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Health Care

Universal Single-Payer: A Health Care Plan that Curbs Obscene Costs and Eliminates Cherry Picking and Lemon Dropping- Part 2 of a 3-Part Series (Full Length Version)

April 30, 2013




Universal Single-Payer: A Health Care Plan that Curbs Obscene Costs and Eliminates Cherry Picking and Lemon Dropping

Joie Meissner, ND



Firstintroduced to the House of Representatives in 2003, H.R. 676, the national version of the single-payer health care plan, is very much like Medicare. One entity collects all the funds/fees and pays all the clinics and doctors. A single-payer plan eliminates the excessive administrative costs inherent in managing the thousands of different health care plans and organizations such as PPOs (preferred provider organizations), CDHPs (consumer directed health plans), HMOs, and HSAs in our current multi-payer system. By streamline all of these plans and carriers into one efficient system that contains checks and balances on hospital, drug, and device prices, a single-payer system would provide an estimated savings of more than $200-$300 billion annually. [1], [2] By controlling drug prices in a manner a kin to that of other countries with single-payer systems we could save billions each year on our drug costs.

By streamlining the thousands of plans into a single, user-friendly system, many health care  providers and patients who submit their own claims (including naturopathic physicians and their patients), would spend less time haggling over insurance claims and therefore, doctors would have more resources to devote to their patients and patients would have more time to devote to their own health. As the legions of billing clerks at hospitals like Duke University hospital are reduced to manageable numbers, fewer resources will need to be expended on dealing with the financial overhead of health care. With less need for physicians to act like billing clerks, the quality of care we can provide to our patients and that we receive from our providers would likely be greatly enhanced. (More on this topic will be discussed in article 3 of this series.)

Whereas our current multi-payer private insurance system is run as a for-profit enterprise, a Medicare style universal single-payer system is a socially responsible health care insurance system designed to serve the public good. Because universal single-payer covers all persons regardless of their health status and is free at the point of care, it eliminates the standard operating insurance practices of cherry picking and lemon dropping where health plans offer coverage to healthy patients and deny or restrict coverage to those whose needs are greater.  Hence there would no longer be an incentive nor any means of denying coverage, imposing increased premiums for those with pre-existing conditions, providing under coverage that can leave people bankrupt or engaging in other lemon dropping activities that restrict access to care.

Under a universal single-payer plan, everyone would be covered including the 30 million Americans who will still have no insurance after Obama care has been implemented. [3] Adequate health care would be available to all and medical bankruptcies would no longer be a common place American phenomenon but instead would become a relic of the past. [4]

All Americans would be covered for all medically necessary services such as office visits, inpatient and outpatient services, long-term care, mental health, reproductive health care, dental, vision, prescription drug and medical supply costs which could include certain drugs, medical equipment; midwifery and natural medicines may also be included. Under a Medicare style single-payer plan patients would be able to see any licensed health professional they wish and most hospitals and clinics would remain privately owned and operated, receiving a budget from the NIH to cover all operating costs.[5] Rather than imposing relatively more financial burdens on the sickest among us who are often less able to bear these financial burdens as we do in our current system, because everyone (including the healthier among us-the cherries) would be included in the insurance pool such that the burdens of health care expenditures are more humanely distributed.   

Under a universal single-payer system, health care would no longer be tied to employment and its cost would no longer be an incentive to employers to limit the hours that an employee is allowed to work. We would no longer be the only industrialized country in the world that does not provide some type of universal health coverage to its people. [6]


How Would We Pay for a Universal Single-Payer Health Care Plan?

Single-payer systems that have been proposed place a strong emphasis on preventive care. In general, it is less expensive to prevent a disease or to properly manage a disease process that has already begun than it is to treat its more advanced stages. Because providing access to preventive care would presumably lead to increased primary and secondary prevention of disease it would lessen the use of expensive heroic treatments like by-pass surgery, chemotherapy, and kidney dialysis and decrease the number of costly emergency room visits for routine care.  Paradoxically, a single-payer model would thus, lower health care costs by making health care services free at the point of care (e.g. no copays or deductibles) and increasing the coverage for preventive health services thereby encouraging patients not to avoid or delay seeking care but rather to embark on and maintain a life-long practice of preventive care which saves lives and money.

