Doctors are taking a lead in efforts to heal the ailing U.S. healthcare system with a proposal for a single-payer insurance program that mimics Medicare.
More than 47 million Americans are uninsured and millions others have suffered healthcare-related financial ruin. Fifty percent of all bankruptcy filings were, in part, the result of medical bills yet 68% of those who filed for bankruptcy had health insurance, according to the journal Health Affairs.
Physicians across the U.S. are joining forces in support of a bill in Congress, H.R. 676, which embodies the single-payer approach and has 90 co-sponsors, more than any other health reform proposal in history.
"We have a very expensive, privately funded financing system for healthcare, with very few cost controls built in," John Geyman, MD, professor emeritus of family medicine at the University of Washington (Seattle) and past president of Physicians for a National Health Program (PNHP; Chicago), told Medical Device Daily.
"Our private insurance industry has 1,300 insurers, with 15% to 30% of healthcare dollars. The overhead of traditional Medicare is 2% to 3%. It's not for profit," Geyman said. "The private insurance industry is investor-owned, for profit, and services its shareholders. The average family of four spends over $12,000 a year for healthcare and gets less and less. We figure we would save $350 billion a year, or $2,300 a person, with publicly financed Medicare for all, due to administrative simplification, bulk purchasing, improved access to preventive services and earlier diagnosis, basically getting rid of a very inefficient private insurance system."
PNHP includes more than 15,000 physicians who support a single-payer national health insurance program that's represented in H.R. 676, a bill introduced by Rep. John Conyers Jr. (D-Michigan) in January 2007. It was referred to, and remains with, the Subcommittee on Health.
Lest anyone start using the "S" word i.e., socialized medicine Geyman answers: "It's not socialism. The current Medicare system isn't socialized medicine. It's a private delivery system with public financing. This would also be a private delivery system with public financing. Nobody complains about Medicare."
However, political opposition to this potential dramatic shift is huge.
Despite the apparent opposition, device and drug companies, medical suppliers and insurers could do "just fine" with a new, one-payer system, Geyman said, because they still would have to compete for a single, very large market: 300 million Americans in a risk pool with healthcare for all.
"Half of American can barely afford healthcare, medical bankruptcies are going up all the time. The only way to get a handle on this is to move to a public financing system," said Geyman, who is the author of six books, including the forthcoming Do Not Resuscitate: Why the Health Insurance Industry is Dying, and How We Must Replace It.
"Over the past 40 years, private insurance has evolved from a not-for-profit activity into a $300-billion-a-year, for-profit, investor-owned industry," he said. "The six biggest insurers made over $10 billion in profits in 2006. They did so by enrolling healthy people, denying claims and screening out the sick, who increasingly are being shunted into our beleaguered public safety net programs."
When asked to compare a potential U.S. single-payer system to Canada's publicly funded healthcare system, where most services are provided by private entities, Geyman pointed out that Canada's government pays little more than half of what U.S. citizens do for healthcare on a per capita basis.
"We have a huge capacity, but we have an affordability problem," he said. "A lot of people in the U.S. can't afford care, so they put it off," which later leads to emergency room care and more advanced states of diseases and conditions that must be treated at higher-costs.
Geyman said that a U.S. system would be "much more focused" on prevention and early diagnosis.
Should this country be willing to adopt this system, a new federal organization would be needed to oversee the mammoth program. He said it should be closely focused on the cost effectiveness of treatments and products and include health policy experts who can assess the effectiveness of care.
Last week, Physicians for a National Health Program held rallies in 17 cities across the U.S. in an attempt to bring attention to their efforts. The biggest rally took place outside San Francisco's Moscone Center, where delegates to the convention of America's Health Insurance Plans (Washington) gathered, including about 35,000 insurance company executives.