| What does "Single-Payer" mean? |
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Single-payer is about empathy, the soul of democracy, caring for, protecting and empowering you and your fellow beings, leading to principals of freedom and fairness for all.
Single-payer is about
The term "Single-payer" means that one fund, administered by a non-profit government agency accountable to the public would make payment for all medical services. Period. The hundreds of private health insurance companies that currently do this work—each raking in profits for its stockholders and each with its own expensive bureaucracy and complicated policies—would no longer be involved as middle men. The choice of doctors and hospitals would be yours and decisions about your care would be made by you and your doctor, not an insurance company executive interested only in the bottom line. Medicare is one example of a single-payer plan.
What is HR676? Watch this excellent 4-part video and find out. Animations
For an entertaining and informative overview of single-payer, take a look at "WHAT IS SINGLE-PAYER?" an animation created for the general public by Stanford University Medical Student Graham Walker. Like music with your messages? "PIRATES OF THE HEALTH CARE-IBBEAN," an animation with music by the Austin Lounge Lizards, will tickle your funnybone.
Single-Payer FAQ
Check out the Physicians for a National Health Program web site (www.pnhp.org). It lays out, point by point, how a national single-payer system would work and explains in clear language why single-payer is the best solution to the health care crisis in America.
Why the US Needs a Single-Payer Health System Our pluralistic health care system is giving way to a system run by corporate oligopolies. A single payer reform provides the only realistic alternative. A few giant firms own or control a growing share of medical practice. The winners in the new medical marketplace are determined by financial clout, not medical quality. The result: three or four hospital chains and managed care plans will soon corner the market, leaving physicians and patients with few options. Doctors who don’t fit in with corporate needs will be shut out, regardless of patient needs. A single payer system would save on bureaucracy and investor profits, making more funds available for care.Private insurers take, on average, 13% of premium dollars for overhead and profit. Overhead/profits are even higher, about 30%, in big managed care plans like U.S. Healthcare. In contrast, overhead consumes less than 2% of funds in the fee-for-service Medicare program, and less than 1% in Canada’s program.
Blue Cross in Massachusetts employs more people to administer coverage for about 2.5 million New Englanders than are employed in all of Canada to administer single payer coverage for 27 million Canadians. In Massachusetts, hospitals spend 25.5% of their revenues on billing and administration. The average Canadian hospital spends less than half as much, because the single payer system obviates the need to determine patient eligibility for services, obtain prior approval, attribute costs and charges to individual patients, and battle with insurers over care and payment. Physicians in the U.S. face massive bureaucratic costs. The average office-based American doctor employs 1.5 clerical and managerial staff, spends 44% of gross income on overhead, and devotes 134 hours of his/her own time annually to billing2. Canadian physicians employ 0.7 clerical/administrative staff, spend 34% of their gross income for overhead, and trivial amounts of time on billing2 (there’s a single half page form for all patients, or a simple electronic system). According to U.S. Congress’ General Accounting Office, administrative savings from a single payer reform would total about 10% of overall health spending. These administrative savings, about $100 billion annually, are enough to cover all of the uninsured, and virtually eliminate co-payments, deductibles and exclusions for those who now have inadequate plans - without any increase in total health spending. The current market-driven system is increasingly compromising quality and access to care.The number of uninsured has risen rapidly, to 39.7 million nationally [update: This figure is now over 42 million!]. The proportion of people with coverage paid by an employer is dropping, and those with employer-paid coverage face rising out-of-pocket costs. Only massive Medicaid expansions - 10.5 million nationally since 1989 - have averted a much larger increase in the uninsured. Proposals for welfare reform and Medicaid managed care programs would shrink Medicaid enrollment (increasing the number of uninsured) and threaten the quality of care for those left on Medicaid.
