Several medical students recently published editorials in The DO concerning proposals for a single-payer health care system, evidence that future graduates sense our health care system is in crisis. Their generation has the burden of building something new and they understandably struggle with what this new system will be.
As physicians, our patients and the nation look to us for leadership. If we are to honor this profession, we need to unite around the facts, using our education and experience to be open-minded, selfless and visionary.
Powerful forces divide us
First, let’s agree that our current system is in crisis. In 2016, health care spending was 17.9 percent of GDP, and it is projected to rise to 19.7 percent by 2026. Employer-sponsored insurance health spending increased by 44% from 2007 to 2016, which contributed to wage stagnation and shifted costs onto employees. Roughly a quarter of American households are struggling with medical debt.
Despite partisan changes in 2010 and 2016, 12 percent of Americans are uninsured, while many insured Americans face ominous deductibles, restrictive networks, surprise bills and unaffordable meds. Physicians are forced to ask permission of insurance companies prior to many procedures. Pharmaceutical companies are allowed to advertise directly to patients, providing “education,” while drug profits and overdose deaths skyrocket.
A system in crisis justifies revolution
Our basic problem is shared by peer nations, who have almost all met that challenge by providing universal health care. The United States stands alone, hanging on to our antiquated for-profit, multi-payer system. It is foolish to judge all those countries as wrong while they have better overall results at half the cost.
A single-payer system will massively reduce administrative waste, saving an estimated $500 billion annually, while the ability to negotiate drug and device prices on behalf of 320 million would cut costs even further. A paradigm shift from crisis care to preventive care would also be more cost-effective, resulting in additional savings.
Many fear a single-payer system will restrict access to care. Canada’s single-payer system has wait lists for elective procedures because they choose to balance between need versus spending.
Listen to the patients
A recent Reuters poll revealed 70 percent of Americans want comprehensive Medicare for All.
The current Medicare for All bill would provide primary care and prevention, approved dietary and nutrition therapies, outpatient care, full dental (including oral surgery), basic vision and vision correction, prescription medications, hearing services and hearing aids, podiatry, diagnostic services, emergency care, inpatient care, durable medical equipment, mental health services, substance abuse services, long-term nursing home care and palliative care—all with no deductibles, copayments or coinsurance required from patients.
The myriad ways this single-payer system could be paid for are outlined here. Of note: Ninety-five percent of American households would come out financially ahead under this plan, and any new taxes would be modest, progressive, and offset by the absence of high premiums and numerous out-of-pocket expenses.
Medicare for All is health-centered and transparent
A single-payer system creates a national insurance that is publicly funded, while care delivery remains private. Treatment decisions will be made by clinicians and patients, instead of profit-centered corporations or legislators.
Decisions regarding payments, formularies and best practices will have public accountability and transparency. This democratic process would involve regional, state and national boards comprised of health care professionals, representatives of health care institutions, health care advocacy groups, labor unions, and citizen patient advocates. None would be allowed to have a financial conflict of interest.
The osteopathic profession has a proud origin, based on casting out a health system that was known to be ineffective and often harmful. This is a similar fight … and it is our time to lead.