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Life Health > Health Insurance > Health Insurance

Single-Payer Takes Spotlight

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Rep. John Conyers Jr. today appeared before a House panel to promote a bill that would create a single-payer health care option.

The bill, H.R. 676, the United States Health Care Act, would set up a nonprofit, publicly financed, “privately delivered health care system.”

The single-payer bill, which has 79 cosponsors, is a response to “partial reforms,” such as the Massachusetts health reform program, that leave some individuals uninsured and do little to contain growth of health expenditures, Conyers, the lead sponsor of the bill, said at a hearing organized by the House Health, Employment, Labor, and Pensions Subcommittee.

“The Massachusetts reform effort has failed to contain costs and provide universal coverage because it is built around our broken for-profit private insurance system,” Conyers said, according to a written version of his remarks.

Opponents of single-payer proposals say dismantling the employer-based health care system is untenable, but Congress heard that same argument when it established Medicare, Conyers said.

Taiwan made a shift to a single-payer system, from a system similar to the U.S. system, in 1995, and, “today, their system boasts a 70% approval rating from doctors and patients, while only spending 2% on administrative costs,” Conyers said.

Conyers also rejected arguments that a single-payer option would lead to rationing of care.

“Waiting lines exist when government invests too little in the medical professionals and equipment that make up our health care infrastructure,” Conyers said. “It is true that Canada and the United Kingdom have had waits for elective procedures, but that is because they spend 60% and 33% less than we do on health care.”

Dr. David Gratzer, a Canadian physician who is a senior fellow at the Manhattan Institute, New York, a think tank that promotes a free-market approach to addressing public policy issues, appeared at the hearing to discuss arguments against setting up a public-payer system.

In the United States, some residents lack coverage, or find that their plans deny coverage for care, Gratzer said.

“Canada’s single-payer system also denies care,” Gratzer said. “Instead of denying insurance coverage, Canada’s public insurance plans simply limit the supply of costly medications and capital-intensive procedures.”

In Alberta, for example, 50% of outpatients had to wait more than 41 days for an MRI scan in 2008, Gratzer reported.

In theory, Canadians are free to choose their own doctors, but the country faces a severe shortage of primary care physicians, in part because of government efforts to control costs by reducing medical school enrollment, Gratzer said.

Canadians do have a longer life expectancy than U.S. residents, “but life expectancy is a product of a complex series of inputs, including wellness, fitness, and other environmental factors – like America’s anomalously high homicide rate,” Gratzer said.

Studies have shown that Canadians who suffer from insured illnesses tend to do worse than U.S. residents with similar illnesses, and other studies have shown that Canadians are less likely to get the recommended health screenings, Gratzer said.

Gratzer said Canadians in “at risk” groups were about 15% less likely than comparable U.S. patients to have ever had a mammogram and about 20% less likely to have ever had a colonoscopy test for colorectal cancers.

Even if the government simply created a “public option plan,” that likely would lead to the same result as creating a pure single-payer system, because elected officials would face pressure to try to control costs and deliver benefits directly, Gratzer said.

Links to copies of the witnesses’ written testimony and other hearing documents are available here


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