U.S. Healthcare and other investor-owned managed care plans are inserting “gag” clauses in physicians’ contracts. Our own U.S. Healthcare contracts forbid physicians to “take any action or make any communication which undermines or could undermine the confidence of enrollees, potential enrollees, their employers, their unions, or the public in U.S. Healthcare or the quality of U.S. Healthcare coverage” and forbids any disclosure of the terms of the contract. Meanwhile, Leonard Abramson, U.S. Healthcare’s CEO, took home $20 million in a single year, and holds company stock valued at $782 million. Insurers are gutting mental health benefits, denying needed care, cutting payment rates, and insisting on the cheapest - and often not the best - form of therapy. HMOs have sought to profit from Medicare and Medicaid contracts by providing substandard care, and even perpetrating massive fraud. The largest Medicare HMO, IMC in Florida, induced thousands of the elderly to sign over their Medicare eligibility and then absconded with $200 million in federal funds. Nationwide, Medicare HMOs provide strikingly substandard homecare and rehabilitation to the disabled elderly. Tennessee Medicaid HMOs have failed to pay doctors and hospitals for care. After 360,000 women and children were enrolled (and $650 million was spent annually), Florida suspended enrollment in its Medicaid HMO program because of flagrant abuses. Administrative costs consumed more than 50% of Medicaid spending in at least 4 Florida HMOs. In one plan that enrolled 48,000 Medicaid recipients, 19% of total Medicaid dollars went for the three owners’ salaries. Thousands of patients were denied vital care; sales reps often illegally pressured healthy people into joining HMOs, while discouraging those who were ill; patient complaints, and inspectors’ findings of substandard care were repeatedly ignored. Overall, a cursory state audit found serious problems at 21 of the 29 HMOs participating in the program. A more extensive evaluation is just beginning. These Florida scandals are a virtual replay of California’s earlier Medicaid HMO experience. HMO payment incentives increasingly pressure primary care physicians to avoid specialty consultations and diagnostic tests. In this coercive climate, errors of judgment will inevitably occur, denying patients needed specialty care, while specialists are idle. In some areas of the nation (eg. New York City and California) market imperatives have led to growing unemployment of physicians, while huge numbers of patients don’t get adequate care. Surveys show that patients greatly prefer care in the small-scale, non-institutional practices that are being wiped out in the current system. A single payer system is better for patients and better for doctors. Canada spends $1000 less per capita on health care than the U.S., but delivers more care and greater choice for patients. Combining the single payer efficiency of Canada’s system with the much higher funding of ours would yield better care than Canada’s or ours at present.
Canadian patients have an unrestricted choice of doctors and hospitals, and Canadian doctors have a wider choice of practice options than U.S. physicians. Canadians get more doctor visits and procedures, more hospital days, and even more bone marrow, liver and lung transplants than Americans. While there are waits for a handful of expensive procedures, there is little or no wait for most kinds of care in Canada. An oft-cited survey that alleged huge waiting lists counted every patient with a future appointment as “in a queue.” (The fringe group that conducted the survey also advocates the abolition of the licensing of physicians to open up free competition among “healers”). More legitimate research shows that the average waiting time for knee replacement in Ontario is 8 weeks, as compared to 3 weeks in the U.S. But patient satisfaction levels with the procedure and care are identical. The time from first suspicion to definitive therapy for breast cancer is actually shorter in British Columbia than in Washington State. There are virtually no waits for emergent coronary artery surgery in Canada, though elective cases face delays, particularly with the surgeons held in highest regard. Interestingly, though Canadian MI patients receive substantially fewer invasive diagnostic and therapeutic procedures, death and reinfarction rates are comparable in the two nations. Finally, under a single payer system we would face much less restraint on care than Canada because we spend (and would certainly continue to spend) much more, and have many more specialists and high tech facilities. Hence even the modest limitations on care seen in Canada are unlikely here. Surgical outcomes for the elderly (all of whom are insured in the U.S.) are, on average, slightly better in Canada. Surveys show that Canadian doctors are far happier with their system than we are with ours. According to a 1992 poll, 85% prefer their system to ours; 83% rate the care in Canada as very good or excellent, and most physicians would urge their children to enter the profession. Fewer than 300 out of Canada’s 50,000 physicians emigrate to the U.S. each year, and a survey of doctors who have practiced in both nations shows a clear preference for the Canadian system. Medicine has remained an extremely desirable profession; medical school admission is even more competitive in Canada than here. Surveys show very high patient satisfaction in Canada. 96% prefer their system to ours, and 89% rate care good or excellent (up from 71% 4 years ago). Canadian physicians’ income are comparable, in most specialties, to those in the U.S., and have kept pace with inflation for the past 25 years. It is perhaps comforting to know that Canada’s highly regarded and efficiently managed health system is run by a government no more competent nor popular than our own. Their postal service and public railroad system generally receive lower marks than ours; their government’s record on fiscal management is not better than ours; and polls show that Canadians distrust their government even more than we do. Many of us have negative feelings toward government, and examples of government inefficiency and incompetence abound. Yet the record of private insurers is far worse. Their overhead is, on average, 600% above that of public programs, and no private insurer’s overhead is as low as Medicare’s. Dozens of financial scandals have wracked insurers and HMOs in the past year alone (our personal favorite is the $500,000 travel budget consumed by the head of one Blue Cross plan, including a $7000 junket to Africa to lecture on insurance fraud). Moreover, Medicare treats doctors and patients more respectfully than most private insurers, funds virtually all residency training, and pays Massachusetts hospitals higher rates than do most HMOs. Finally, when a public program misbehaves we have channels to seek redress; we know where Congress meets, and can vote them out. For-profit firms must answer only to their stockholders. References
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