SINGLE PAYER: TALKING POINTS AND EVIDENCE
- 48 million Americans lacked health insurance in 2012(1), and after full implementation of the Affordable Care Act an estimated 31 million Americans will remain uninsured in 2023(2).
- The U.S. ranks worst of 19 high-income countries in preventing deaths amenable to medical care (45,000 deaths/year) before age 75(3)
- Underinsurance is growing with 46% of 19-64 year olds either uninsured or underinsured. In 2012 as many patients are forced into insurance plans with high-deductibles (> $1,000) and narrow and ultra-narrow networks of providers(4,5).
- The United States spends twice as much per capita on health care as the average of wealthy nations that provide universal coverage(6).
- Medical bills contribute to 62% of all personal bankruptcies(7) and medical bankruptcy did not fall in Massachusetts after that state’s implementation of reform in 2006(8). 75% of people bankrupted by medical bills had private insurance at the onset of illness or injury,
- Private insurance companies consume, on average, 13% of premiums in overhead compared to fee-for-service Medicare’s overhead of under 2%(9).
- Providers are forced to spend tens of billions more dealing with insurers’ billing and documentation requirements(10), bringing total administrative costs to 31% of U.S. health spending, compared to 16.7% in Canada(11).
- The U.S. could save over $380 billion and Minnesota 4 billion annually on costs with a single-payer system(12,13).
- The savings from slashing bureaucracy would be enough to cover all of the uninsured and eliminate cost sharing for everyone else(14).
- A single-payer system could control costs through proven-effective mechanisms such as global budgets for hospitals and negotiated drug prices(15), thereby making health care financing sustainable, and
- A single-payer reform would reduce malpractice lawsuits and insurance costs because injured patients would not have to sue for coverage of future medical expenses.
- A single-payer system would facilitate health planning, directing capital funds to build and expand health facilities where they are needed, rather than being driven by the dictates of the market.
- A single-payer reform would dramatically reduce, although not eliminate, health disparities. The passage of Medicare in 1965 led to the rapid desegregation of 99.6% of U.S. hospitals(16).
- A single-payer system would allow patients to freely choose their doctors, give physicians a choice of practice setting, and protect the doctor-patient relationship.
- There is single-payer legislation in both houses of Congress, H.R. 676 and S. 1782, and Vermont passed legislation in 2011 to create a “pathway to single payer” in that state starting in 2017, the soonest allowed under federal law. Minnesota is considering similar legislation, the Minnesota Health Plan (MHP).
Doesn’t it make sense to express our support for universal access to comprehensive, affordable, high-quality health care through single-payer health insurance, both at a state and national level?
1. “Income, Poverty and Health Insurance Coverage in the U.S.: 2012,” U.S. Census Bureau, September 2013.
2. CBO’s “Estimate of the Effects of the Affordable Care Act on Health Insurance Coverage,” May 2013.
3. Nolte E, Ph.D., and McKee CM, M.D., “Measuring the Health of Nations: Updating an Earlier Analysis,” Health Affairs, January/February 2008.
4. Kaiser Family Foundation/Health Research & Educational Trust (HRET) 2013 Employer Health Benefits Survey.
5. Commonwealth Fund Biennial Health Insurance Survey Surveys month April-August 2012
6. Woolhandler S, M.D., et al. “Paying for National Health Insurance – And Not Getting It,” Health Affairs 21(4); July/August 2002.
7. Himmelstein DU, M.D., et al., “Illness and Injury as Contributors to Bankruptcy,” Health Affairs Web Exclusive, Feb. 2, 2005.
8. Himmelstein DU, et al., “Medical bankruptcy in Massachusetts: Has health reform made a difference?” American Journal of Medicine, March 2011.
9. Sullivan K, J.D., “How to Think Clearly about Medicare Administrative Costs: Data Sources and Measurement,” Journal of Health Politics, Policy and Law, Feb.15, 2013.
10. Morra D, M.D., et al., “U.S. Physician Practices Versus Canadians: Spending Nearly Four Times As Much Money Interacting With Payers,” Health Affairs, August 2011.
11. Woolhandler S, et al., “Costs of Health Administration in the U.S. and Canada,” NEJM 349(8), Sept. 21, 2003.
12. Woolhandler S. “Cutting Health Costs by Reducing the Bureaucracy,” New York Times, Nov. 20, 2011.
13. Lewin 2012 Analysis: Beyond the Affordable Care Act: An analyis of a Unified System of Health Care for all Minnesota , Growth and Jestice http://www.growthandjustice.org/publications/P10
14. Friedman G, Ph.D., “Funding H.R. 676: The Expanded and Improved Medicare for All Act. How we can afford a national single-payer health plan,” July 31, 2013, online at www.pnhp.org
15. Marmor T, Ph.D., and Oberlander J, Ph.D., “From HMOs to ACOs: The Quest for the Holy Grail in U.S. Health Policy,” Journal of General Internal Medicine, March 13, 2012 (online).
16. Himmelstein DU, and Woolhandler S, “Medicare’s Rollout vs. Obamacare’s Glitches Brew,” Health Affairs blog, Jan. 2, 2014.
5/13/2014 Adapted from Medical Group Resolution