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Creating positive change: The case for single-payer healthcare

Published: September 18, 2009
Section: Opinions


The last few months of the health care debate have offered a chaotic stream of political incidents that fall somewhere between entertaining and disheartening. Bitten-off fingers at town halls and catchy sound bites like “death panels” and “you lie!” have stolen the show, turning the process of health care reform into an ill-fated media circus.

Some of these outbursts appear to be political savvy, scoring hundreds of thousands of dollars for Representative Wilson and scaring Americans away from meaningful reform. Others underscore shocking misconceptions about the government and its role in health care. One refrain heard at town halls this summer seems particularly tragic: “Keep the government out of my Medicare!”

This quote defines the current debate in one short and effective sentence. Americans dislike big government on ideological grounds and continue to protest a “government take-over” of health care. The problem arises when, in practice, Americans actually love the health care that government provides. They can protest the government ideologically, but the evidence shows that Medicare, a form of (gasp!) single-payer health care, enjoys not only quality and efficiency, but also immense popularity.

In a point that has gone unacknowledged throughout the current debate, Medicare has endured as one of the most effective components of our health care system. Now, instead of decrying the role of government in health care, Americans should embrace it and expand Medicare to all citizens in an inclusive single-payer system.

As most other advanced nations have figured out, single-payer health care offers a superior and comprehensive alternative to the train wreck that is the American system. Unlike socialized medicine, where the government runs a nation’s hospitals and employs its doctors, single-payer health care simply means that the government assumes the role of one big insurance company paying health care costs to both public and private institutions.

If the U.S. were to magically make this switch, it could expect a number of unique positive results, the most important of which will be addressed in this article. First and foremost, every single citizen would have, for the first time in our history, access to the high-quality care that many insured people enjoy today.

Americans could expect their overall health to improve with the new availability of routine physicals and check-ups as well as access to specialists and hospital care. Most crucially, this would shift the focus from secondary to preventative care.

Instead of paying sky-high rates to treat the uninsured in the emergency room, the government can ensure that people have access to treatment for conditions like high blood pressure and pregnancy before their health problems threaten their lives and cause bankruptcy. By doing so, it prevents many avoidable medical catastrophes in a cost-efficient and effective way.

While focusing on preventative care cuts costs both immediately and in the long run, some of the most significant savings occur in health care administration. Switching to single-payer health care would immediately cut the percentage of money wasted on administrative costs from our high of fifteen percent to the low three-to-four percent that most other nations enjoy, effectively reducing some of the most wasteful and bureaucratic spending in the system.

The U.S. has already witnessed these savings in its current single-payer systems, particularly Medicare; Medicare spent a mere two percent of its budget on administrative costs in 2004. By eliminating America’s nationwide mess of private insurers, claims, policies, and corporate legalese, a single-payer system would eliminate red tape and bring the focus back to health care delivery. Other reforms, like advancing electronic medical records, would create even more efficiency in health care administration and ultimately hold down costs in the long run.

Businesses and employees would also get to take advantage of the single-payer system’s sweeping cost cuts. Entrepreneurs could start up their own companies with the security of guaranteed, life-long insurance. At the same time, small businesses would no longer have to spend a significant portion of their earnings on providing health insurance to employees, a costly problem that discourages wage increases and company expansion.

Finally, employees themselves could change jobs or career paths instead of getting stuck in dead-end jobs for the fear of losing insurance. No other reform option on the table offers so many unique and significant advantages to small business, but like single-payer health care itself, these have been systematically ignored throughout the health care debate.

Many people reading this article are probably shaking their heads and declaring that the U.S. will never make the move towards “socialized health care.” This seems to be accepted as fact, but why do Americans continue to oppose single-payer health care in such huge numbers? It seems preposterous that anyone would oppose what is essentially an effective, low-cost, fair, and comprehensive expansion of Medicare, a government program that enjoys an approval rating as high as 76%.

It also seems unlikely that anyone could approve of the current system, where at best, people pay sky-high premiums for below-average health care and at worst, hardworking citizens die of treatable medical problems for lack of coverage. The problem is that no matter how well a single-payer system works, Americans cannot get past the false idea that government seeks to “take over” health care. This ideological quagmire has prevented meaningful reform for years, and now we have the failed health care system to prove it.

The best idea that Republicans can offer is low-impact tort reform, and the only decent proposal from Democrats, the public option, remains woefully inadequate at addressing our system’s most fundamental cost problems. Neither of these options holds the potential to create the positive change that is so desperately needed in the system today.

Obama’s health reform speech contained the line, “I believe it makes more sense to build on what works and fix what doesn’t, rather than try to build an entirely new system from scratch.” President Obama is dead wrong about that. American health care delivery is fundamentally flawed, and nothing short of a complete overhaul will change the system.

Switching certainly wouldn’t be easy; it would take years of transition, policy formation, and battles with the private insurance industry to extend Medicare to millions of Americans. Even then, the system would require more cost-cutting mechanisms to help defray the inevitable rising price of high-quality care. The promises this dream holds, though, are too great to pass up.

It’s time for Americans accept that government can and should have an effective, meaningful, and central role in reform, and that their own health and welfare will improve as a result.

For that reason alone, the United States should accept the evidence at hand and pursue a full expansion of Medicare, the system that best guarantees that all Americans will gain access to the high-quality and low-cost health care that only some get to enjoy today.