In honor of a great American:
Of all the forms of inequality, injustice in health care is the most shocking and most inhumane.
- Martin Luther King, Jr.
I was alerted to this article (The battle over the health care bill) which has a pretty good analysis of the PPACA with a focus on the arguments about what that will cost us to repeal it (or not).
To add some perspective to this battle, it is useful to keep in mind the potential for real cost controls inherent to a properly designed system for financing healthcare.
(This diary is inspired by a comment that single payer is but a small part of the whole health care cost picture.)
First, a little review...
Most of the battle over health care reform centered around costs since the policy battle was over early on. Talking about costs alone is meaningless without including some measure of the quality and comprehensiveness of the health care being paid for. The PPACA was designed to keep the costs of the bill for the federal government to a minimum, and much to the relief of our side the CBOs best estimate showed a slight savings (if you read the linked article you'll get a much more nuanced view). This removed a major impediment to its passage.
The bill was able to get there by doing some good things. By far the largest contributing factor to the positive side of the balance sheet is targeting the excesses of the privatized part of Medicare (the Medicare Advantage plans which cost more than traditional Medicare with no real added value) although it remains possible that enrollees will face cuts in benefits and rising premiums as a result. Most of the rest of the good things in the bill will result in higher or unknown federal costs (expansion of Medicaid, for example). Cost control is a different matter.
Many claim that the bill contains at least the seeds of every kind of cost control that could possibly be envisioned (and these claims are most likely true if we continue on our current path):
http://www.theatlantic.com/...
http://www.kaiserhealthnews.org/...
Lost in this discussion is the potential for cost savings in a properly designed system for financing health care - a single payer system (which is the optimized form for publicly funded health care).
In broad brushstrokes, then, how does single payer control costs? There's a few obvious ones:
Leveraging the buying and negotiating power of the single payer for purchasing pharmaceuticals, durable medical equipment, and setting medical care delivery reimbursement rates. This places a direct cost control in the hands of the people.
Over 90% of health care dollars will actually go towards providing health care. Currently it is estimated that 31-38% of every dollar is wasted on administrative costs (mostly at the insurance gatekeepers' end and partly at the delivery end). The current system also encourages clinical waste (for reasons beyond this discussion). All told, this waste can be over 50% of our health care. The incentive for ever-spriralling upward profits of the gatekeepers is removed completely.
Centralized planning for investment in infrastructure. No longer will every clinic be sporting its very own shiny new MRI machine that sits idle for most of the time, for example.
There are a few not so obvious ones:
Medical malpractice insurance rates will plummet (the bulk of malpractice awards are to cover the health care of the victim). This is yet another area where the gatekeeper insurers strive for profit with no controls. Once awards drop, their premiums will go down along with their scare tactics.
The elimination of medical bills also eliminates the oppressive debt that many people with medical conditions or emergencies endure. Since everyone is now paying for their health care, the incentive for clinical waste (unnecessary tests and procedures for those with insurance) to cover the costs of those that can't pay is eliminated.
There are also many things that can be easily implemented in a single payer plan due to its uniformity that may not save any money but definitely increase the quality of our health. Among these are electronic medical record keeping, chronic disease management, and a widely shared physicians database of best practices. None of these specifically control costs, of course, but they all give us a much better set of tools to work with for seeing where controls are needed.
I could litter this with links (a practice I sometimes admire - I'm looking at you, silly rabbit - and othertimes find annoying). Instead I'll just mention a few really good websites for information on this topic.
PNHP.org (Physicians for a National Health Program) has an embedded google search engine that will give you good stuff on virtually any health care topic. I highly recommend signing up for the "quote of the day" if you can stomache receiving yet one more email per day.
Public Citizen has a wealth of information on health care topics of interest, more specifically to this discussion many articles on malpractice (again just enter "malpractice" in their embedded search engine).
In conclusion, the single payer plan can only be comprehensive if it is mandated to be comprehensive, there is nothing inherent in a single payer system that requires this. However, in a properly designed system it is optimal to have a comprehensive plan because anything less allows precious resources to leak into the privatized arena with its penchant towards spending health care dollars on things other than healthcare (i.e. waste).
An informed and activist citizenry will be required to ensure the comprehensiveness of the plan.
Quality is promoted naturally in a single payer system if the delivery of health care is largely accomplished through competition (not necessarily of the free market variety, but possibly under well-regulated conditions). Competition is no longer based on price (all providers within a region are paid the same) and will be based on quality.