Single Payer

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http://www.truthout.org/docs_2006/010207L.shtml

A Healthy New Year

By Krugman

The New York Times

Monday 01 January 2007

The U.S. health care system is a scandal and a

disgrace. But maybe, just maybe, 2007 will be the year we start the move

toward universal coverage.

In 2005, almost 47 million Americans - including more

than 8 million children - were uninsured, and many more had inadequate

insurance.

Apologists for our system try to minimize the

significance of these numbers. Many of the uninsured, asserted the 2004

Economic Report of the President, " remain uninsured as a matter of

choice. "

And then you wake up. A scathing article in

yesterday's Los Angeles Times described how insurers refuse to cover

anyone with even the slightest hint of a pre-existing condition. People

have been denied insurance for reasons that range from childhood asthma

to a " past bout of jock itch. "

Some say that we can't afford universal health care,

even though every year lack of insurance plunges millions of Americans

into severe financial distress and sends thousands to an early grave. But

every other advanced country somehow manages to provide all its citizens

with essential care. The only reason universal coverage seems hard to

achieve here is the spectacular inefficiency of the U.S. health care

system.

Americans spend more on health care per person than

anyone else - almost twice as much as the French, whose medical care is

among the best in the world. Yet we have the highest infant mortality and

close to the lowest life expectancy of any wealthy nation. How do we do

it?

Part of the answer is that our fragmented system has

much higher administrative costs than the straightforward government

insurance systems prevalent in the rest of the advanced world. As

Bernasek pointed out in yesterday's New York Times, besides the overhead

of private insurance companies, " there's an enormous amount of

paperwork required of American doctors and hospitals that simply doesn't

exist in countries like Canada or Britain. "

In addition, insurers often refuse to pay for

preventive care, even though such care saves a lot of money in the long

run, because those long-run savings won't necessarily redound to their

benefit. And the fragmentation of the American system explains why we lag

far behind other nations in the use of electronic medical records, which

both reduce costs and save lives by preventing many medical errors.

The truth is that we can afford to cover the

uninsured. What we can't afford is to keep going without a universal

health care system.

If it were up to me, we'd have a Medicare-like system

for everyone, paid for by a dedicated tax that for most people would be

less than they or their employers currently pay in insurance premiums.

This would, at a stroke, cover the uninsured, greatly reduce

administrative costs and make it much easier to work on preventive

care.

Such a system would leave people with the right to

choose their own doctors, and with other choices as well: Medicare

currently lets people apply their benefits to H.M.O.'s run by private

insurance companies, and there's no reason why similar options shouldn't

be available in a system of Medicare for all. But everyone would be in

the system, one way or another.

Can we get there from here? Health care reform is in

the air. Democrats in Congress are talking about providing health

insurance to all children. began his presidential campaign

with a call for universal health care.

And there's real action at the state level. Inspired

by the Massachusetts plan to cover all its uninsured residents,

politicians in other states are talking about adopting similar plans.

Senator Ron Wyden of Oregon has introduced a Massachusetts-type plan for

the nation as a whole.

But now is the time to warn against plans that try to

cover the uninsured without taking on the fundamental sources of our

health system's inefficiency. What's wrong with both the Massachusetts

plan and Senator Wyden's plan is that they don't operate like Medicare;

instead, they funnel the money through private insurance companies.

Everyone knows why: would-be reformers are trying to

avoid too strong a backlash from the insurance industry and other players

who profit from our current system's irrationality.

But look at what happened to Bill Clinton. He rejected

a single-payer approach, even though he understood its merits, in favor

of a complex plan that was supposed to co-opt private insurance companies

by giving them a largely gratuitous role. And the reward for this

" pragmatism " was that insurance companies went all-out against

his plan anyway, with the notorious " Harry and Louise " ads

that, yes, mocked the plan's complexity.

Now we have another chance for fundamental health care

reform. Let's not blow that chance with a pre-emptive surrender to the

special interests.