Studies have shown that a universal single-payer system could be successfully funded using monies currently paid into government health care programs (Medicare, Medicaid, trusts and other federal health care programs), along with increasing the personal income tax on the top five percent of income earners, instituting a modest and progressive excise tax on payroll and self-employment income, a modest tax on unearned income and a small tax on stock and bond transactions.[7] By eliminating expensive governmental payouts to the privatized multi-payer system, recapturing tax loopholes to employers who provide health benefits, streamlining costs and enabling the ability to bargain down costs of goods and services, dismantling our current for-profit, multi-payer health care system would result in huge savings.  Health care economist Gerald Friedman, PhD reports that “While providing superior health care, a single-payer system would save as much as $570 billion now wasted on administrative overhead and monopoly profits. A single-payer system would also make health care financing dramatically more progressive by replacing fixed, income-invariant health care expenditures with progressive taxes.”[8]  The combination of capturing the money that the federal government now spends on health care, plus the modest tax increases, plus the savings from increased efficiency would finance a single payer health care system at reduced cost to most individuals, families and businesses. Additional revenue currently paid into state funded health care programs can also be used to fund a single payer system.

Health care economists have conducted studies for numerous states. Such studies demonstrate that switching to a single-payer model would lead to substantial savings. The latest of these studies, published in 2013 by the economist Gerald Friedman PhD, examined the economic effects of implementing a single-payer style plan in Pennsylvania. The results of this study show that this plan could reduce costs by 23%, saving $33 billion in 2014. Friedman explains that the savings from this plan would permit Pennsylvania to cover all residents and still save the state $17 billion which he calculates would amount to a savings of $1,335/person. Another positive effect of this plan would be the creation of 120,000-200,000 new jobs in Pennsylvania. [9]  In the near future, Dr. Friedman plans to do a similar study in Washington State. [10]

For a quick summary of how single-payer works and how it could be funded click the link below to watch this fun and informative 4 minute YouTube video    http://www.youtube.com/watch?v=RAvy9jew9dM [11]


What Is the Current Status of the Single-Payer Option at the State and Federal Levels?

Many states have single-payer bills. For example, Vermont’s version of single-payer legislation was passed by both houses and that state is currently applying for a waiver (allowable under P-PACA/Obama care) so that it can implement a state single-payer system. In our legislature there is a single-payer bill, HB 1085, the Washington Health Security Trust (WHST).  As licensed health care practitioners, naturopathic physicians are included in HB 1085. A hearing on HB 1085 that took place on February 1st of this year was very well attended by Washington residents who provided compelling testimony to our legislature. Nevertheless, Representative Eileen Cody, Chair of the House Health Care Committee, decided not to schedule a commit vote, so the bill cannot pass during this legislative session. [12], [13]

Single-payer bills in most of the states have a number of advocacy organizations actively pursuing their passage. For example, Physicians for a National Health Program (PNHP), Health Care for All (HCFA-..) United for Single Payer and Health Care-NOW are single-payer advocacy groups that maintain chapters in Washington State as well as in numerous other states across the country. Some of these state bills’ major proponents are focusing their efforts in forging networks alliances with other social justice groups, funding research on the economic impact of single-payer plans and pressing for the passage of their H.R. 676, the national version of a universal single-payer plan.

At the federal level, H.R. 676, also known as the Expanded and Improved Medicare for All Act, was 1st introduced to the House of Representatives in 2003 and reintroduced again in 2009 and in 2011 by its author, Congressman John Conyers, Jr., D-MI. (Dennis Kucinich, D-OH co-authored the bill.) At the time of its reintroduction in 2009 the bill had 88 co-sponsors. Congressman Conyers again reintroduced H.R. 676 on February 13, 2013.  The bill currently has 46 co-sponsors. [14]

According to Quentin Young MD, a longtime advocate of universal health care, the “health-care-industrial-complex” has something like 34% of our massive health care expenditures at its command to use for the purposes of garnering political influence and mounting mass media campaigns to defeat the single-payer option. Nonetheless, he maintains that polls show that the majority of the general public and of conventionally trained physicians support a universal coverage system like single-payer. [15]

Physicians for a National Health Program of Western Washington (PNHP-WW), Health Care for All Washington HCFA-WA and Health Care-NOW are a few single-payer advocate organizations in Washington State that you may contact or visit their websites if you want more information.[16], [17], [18]


http://www.health care forallwa.org/about-health-care-for-all-washington/

http://www.health care -now.org/seattle-city-council-endorses-single-payer-health

If your congressperson is not already a co-sponsor, you can call or write him/her to see where the/she stands on this issue.  Below is a link to Library of Congress Website that gives a list of H.R.676 co-sponsors  http://beta.congress.gov/bill/113th-congress/house-bill/676/cosponsors [19]


Special Thanks To: Sherry Weinberg, MD, Don Bunger, Helen Thorsen CDP, Don Mitchell, MD,  Jim Squire, MD, Marti Schmidt, JD, David McLanahan, MD, Kathleen Myers, DDS, Betty Capehart, Kathleen Randall, MA 



Part 3 of this article-“How Natural Medicine May Fare in the Universal Single-Payer Plans that Are Currently Being Proposed ” will discuss how natural medicine, naturopathic physicians and their patients could benefit from the implementation of single-payer health care plans that have been proposed with special emphasis on single-payer campaigns in Washington State.


