The issue of health care is one of the most important issues facing our nation and all possible remedies should be carefully scrutinized. While our nation lags far behind Western Europe and most of the developed world, no two nations have identical programs.
Should the United States copy the Netherlands, with a private insurance system similar to that envisioned by Barack Obama and Hillary Clinton, or should the United States adopt a single-payer system like that in Canada? Recognition of an issue is not a guarantor of sufficient support and impetus for successful resolution. Before us are a variety of distinctly different solutions.
Recently, I came across this interesting case for a multipayer system that retains private insurance. Certainly the author offers a strong defense of a private system, at least in the interim. Fundamentally, the nature of the insurance industry is diametrically opposed to the interests of those it insures. Clearly, preventing insurers from dropping patients and requiring that no one can be declined insurance will alter the industry. I doubt, however, that any such changes and bring about a complete reversal in the system, one that would result in true provision of care.
The advantages over adopting a single-payer system now are largely indisputable. Such a system would avoid the massive political debate incurred by legislation that would basically eliminate that industry, allow premium purchasing for things like cosmetic surgery / additional vision, and it assuming it requires everyone to be covered and mandates that people cannot be denied coverage or be dropped, would solve most of the benefits of a single payer system.
For the time being, it seems feasible and reasonable and would serve as a big step towards addressing the health care shortfall. However, a doctor from Physicians for A National Health Care Program spoke with my group, STAT, recently.
She explained the extensive costs in both time and money of having multiple insurers. The massive overhead costs (usually around 10-25% according to Arnold Relman in his book A Second Opinion, p. 114) of private insurance would be largely eliminated with government insurance. Even if the amount of money spent on testing new technologies and treatments was included, government insurance would still be far less expensive. Absent the marketing, profits, aggressive management, billing company offshoots, screening to determine insurability, and altering of premiums to account for increased or decreased health risks of the insured, insurance would be vastly more efficient and less expensive. All of the administrators and billers hired by insurance companies that eat up millions of dollars in big salaries and benefits would be unnecessary with a single payer, insurance for all system. Furthermore, you can subtract out CEO salaries and money spent on shareholders, and all of a sudden the business is way less expensive to run. I won't pretend that such a system wouldn't be expensive, but in the long run it would be more morally responsible, better for our nation, and more efficient.
Reduced overhead costs aren't the only way that a government insurance program would save time and effort over the current bugaboo. In fact, having a cornucopia of insurance options puts pressure and requires additional costs by hospitals and doctors. Each biller and insurance company has different regulations, forms, etc that have to be filled out by doctors and hospitals. This requires hiring and creating departments solely for the purpose of dealing with all of this paperwork. Moreover, doctors spend less time with their patients and more time with insurance companies assuring them that yes, removing the tumor is a normal procedure. Overcharging and, in some cases as Relman notes, outright fraud can easily occur due to the convoluted billing process. A compromise, like the ones floated by Clinton and Obama, would not eliminate (most of) these problems. In a world where there is one insurer, hospitals and doctors submit bills to one agency not ten.
My research on the health care industry has led me to believe that it will be nearly impossible to create a single payer system from scratch. As tends to be the case in the US, we throw together a hasty and well-intentioned but poorly-crafted solution right before we have to. This time, I can only hope that we move quickly yet wisely to rectify this tragedy.