The Time For Single-Payer Is Now

Failure to Repeal and Replace ACA has created an Opening
By Margalit Gur-Arie

The Trump administration chose to impale itself on the national spear known as healthcare in America. The consequences so far are precisely as I expected, but one intriguing phenomenon is surprisingly beginning to emerge. People are starting to talk about single-payer.

            The all too public spectacle of a Republican party at war with itself over repealing and replacing Obamacare is teaching us one certain thing. There are no good solutions to healthcare within the acceptable realm of incremental, compromise driven, modern American solutions to everything, solutions that have been crippling the country and its people since the mid-seventies, which is when America lost its mojo.

            Single-payer health care is one such bold solution.

            We have $3 trillion in our healthcare pot right now. We have 325 million Americans, men women and children of all ages. First-grade arithmetic says we have almost $10,000 per year to spend on each American, the vast majority of whom is either young or healthy or both. For comparison, Medicare spends on average around $12,000 per year for the oldest and sickest population. So please, tell me again how we can’t afford to pay for everybody’s health care needs at a Medicare actuarial level?

            And no, we need not increase taxes either. You keep paying what you’re paying. Your employer keeps paying what it is paying. The government keeps paying what it’s paying. But instead of dispersing all that cash to all sorts of corporate entities standing in line with their golden little soup bowls ready to catch the last drop, we put it all together in one big beautiful barrel, and pay for care directly to those who provide care – one pool, one budget, and one accounting system for all.

 

Single-payer will cause millions to lose their jobs

 

Hundreds of thousands of people work for commercial insurers. Claims need to be processed, money needs to be collected and paid out, books need to be kept, customers and service providers need to be supported, computers have to be maintained, audits need to be performed, contracts need t be managed, lots and lots of labor and lots and lots of decently paying jobs. Do you have any idea how Medicare administration works?

            Medicare is run by private administrative contractors called MACs, each assigned to specific geographical regions and specific portions of Medicare services. In addition to the MACs there are slews of functional contractors that specialize in one or more types of supporting services to the MACs. They employ thousands of people and if Medicare becomes our single-payer, there will be more MACs, more functional contractors, and hundreds of thousands more private employees.

           

Single-payer will take away our freedom

 

Traditional Medicare allows you to choose your doctor and your hospital and it pays for all medically necessary services. No commercial plan can say the same unless it’s one of those platinum things nobody can afford. Traditional Medicare can do that because it sets the prices for all healthcare providers, instead of negotiating with a few preferred vendors. Medicare can take these liberties because it’s big enough and because it’s a federal program. But Medicare doesn’t pay for everything. That’s why most seniors purchase supplemental plans if they can afford them.

 

Single-payer will destroy our healthcare
 

Precisely because of the lessons learned from the mighty military industrial complex, single-payer reform will have to change three things in the structure of our current so-called healthcare system. First, all hospital consolidation and acquisition of physician practices will need to be rolled back. Second, petty regulations, vindictive carrots and sticks strategies and crude attempts at social engineering by clueless bureaucrats, will have to be dismantled brick by brick. Third, physicians will need to form a union of independent small contractors to negotiate fees and terms alongside the already powerful hospital associations.

 

Single-payer is not the American way

 

We have been conditioned by large corporations to think that what they do to us is the nature of free markets, and thus the only way to achieve prosperity for all. I would submit (for the millionth time) that what Apple is doing to the world has nothing to do with Adam Smith’s free markets. The actors in classic free markets must be approximately equal.

            There can however be competition. Perhaps not in sparsely populated areas, and perhaps not for highly complex procedures, but there can be competition for most healthcare services in most places. The uniform single-payer price should be set so that innovative hospitals and entrepreneurial physicians can thrive by charging less and those holding themselves in higher than usual esteem, or those who choose to provide luxury, are free to charge more.

            Will there be a role for private insurance?  There could be, but private insurance should not be allowed to cover any services covered by the single-payer because that would take us back to where we are today. Let private insurance cover stuff nobody needs, but wealthy people like to flaunt, like fresh baked brioche for breakfast after having a baby.

            Single-payer will create a new set of losers. Healthcare executives making tens of millions of dollars every year for no particular reason will be losers. Health insurance stocks will tank and improperly managed pension funds will also. People running for elections will see a major cash cow go dry after the initial struggle is over and done with.

            But Obamacare has its losers too. Hard working, taxpaying middle-class citizens were the designated losers of Obamacare. Some by commission and most by omission, because Obamacare made no attempt to solve the healthcare problems facing the vast majority of workers with employer sponsored health insurance. That bomb keeps ticking away at a steady pace.There is nothing more we can do here. We tried everything else, and now it’s time to do the right thing. It’s the American way.

 

Margalit Gur-Alie is a healthcare IT executive. A version of this article originally appeared at The Health Care Blog.