Works Cited

[1]“Proposal of the Physicians’ Working Group for Single-Payer National Health Insurance,” JAMA 290.6: Aug 30, 2003.http://jama.jamanetwork.com/article.aspx?articleid=197083Web. 14 Apr. 2013.

[2]Woolhandler, et al “Costs of Health Administration in the U.S. and Canada,” NEJM 349. 8  21 Sept. 2003. http://www.pnhp.org/publications/nejmadmin.pdfWeb. 14 Apr. 2013.

[3] Gregory, Paul Roderick. “Government Study Finds Obama Care Leaves Thirty Million Uninsured.” Forbes 22 Feb. 2013. http://www.forbes.com/sites/paulroderickgregory/2013/02/22/government-study-finds-obama-care-leaves-thirty-million-uninsured/ Web. 14 Apr. 2013.

[4] Physicians for a National Health Program. “What is single payer?”, “What will be covered?”, “What about alternative care, will it be covered?”. Single-Payer FAQ. http://www.pnhp.org/facts/single-payer-faq Web. 14 Apr. 2013.

[5] Physicians for a National Health Program. “What is single payer?”, “What will be covered?”, “What about alternative care, will it be covered?”. Single-Payer FAQ. http://www.pnhp.org/facts/single-payer-faq Web. 14 Apr. 2013.

[6] Vladeck, Bruce Ph.D. “Universal Health Insurance in the United States: Reflections on the Past, the Present, and the Future.” Am J Public Health. 93.1 (2003): 16–19. PMCID: PMC1447684 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1447684/ Web. 14 Apr. 2013.

[7] Physicians for a National Health Program. Summary: H.R. 676, The Expanded & Improved Medicare For All Act. 12 http://www.pnhp.org/news/2011/february/summary-hr-676-the-expanded-improved-medicare-for-all-actWeb. 14 Jun. 2013.

[8] Friedman, Gerald, Ph.D. “Funding a National Single-Payer System ‘Medicare for All’ would save billions, and could be distributive” 17 Apr. 2012 Dollars and Sense, March/April 2012. PNHP. http://www.pnhp.org/news/2012/april/funding-a-national-single-payer-systemWeb. 14 Jun. 2013.

[9]Friedman, Gerald, Ph.D. “Executive Summary: The Pennsylvania Health Care Plan Impact and Implementation.” 5 Mar. 2013. http://healthcare4allpa.org/wp-content/uploads/2013/03/EISExecutiveSummary.pdfWeb. 14 Apr. 2013.

http://healthcare4allpa.org/wp-content/uploads/2013/03/EconomicImpactStudy3513.pdf Web. 14 Apr. 2013.

[10] Friedman, Gerald Ph.D. “Why Economists Have Been Wrong about Healthcare.” Conference call. 7 Apr. 2013.

[11] Robbins, Katie. “Nation Single-Payer Health Security.” YouTube Video Uploaded 25 Apr. 2008. http://www.youtube.com/watch?v=RAvy9jew9dM Web. 14 Apr. 2013.

[12] HB 1085 – 2013-14. Washington State Legislature Access Washington. http://apps.leg.wa.gov/billinfo/summary.aspx?bill=1085&year=2013 Web. 14 Apr. 2013.

http://www.tvw.org/index.php?option=com_tvwplayer&eventID=2013020032 Web. 14 Apr. 2013.

[13] Appleton, Sherry (D) 23rd Legislative District.  House Bill 1085 http://apps.leg.wa.gov/documents/billdocs/2013-14/Pdf/Bills/House%20Bills/1085.pdf Web. 14 Apr.2013.

[14]Library of Congress. “H.R.676 – Expanded & Improved Medicare for All Act-113th Congress (2013-2014)”. LOC-Congress.Gov. http://beta.congress.gov/bill/113th-congress/house-bill/676/cosponsors Web. 14 Apr. 2013.

[15] Young, Quentin M.D. 7th PNHPWW Annual Public Meeting – 2012. http://www.pnhpwesternwashington.org/  Web. 14 Apr. 2013.

http://www.youtube.com/watch?v=zSHxSdVh4T8 Web. 14 Apr. 2013.

[16]Physicians for a National Health Program (PNHP-WW) http://www.pnhpwesternwashington.org/ Web. 14 Apr. 2013.

[17]Health Care for All-Washington (HCFA-WA) http://www.healthcareforallwa.org/  Web. 14 Apr. 2013.

[18]HEALTHCARE-NOW! http://www.healthcare-now.org/ Web. 14 Apr. 2013.

[19] Library of Congress. “H.R.676 – Expanded & Improved Medicare for All Act-113th Congress (2013-2014)”. LOC-Congress.Gov. http://beta.congress.gov/bill/113th-congress/house-bill/676/cosponsors Web. 14 Apr. 2013.



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