A physician's case for a single-payer health care

 
By John Perryman
Guest columnist
Posted1/8/2019 1:00 AM
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Shane Patrick Boyle, a Type 1 diabetic living in Texas, had to move to Arkansas to care for his sick mother. His health insurance did not provide coverage in that state, so he set up a GoFundMe page to help cover his medical expenses until he could obtain new insurance. He got within $50 of his goal, rationing his insulin until he could obtain more.

Then he died from complications of his diabetes.

This tragedy and many others like it demonstrate some of the many failings of American health care.

The United States spends more on health care than every other nation on earth, yet is the only rich country that does not guarantee it for its citizens. Our high costs put incredible strains on patients, their families, businesses and the economy. Medical costs are a leading cause of personal bankruptcy and mortgage foreclosures.

In 2017, the U.S. spent $3.5 trillion on health care, or about $10,700 per person. This represents 18 percent of GDP, or one dollar of every six spent in the American economy. And costs continue to rise.

One might be comforted if we had the best health care in the world. While this is true for some of us, the performance of our system as a whole is severely lacking. Based on reports from the Organization for Economic Cooperation and Development for the year 2017, we ranked 26th in the world in life expectancy, 31st in infant mortality and 26th in maternal mortality. We are the only wealthy nation where our new moms are dying at increasing rates.

Even with passage of the now endangered Affordable Care Act, we still have 28 million uninsured Americans. Based on reports in medical literature, this leads to over 36,000 deaths a year. Tens of millions more are underinsured, meaning that they can't afford the high out-of-pocket costs of their insurance plan. When faced with a serious illness or injury, they have the choices of going into debt, going broke or going without care. Meanwhile, insurers make billions in profits.

We pay more, but we get less. Where is the money going?

One place where we spend more than other nations is on administrative costs and insurer profits. Commercial insurers have overhead of 12-20 percent, compared to traditional Medicare, which is around 3 percent. All told, higher administrative costs add hundreds of billions a year to our health care tab.

High drug prices are another major contributor. If we negotiated and paid what most other nations do for medicines, we would save about $150 billion a year. The pharmaceutical industry has been raising drug prices relentlessly and made over $40 billion in profits in 2017.

Rising insulin prices killed Shane.

Faced with all of these considerations; the costs, the suffering and death, it is clear that something fundamental needs to change.

A single-payer, improved Medicare for All system provides the best way forward.

Under such a plan, as proposed in house bill HR 676, a government funded, national health insurance system is created. Providers would remain private. All people are provided comprehensive coverage from birth to death for medical, drug, dental, vision and long-term care. Mental health and addiction treatment are covered.

Additionally, there are no out-of-pocket expenses; no co-pays, deductibles or co-insurance.

One might logically ask how we could afford such a system. When factoring in administrative savings from reduced overhead, lower drug costs brought about by negotiating with pharmaceutical companies and other cost reductions, many studies indicate that our health care expenditures would actually be less than what we pay now.

Further evidence of this is demonstrated by what other nations with guaranteed coverage pay. Most of them spend around 11-12 percent of GDP, versus our 18 percent. If we were spending 12 percent of GDP, that would represent a trillion-dollar reduction per year.

More importantly, no one would be financially ruined by illness. No one would die because of a lack of coverage.

These are goals worthy of America. A single-payer system is the best way to achieve them.

Dr. John Perryman, of St. Charles, is a physician in the Rockford area and co-president of the northern Illinois branch of Physicians for a National Health Program.

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