage enough?

  1. People need to raise their voices.

    The insurance industry is dumping a ton of money into this reform so that they don’t get left out. They employ a swarm of lobbyists, make huge political contributions, and fund a ton of anti-government propaganda. The propaganda is a serious influence that we need to confront. Read this quote for the 1928 book Propaganda, and think about how this effects our Democracy.

    “The conscious and intelligent manipulation of the organized habits and opinions of the masses is an important element in democratic society. Those who manipulate this unseen mechanism of society constitute an invisible government which is the true ruling power of our government.” ~ Edward Bernays

    This is a for-profit service available to anyone who can afford it. It was very powerful back when TV was high tech and people had to go to the library to research anything, but the world has changed.

    The insurance industry would like to pass mandates that employ our government to extract their profit from the people, and tax the rich to pay for the profit that they couldn’t extract from the poor. These are not typical Republican values, and I don’t think they would support it if they knew what they were supporting. It’s not true support though, it’s irrational opposition to single payer, created by fear and disinformation. And it makes them very difficult to talk to. The ‘Right’ is not the source of the propaganda as many believe, but rather a product of it. A few on the ‘Left’ buy into it too. You get the idea. Confronting the propaganda at the source is probably the most effective way to ensure support for Single Payer. Polls will be taken.

    For our bought and paid for politicians. I suggest talking to them about their campaign contributers as they relate to the issues. Not in letters, except to the editor. It’s like this. You don’t march on Washington, they already know what you have to say, you march on the people, because they don’t. Get it in front of the people, and out in the open where it effects public opinion. Whatever it is, asking tough questions in the public forum lets politicians know you’re serious.

    I was promised a government of, by and for the people. I don’t know who all made that promise, but I know it is up to us to keep it.

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