Last week, more than 2,200 physicians announced their support for a proposal for a single-payer national health program (NHP); a related editorial was published in the American Journal of Public Health.
The doctors appear to be fed up with the current healthcare system. “Caring relationships are increasingly taking a back seat to the financial prerogatives of insurance firms, corporate providers, and Big Pharma,” Dr. Adam Gaffney, a Boston-based pulmonary disease and critical care specialist and lead author of the editorial, said in a press release. “Our patients are suffering and our profession is being degraded and disfigured by these mercenary interests.”
The NHP would be funded by combining current government health expenditures into a single fund; it would also require a tax increase, which the doctors say will “be fully offset by reductions in premiums and out-of-pocket spending.”
The proposal estimates that the NHP would save around $15 billion annually by cutting administrative costs.
Details of the NHP
Highlights of the NHP proposal include the following:
- All residents of the U.S. would be covered for all necessary medical care, regardless of immigration status.
- Coverage would include inpatient and outpatient care, rehabilitation services, mental health services, long-term care, dental care and prescription drugs.
- Patients could choose to go to any hospital or doctor.
- Premiums, co-pays, deductibles, and co-insurance would be eliminated.
- Medical bills for covered services would be eliminated for U.S. residents.
- Most hospitals and clinics would remain privately owned and operated; they would receive a budget from the NHP to cover all operating costs.
- Physicians could continue to practice on a fee-for-service basis, or receive salaries from group practices, hospitals, or clinics.
Medicare for All
Democratic presidential candidate Bernie Sanders (I-VT) has also developed a proposal for a single-payer plan, which has been dubbed Medicare for All. Under this system, all US citizens would be automatically enrolled into Medicare.
The program would be financed by various tax revenues, credits and subsidies.
According to the Medicare for All website, the plan will cost more than $6 trillion less than the current healthcare system over the next 10 years.
Under the plan:
- Patients could choose to go to any hospital or doctor.
- Premiums, co-pays and deductibles would be eliminated.
- Coverage would include inpatient and outpatient care; preventive care; emergency care; primary care; long-term and palliative care; vision, hearing and oral health care; mental health and substance abuse services, prescription medications and medical equipment, supplies, diagnostics and treatments.
However, a new report from Urban Institute's Health Policy Center from this week estimated Sanders' (I-VT) single-payer plan would increase federal spending $32 trillion over the next 10 years - much more than the $13.8 trillion he said his plan would cost and the $15.3 trillion in new revenue he estimated it would raise. This would leave a $16.6 trillion hole the government would need to pay for the single-payer plan, according to the study.
Possible hurdles to a single-payer system
In an article for Vox, Harold Pollack, a liberal healthcare policy expert at the University of Chicago, said: “Single-payer would require a serious rewrite of state and federal relations in Medicaid and in many other matters.” Pollack also said converting to a single-payer system would require complex negotiations to transition people from employer-based coverage.
Additionally, most of the healthcare industry would undoubtedly put up a fight against any single-payer proposal. “The entire supply side of the medical economy would be opposed to efforts to increase the bargaining power of the government and to set prices and terms of care,” Pollack, told Modern Healthcare.
Will Colorado lead the way for the rest of the US?
In November, voters in Colorado will consider a ballot measure to implement a single-payer system called ColoradoCare. If it passes, a national debate on universal health coverage for all will likely follow.