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the blog

Tuesday Aug 4, 2009

Single-payer questions and answers (updated)

I posted a little something on my Facebook page which stated if we went with single-payer would you save anywhere between $3 - 4 trillion over 10 years. Some of my friends began to seize when they saw that number. So I thought that I would take some time to explain where that number came from and answer some of other questions.

Are you dreaming?

Although it is nice to dream, I don't think I've ever dreamed about healthcare or healthcare reform. As a matter of fact, I'm really not looking forward to dreaming about healthcare. I like dreaming about Tyra Banks, Cindy Crawford and/or Stacy Williams. On the serious side, in 2007, we spent $2.2 trillion on health care. This averages out to be about $7200 per American. If we go to a single-payer system (government payer system) this would eliminate a price when $700 billion which currently goes to health insurance overhead and administration. We can use half of the $700 billion to cover the 46 million Americans who are currently without health care. This leaves approximately $350 billion left over. Now, it is true that the folks in Washington seem to be able to find things to do with money that is left over. That's not the point. The point is we would end up with $350 billion. Multiply that by 10 years and you get $3.5 trillion. That's a lot of savings.

Healthcare reform is about control?

While I will grant the critics of the America's affordable health choices act of 2009 that there is a lot of garbage in this bill, I'm not sure that you can make the leap that healthcare reform is about control. Currently we spend of roughly 16% of our gross domestic product on health care. We've seen healthcare expenditures skyrocketed over the last 10-20 years. There are estimates, that are legitimate, that suggests that by the year 2025, at our current rate, would spend approximately 25% of our gross domestic product on health care. There's no way that this is acceptable.

I'm not sure how anyone could leap to the conclusion that this is about control since you will be able to keep your same hospital and your same physician. Maybe, it is about controlling health care costs. If one of the goals of healthcare reform is to control costs and the simplest way is going with single-payer which frees up $700 billion. If, on the other hand, you want to jerryrig the current system then you need to put more money in the system in order to cover the 46 million Americans who are currently not covered. How much money will be needed? 46 million x $7200 = $330 billion. For those folks that don't want single payer they will need to figure out how to raise over $300 billion per year.

Where does the number 46 million come from? How many economic refugees (illegal aliens) are in the 46 million who don't have insurance?

The US Census Bureau published a document in August 2008 called Income, Poverty, and Health Insurance Coverage in the United States: 2007. According to this document, 45.7 million Americans do not have health insurance in 2007. (Page 19) According to the same document 9.7 million economic refugees do not have health insurance. (Table on page 22)

Update: I thought of a few more questions that I have been asked over the last several months

Should we all invest in a hospice?

Many conservatives are trying to get seniors worked up into a lather. They claim that there is provision in the bill America's Affordable Health Choices Act of 2009 which basically kills off seniors. The ridiculousness of this claim cannot be understated. In section 1233 (page 424), the bill talks about an advance care planning consultation. The bill provides funds for Americans to sit down with a health professional and talk about end-of-life issues. It isn't mandatory. It doesn't stop your healthcare nor does it tell doctors never to treat you again. As a physician i think that Americans need to talk with their spouses and their primary care physicians about end-of-life issues. We don't do this enough in this country. I see way too many trauma patients who have told their spouses or partners nothing about their end-of-life wishes. So, if you want to invest in a hospice, do as you wish with your money. I don't foresee any signifiicant uptick in the death rate if this legislation passes.

Isn't this the same thing that they have in England? Isn't this socialized medicine?

Yesterday afternoon, I was a guest on health care forum on a local radio show called Take A Stand. I was representing both healthcare and a progressive point of view. A caller related a very long story in which a friend of his had to wait 2-3 months for a particular procedure. During this long time period, this friend remained in the hospital. Isn't that the same type of medicine that were bringing here? No! In England, they have a socialized medicine system. The doctors, the nurses, all of the healthcare professionals are employees of the state. With a single-payer system, the government pays the bills, we pay the bills. The hospitals remain privately owned. Doctors continue to be in solo or group practices as they see fit. Nurses would continue to be employed by the hospital or doctor or nursing home.

Many politicians have pointed out the fact that we spend twice as much on health care as other industrial countries. Some have pointed to this as a bad thing. I don't know whether it is good or bad. I can tell you that some of the differences in expenditures are because we, Americans, expect a certain type of service. We don't expect to be waiting in the hospital for procedures. We expect to have access to whatever tests we need, in a timely fashion. That will not change under a single-payer system. As a matter fact, the speed may actually increase with a single-payer system because you don't have to wait for your procedure to be certified by your insurance company.

A variation on the same theme is that a single-payer system (government payer) will turn hospitals all across the country into VA's. I'm sorry, I don't follow this line of reasoning. A hospital that was for profit yesterday would still be for profit under a single-payer system. If the hospital was efficient before single-payer why would it be less efficient after the implementation of a single-payer system in which the hospitals billing apparatus could be streamlined because the hospital only has to bill the government. Hospitals don't have to bill 15 or 20 different insurance companies. Finally, I would say that the VA was designed to take care of relatively elderly men. Therefore, the VA is very good at taking care of heart attacks, strokes, diabetes, prostate cancer and colon cancer. If you are young, if you are female or if you have something out of the norm, the VA has had a hard time taking care of these patients because it wasn't designed to take care of these patients.

Posted by Errington Thompson on Aug 4, 2009 email post email Spotlight / / You are in Health Care